关键词: 视网膜色素上皮脱离/无血管性, 年龄相关性黄斑变性

Abstract: Objective To observe and analyze the changes and prognostic characteristics of large avascular retinal pigment detachment (aPED) associated with dry age-related macular degeneration (AMD). Design Retrospective case series. Participants 17 eyes of 15 cases diagnosed with large (the maximum horizontal diameter of PED is greater than 1500 μm, the height is greater than 165 μm) aPED in dry AMD at Beijing Tongren Eye Center from January 2013 to January 2023. Methods We retrospectively analyzed the patients’ medical records, and the average follow-up time was （19.76±17.39） months. The characteristics of OCT, including choroid thickness, PED height, PED width, RPE collapse, hyperplasia of RPE, inner retinal capsules, hyperreflective foci, subretinal fluid, RPE laceration, geograghic atrophy (GA), neovascularization, and the changes of best corrected visual acuity (BCVA) were evaluated. Main Outcome Measures The BCVA, the choroidal thickness and the height and width of PED measured by OCT. Results At baseline, LogMAR BCVA was 0.55±0.31, the mean choroidal thickness of the macular center was (237.29±77.39) μm, the mean height of PED was (476.67±313.83) μm, and the mean width of PED was (3268.17±1482.28) μm. At the last follow-up, LogMAR BCVA was 0.70±0.34, which was significant worse than that at baseline (t=-2.842, P=0.012). In 5 eyes with PED collapse at baseline, 4 eyes had GA, another 1 eye had the RPE proliferation aggravated and RPE collapse, and had inner retinal capsules during the follow-up. One eye with retinal inner capsule at baseline appeared GA during the follow-up. There were 6 eyes (35.29%) with increased height and width of PED, of which 5 eyes had increased proliferation of RPE and 1 eye had no significant change; there were 4 eyes (23.53%) with the width of PED bottom diameter increasing and the height decreasing, all of which had the collapse of PED; RPE laceration occurred in one eye (5.89%); There was no obvious change in 2 eyes (11.76%), and no neovascularization was seen. At the last follow-up, the mean choroidal thickness of the macular center was (223.12±67.53) μm, which was no significant difference with the baseline. There were 12 cases with PED at the last follow-up which the mean height of PED was (370.08±242.25) μm, and the mean width of PED was (3545.17±1313.10) μm.There was no significant difference with the baseline (t=1.409、-2.105, P=0.186、0.059). Conclusion For large aPED associated with dry AMD, its natural prognosis is mostly transformed into GA, which seriously affects the vision of patients. The collapse of RPE and the appearance of retinal inner capsule can be used as biomarkers for the progress of the disease. Clinicians should pay enough attention to the mand increase the number of follow-up visits so as to detect the changes of the disease as soon as possible. (Ophthalmol CHN, 2023, 32: 217-221)

Key words: retinal pigment epithelium detachment/avascular, age-related macular degeneration