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Natural history of incomplete retinal pigment epithelial and outer retinal atrophy in age-related macular degeneration

Published:February 01, 2021DOI:https://doi.org/10.1016/j.jcjo.2021.01.005

      Abstract

      Objective

      To assess the time course and risk factors for conversion of incomplete retinal pigment epithelium and outer retina atrophy (iRORA) to complete retinal pigment epithelium and outer retina atrophy (cRORA) in eyes with non-neovascular intermediate age-related macular degeneration (iAMD), using optical coherence tomography (OCT) analysis.

      Design

      Retrospective survival study.

      Participants

      Tracked structural Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany) volume datasets from 2 retinal specialists at the University of California–Los Angeles were retrospectively screened to identify consecutive participants with non-neovascular iAMD without signs of atrophy or macular neovascularization in either eye at baseline.

      Methods

      In the first stage of selection, 321 consecutive iAMD eyes were screened for onset of iRORA. Eyes that developed iRORA within the first 24 months were followed for an additional 24 months to assess the rate of conversion to cRORA. A Kaplan-Meier survival curve was formulated to illustrate the conversion from iRORA to cRORA.

      Results

      Among 321 baseline participants with iAMD, 87 incident iRORA lesions (50 eyes, 42 participants) were included in the conversion analysis. Eighty-one iRORA lesions (93.1%) converted to cRORA within 24 months (median 14 months). Multivariate binary logistic regression analysis indicated that intraretinal hyperreflective foci and extrafoveal iRORA location at baseline were associated with a faster rate of progression to cRORA (model R2 = 0.816, p < 0.05).

      Conclusions

      The majority of incident iRORA lesions progress to cRORA within a 24-month period. These findings may be of value in the design of early intervention trials for risk stratification and prognostication but need to be validated with a prospective analysis.

      Objectif

      Évaluer, grâce à la tomographie par cohérence optique (OCT, pour optical coherence tomography), la chronologie et les facteurs de risque de transformation d'une atrophie incomplète de l'épithélium pigmentaire et de la rétine externe (iRORA, pour incomplete retinal pigment epithelium and outer retina atrophy) en une atrophie complète de l’épithélium pigmentaire et de la rétine externe (cRORA, pour complete retinal pigment epithelium and outer retina atrophy) dans la dégénérescence maculaire liée à l’âge intermédiaire (DMLAi) non néovasculaire.

      Nature

      Étude rétrospective sur le taux de survie.

      Participants

      Les données volumétriques structurelles enregistrées par 2 rétinologues de la University of California–Los Angeles obtenues à l'aide du tomographe Spectralis® (Heidelberg Engineering, Heidelberg, Allemagne) ont fait l'objet d'un dépistage rétrospectif visant à identifier des participants consécutifs présentant au départ une DMLAi non néovasculaire sans signe d'atrophie ni de néovascularisation maculaire.

      Méthodes

      Pendant la première étape de sélection, on a soumis 321 yeux consécutifs présentant une DMLAi à un dépistage afin d'identifier un début d'iRORA. Les yeux chez lesquels est apparue une iRORA au cours des 24 premiers mois ont été suivis pendant 24 mois supplémentaires afin de mesurer le taux de transformation en une cRORA. Une courbe de survie de Kaplan-Meier a servi à illustrer la transformation d'une iRORA en une cRORA.

      Résultats

      Au sein des 321 participants initiaux qui présentaient une DMLAi, 87 lésions incidentes d'iRORA (50 yeux, 42 participants) ont été incluses dans l'analyse de conversion. Or, 81 lésions d'iRORA (93,1 %) se sont transformées en une cRORA au cours des 24 mois suivants (médiane : 14 mois). Selon l'analyse de régression logistique binaire multivariée, la présence de foyers hyperréflectifs intrarétiniens et la localisation extrafovéale de l'iRORA au départ étaient associées à un taux de transformation plus rapide en une cRORA (R2 du modèle = 0,816; p < 0,05).

      Conclusions

      La majorité des lésions incidentes d'iRORA se sont transformées en une cRORA dans un délai de 24 mois. Ces résultats pourraient servir à la conception d’études d'intervention précoce en vue de la stratification du risque et de l’établissement du pronostic, mais devront être validés dans le cadre d'une analyse prospective.
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