An integrated analysis of clinical and morphometric indications of atrophic forms of age-related macular degeneration

N V Neroeva,V V Neroev,M V Ryabina,A G Karmokova

doi:10.21516/2072-0076-2021-14-4-65-73

Abstract

The atrophic form of late age-related macular degeneration (AMD) is a common cause of severe vision loss. Recently, a new classification system has been proposed, which identifies two types of atrophy in the late stage of AMD that require a more detailed study: (1) drusenassociated geographic atrophy (GA), which is the final stage of progression of dry AMD, and (2) macular atrophy (MA), which occurs in wet AMD, including the period of AMD treatment with angiogenesis inhibitors. Purpose: an integrated analysis of clinical and morphometric signs of atrophic AMD forms. Material and methods. 48 people (61eyes) aged 48–84 with GA (group 1) and MA (group 2) and a control group, recruited from age-matching 25 healthy volunteers (35 eyes), underwent standard ophthalmological examinations, fundus autofluorescence (FAF) with lesion area measurement, fundus photography, optical coherence tomography (OCT) in the standard mode and Enhanced Depth Imagine Mode, Multicolor, and OCT angiography. Results. The comparative analysis of two atrophic AMD forms showed that in GA eyes, foci of atrophy capturing the fovea were significantly more common, while, contrariwise in MA eyes atrophic foci not capturing the fovea were more frequent (p < 0.05). Photoreceptor tubulation was diagnosed mainly in eyes with GA (p < 0.05). The morphometric analysis showed a significant decrease in the subfoveal thickness of the choroid in the groups with GA and MA as compared to the control (p < 0.05), whilst no significant differences between two groups were noted. The assessment of the frequency of occurrence of types of fundus AF patterns in groups 1 and 2 followed by a comparative analysis, showed the presence of all types of patterns in GA patients, including the heterogeneous and the bordering pattern (p < 0.05). In the MA group, diffuse and focal types of patterns were revealed, while the frequency of the diffuse pattern turned out to be significantly more frequent (p < 0.05). Conclusion. The integrated analysis revealed the main semiological signs and morphometric parameters, their features and prevalence in GA and MA, which may have diagnostic and prognostic importance for the management and treatment of patients with AMD.

Highlights

The atrophic form of late age-related macular degeneration (AMD) is a common cause of severe vision loss
A new classification system has been proposed, which identifies two types of atrophy in the late stage of AMD that require a more detailed study: (1) drusenassociated geographic atrophy (GA), which is the final stage of progression of dry AMD, and (2) macular atrophy (MA), which occurs in wet AMD, including the period of AMD treatment with angiogenesis inhibitors
The morphometric analysis showed a significant decrease in the subfoveal thickness of the choroid in the groups with GA and MA as compared to the control (p < 0.05), whilst no significant differences between two groups were noted

Summary

Неоваскулярная Neovascular

Примечание. n — количество глаз; «–» — признак не определяется; * — достоверность отличия показателей между 1-й и 2-й группами (p < 0,05). Из 35 глаз с ГА в 8,6 % случаев выявлены интраретинальные полости дегенеративного характера в зоне истончения нейросенсорной сетчатки В зависимости от конфигурации и распространенности АФ вокруг зоны атрофии выделены 4 паттерна: фокальный, неоднородный, окаймляющий, диффузный 6. Интраретинальные полости дегенеративного характера в зоне истончения сетчатки у пациента с ГА Fig. 6. 9. Типы паттернов АФ: А — без, Б — фокальный, В — окаймляющий, Г — неоднородный, Д — диффузный Fig. 9. В 3 (11,5 %) глазах у пациентов с МА зафиксирован субретинальный фиброз, и в одном глазу (3,8 %) диагностирована прехориоидальная щель Настоящее исследование включало комплексную диагностику ГА и МА, в том числе с применением инструментальных методов обследования, позволившую выявить различные семиологические признаки (наличие ВМА, РПД, тубуляции фоторецепторов, интраретинальных гиперрефлективных фокусов, локализации атрофического фокуса, различные паттерны АФ и т.д.), их особенности, Таблица 2. Measurement data of subfoveal choroidal thickness by groups (M ± m)

Параметр Parameter

Findings

Статистическая значимость