| Purpose: Age-related macular degeneration (AMD) is the major cause of severe irreversible vision loss in the elderly. It is a degenerative disease which exists in retinal pigment epithelium(RPE)-Bruch membrane-choriocapilliaris complex and (peri)retina. So there is likely to be abnormal choroidal circulation in early and advanced AMD. This study was designed to observe the choroidal circulation change of eyes with AMD, and to further investigate the relationship of AMD with the abnormal choroidal circulation change, in order to provide valuable theories for preventing and treating AMD in clinic. Methods 1,All subjects (AMD in 275 eyes of 141 patients and controls in 46 eyes of 23 subjects) were examined by oculists, some are excluded for their general diseases and other ocular diseases. 2,According to "the classification and grading system for AMD and drusen"and the results of fundus fluorescein angiography (FFA), AMD patients were divided into non-exudative and exudative AMD. Non-exudative AMD were subdivided into early AMD and geographic atrophy(GA). In addition, early AMD were subdivided into 4 groups, including the high-risk and low-risk eyes with bilateral macular drusen (group 1 and 2), and the high-and low-risk fellow eyes of patients with unilateral neovascular AMD (group 3 and 4); exudative AMD were subdivided into 2 groups, including the active choroidal neovascularization (CNV) (group 5) and the silent CNV ( the scar) (group 6). 3,Some subjects, including AMD in 121 eyes of 64 patients and control group in 23 eyes of 23 subjects, were examined by fundus fluorescein and indocyanine green angiography (FFA and ICGA), at the same time, observed and analysised both types of angiographic results, and evaluated the condition of choroidal microcirculation of them in the early and late phases of ICGA. 4,Color Doppler flow imaging (CDFI) was used to quantitate the peak systolic velocities (PSV), end diastolic velocities (EDV) and resistence index (RI) of ophthalmic artery (OA), temporal posterior ciliary artery (PCA1), nasal posterior ciliary artery (PCA2), central retinal artery (CRA) and the mean velocities of central retinal vein (CRV) of AMD in 198 eyes of 99 patients and control group in 34 eyes of 17 subjects; statistic software was used to analysis them. 5,Exudative AMD in 22 eyes of 22 patients were investigated the correlation of the choroidal microcirculation change by ICGA and hemodynamic parameters of CDFI.Results 1 The characteristics of AMD in fluorescein and indocyanine green angiography Of 64 cases (121 eyes) with AMD, 46 eyes with exudative AMD have the photograph in the early phase of ICGA,however, there were too few patients with early AMD and geographic atrophy to be analysised with statistic software. 1.1 Of 46 eyes with exudative AMD, choroidal arteries filling time and choriocapillaris filling phase (CFP) were individually 14.15±2.70s and 15.74±2.30s, and they were significantly prolonged compared with the control group. (P=0.0001and P= 0.0012). In addition, choroidal artery filling time of 15 eyes (32.6%) were longer than the central retinal artery (CRA) filling time. 1.2 Except for 4 eyes with extensive (peri)retinal hemorrhage, of the rest 42 eyes with exudative AMD, 11 eyes(26.1%)have extensive choroidal filling deficiency, 8 eyes(19%)have local deficiency, while no one of 23 control eyes have apparent deficiency, which were divided according to the choroidal vessels filling in the early phase of ICGA. The difference between both groups is significant (P=0.001). 1.3 Of 42 eyes with exudative AMD, 25 eyes(59.5%)have the macular choroidal watershed zones (CWZ), while only 5 eyes (21.7%) of 23 control eyes. The difference is significant (p=0.003). In addition, of 25 exudative AMD eyes with the macular CWZ, there were 22 eyes(88%)of which CNVappeared in or by the CWZ. 1.4 Except for 20 eyes with poor photography in the late phase of ICGA, of the rest 52 eyes with exudative AMD, 9 eyes(17.3%)and 21 eyes(40.4%)individually have extensive and locol choroidal filling deficiency in the late phase of ICGA, while of 48 eyes with early AMD, only 19 eyes have locol deficiency, and no one of 23 control eyes have apparent deficiency. The differences between two AMD groups and the control group are significant (P=0.001 和P=0.001), in addition, the difference between both AMD groups is significant (P=0.007). 1.5 The characteristics of 49 eyes with non-exudative AMD in FFA and ICGA: There were 4 eyes with hard drusen which were observed hyperfluorescence by ICGA, and window defect by FFA. There were 44 eyes with hard and soft drusen , of which soft drusen was observed hypofluorescent dots by ICGA,including confused soft drusen in 9 eyes which had patch hypofluorescence intermixed with cluster hyperflurescence in the early phase and persistent patch hypofluorescence in the late phase of ICGA, while hyperfluorescence dots in the late phase of FFA which was fewer and more indistinct than the former; there were 10 eyes with soft drusen in which diffuse moderate hyperfluorescence were observed in the posterior pole portion in the late phase of ICGA, and were more distinct and more than in FFA; there were 12 eyes with soft drusen accompanied with choroidal vessel dilatation. There was 1 eye in which geographicatrophy was observed well-delineated hypofluorescent patches through which the large choroidal vessels could be visualized in the early phase, and persistent hypofluorescent patches were observed in the late phase of ICGA. 1.6 The characteristics of 72 eyes with exudative AMD in FFA and ICGA: There were 16 eyes (22.2%) with classic choroidal neovascularization (CCNV) by FFA, and similar manifestation by ICGA; there were 44 eyes (61.1%)with occult CNV (OCNV) by FFA, while 25 eyes (56.8%) with well-demarcated CNV by ICGA, in addition, except for 3 eyes with (peri)retinal hemorrhage which had no hyperfluorescence by FFA and ICGA, the rest 41 eyes with OCNV by FFA were subdivided into two types: vascularized retinal pigment epitheliopathy in 26 eyes (63.4%), and fibrovascular retinal pigment epithelial detachment in 15 eyes (36.6%); there were 2 eyes (2.8%) with serous retinal pigment epithelial detachment (SPED) which had no CNV by FFA and ICGA; there were 10 eyes (13.9%) with the scar. In addition, Of 6 eyes with SPED by FFA, 4 eyes have CNV by ICGA. 2 The hemodynamic results of retrobulbar vessels of eyes with AMD 2.1 In early AMD eyes, there were significant decreases in PSV of both PCA1 and PCA2 of the high-risk eyes with bilateral macular drusen (group 1) (PSV: 9.02 ±1.36cm/s and 7.21±1.66cm/s) compared with the low-risk group and the control group, and in those of the high-risk fellow eyes ofpatients with unilateral exudative AMD (group 3) (PSV: 8.5±0.97cm/s and 7.62±1.40cm/s) compared with the control group (P<0.05). When 4 groups of eyes with early AMD are compared with each other, there were significant decreases in both PSV and EDV of both PCA1 and PCA2 of the group 3 (EDV: 2.26±0.34cm/s and 2.13±0.54cm/s ), in both PSV and EDV of PCA2 of the group 1 (PSV: 7.52±1.68cm/s and EDV: 2.10±0.57cm/s), and in EDV of PCA2 of the low-risk fellow eyes of patients with unilateral exudative AMD (group 4) (EDV: 2.19±0.41cm/s) compared with the low-risk eyes with bilateral macular drusen (group 2)(P<0.05). 2.2 In exudative AMD eyes, there were significant decreases in both PSV and EDV of PCA1 (PSV: 9.07±1.75 cm/s, EDV: 2.19±0.49 cm/s), EDV of both PCA2 and CRA (EDV: 2.06±0.45 cm/s and 1.87±0.42cm/s) of eyes with silent CNV (group 6) compared with the control group (P<0.05). When 2 groups with exudative AMD(group5,6), 1 high-risk group (group1+3) and 2 low-risk groups (group2,4) with early AMD were compared with each other, there were significant decreases in both PSV and EDV of both PCA1 and PCA2 of eyes with silent CNV (group 6) (PCA2-PSV: 8.14±1.77cm/s ) and the high-risk eyes with early AMD (group1+3) (PCA1-PSV: 8.84±1.15cm/s, EDV: 2.34±0.65cm/s; PCA2-PSV: 7.52±1.61cm/s, EDV: 2.11±0.57cm/s), in both PSV and EDV of PCA1 (PSV: 9.94±2.56cm/s and EDV: 2.58±0.79cm/s) and EDV of PCA2 (EDV: 2.44±0.78cm/s) of eyes with active CNV (group 5), and inEDV of PCA1 and PCA2 of group 4 (EDV: 2.90±0.93cm/s and 2.27±0.52cm/s) compared with group 2 (P<0.05). When the former 3 groups and the control group were compared with each other, there were significant decreases in both PSV and EDV of both PCA1 and PCA2 of group 6 and group(1+3), and in EDV of PCA2 of group 5 compared with the control group (P<0.05). 3 Correlation analysis: There was a negative correlation between the choroidal artery filling time or choriocapillaris filling phase and PSV of PCA1 of eyes with exudative AMD (r=-0.6103, P=0.0026 and r=-0.6842,P=0.0004). Conclusion 1,There is the abnormal choroidal microcirculation in the early AMD eyes. The abnormal condition of eyes with exudative AMD are worse than of eyes with early AMD. The macular choroidal watershed zone may be one of risk factors of CNV in AMD. 2,The soft drusen, choriocapillaris atrophy of the non-exudative AMD eye are shown by ICGA more distinctly than by FFA, especially the high-risk drusen. It is important to find the high-risk early AMD eyes by ICGA as soon as possible. 3,ICGA can show the occult CNV of retinal pigment epithelial detachment and hemorrhage beneath macular in exudative AMD more distinctly than FFA. It is important to improve the treatment of CNV in clinic. 4,The eyes with a few hard drusen may belong to part of aging change. The abnormal choroidal hemodynamic changes of... |
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