Research Of The Deterioration,Risk Factors,and Interventions For Early And Intermediate Age-Related Macular Degeneration

Chapter 1 Incidence and risk factors of advanced age-related macular degeneration in eyes at early and intermediate stagesPurpose:The incidence and timing of development of advanced AMD consisted of neovascular age-related macular degeneration(nAMD)and geographical atrophy(GA)in patients with early and intermediate AMD were observed,as well as related risk factors.Methods:A retrospective analysis of fellow eyes with early or intermediate AMD in unilateral nAMD patients treated at our hospital from 2010 to 2023 was conducted with a follow-up time at least 1 year.Kaplan-Meier method was used to estimate the incidence and time of advance AMD.Cox proportional hazard regression model was used to evaluate risk factors such as characteristics of drusen,pigment changes,intraretinal hyperreflective foci(HRF),shallow irregular retinal pigment epithelium elevation(SIRE),and age-related scattered hypofluorescent spots on latephase indocyanine green angiography(ASHS-LIA)on ICGA for the progression of early and intermediate AMD.Results:1677 AMD patients who had been treated in our hospital were screened.154 eligible unilateral nAMD patients with early and intermediate AMD of the fellow eye were enrolled in this study with an average follow-up time of 38.1 ±29.2 months.A total of 36 eyes(23.4%)developed advanced AMD.The 5-year incidence of advanced AMD in early and intermediate AMD was 13.0%和 49.8%(total incidence 37.3%).The 5-year incidence of fellow eye in the PCV,typical AMD and RAP group was 26.4%,38.8%and 71.4%,respectively.Reticular pseudodrusen(RR=2.565,95%CI 1.177-5.590)and drusenoid PED(RR=2.419,95%CI 1.0745.448)was risk factor of the progression to advanced AMD.Conclusions:The progression risk of early and intermediate AMD eyes in unilateral nAMD patients was high.Reticular pseudodrusen and drusenoid PED are risk factors for early and intermediate AMD progression。Chapter 2 Long-term outcomes of drusenoid pigment epithelium detachment in intermediate AMD treated with subthreshold micropulse laser:A preliminary clinical studyAim:To evaluate the long-term anatomical and visual outcomes of drusenoid PED in intermediate AMD eyes treated with 577nm yellow subthreshold micropulse laser(SML).Methods:In this retrospective study,21 eyes of 16 patients with drusenoid PED in intermediate-AMD were consecutively included and assessed.All the eyes were treated with 577 nm SML in several sessions according to drusenoid PED growth status.The logarithm of the minimum angle of resolution(logMAR)best-corrected visual acuity(BCVA)were assessed at the initial visit and after treatment.Spectraldomain optical coherence tomography(SD-OCT)was performed to evaluate the drusenoid PED lifecycle by volumetric calculations.Regression analysis was used to determine the breakpoint,growth and collapse rate of the drusenoid PED lesions.The progression to advanced AMD was also documented.Results:All the eyes were treated with SML for 2.9±1.0 sessions.The mean follow-up period was 25.3± 12.6 mo.The BCVA was stable from the baseline to final visit.All the eyes were categorized into two groups according to the anatomical changes of the drusenoid PED lesion:the collapse group(n=6,28.6%)and noncollapse group(n=15,71.4%).The change in logMAR BCVA did not differ significantly between the collapse group 0.00(-0.31,0.85)and non-collapse group 0.00(0.00,0.00)(P=0.696).Regression analysis showed that the growth rate was significantly higher in the collapse group(0.090±0.095)mm3/mo than in the noncollapse group(0.025±0.035)mm3/mo(P<0.001).One eye(4.8%)developed nAMD at 11 mo after SML treatment in the non-collapse group.Three eyes(14.3%)developed GA in the collapse group.Conclusion:SML can accelerate part of drusenoid PED lesion and alleviate visual loss and possibility of progression to advanced AMD in eyes with drusenoid PED in intermediate AMD.