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ENGLISH ABSTRACT
进展期年龄相关性黄斑变性成像模式及应用专家共识(2024)
《进展期年龄相关性黄斑变性成像模式及应用专家共识(2024)》专家组
国际转化医学会眼科专业委员会
中国医药教育协会眼科影像与智能医疗分会
作者及单位信息
·
DOI: 10.3760/cma.j.cn115989-20230522-00183
Expert consensus on imaging model and application of advancing age-related macular degeneration (2024)
Expert Workgroup of Expert consensus on imaging model and application of advancing age-related macular degeneration (2024)
Ophthalmic Imaging and Intelligent Medicine Branch of Chinese Medicine Education Association
Ophthalmology Committee of International Association of Translational Medicine
Shao Yi
Chi Wei
Zhang Shaochong
Authors Info & Affiliations
Expert Workgroup of Expert consensus on imaging model and application of advancing age-related macular degeneration (2024)
Ophthalmic Imaging and Intelligent Medicine Branch of Chinese Medicine Education Association
Ophthalmology Committee of International Association of Translational Medicine
Shao Yi
Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
Chi Wei
Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
Zhang Shaochong
Shenzhen Eye Hospital, Jinan University, Shenzhen 518040, China
·
DOI: 10.3760/cma.j.cn115989-20230522-00183
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摘要

进展期年龄相关性黄斑变性(AMD)病理改变以外层视网膜萎缩和变薄,视网膜色素上皮变性、增生或萎缩以及黄斑新生血管为主,包括地图样萎缩和湿性AMD,严重危害患者视力。目前,检测、量化和监测进展期AMD的眼底成像模式主要包括彩色眼底照相、眼底自发荧光、眼底近红外反射、眼底光学相干断层扫描成像、荧光素眼底血管造影和吲哚菁绿血管造影等。近年来发展的眼底成像模式包括眼底光学相干断层扫描血管成像、炫彩眼底成像、广角照相成像和多光谱成像等,也广泛应用于进展期AMD的成像检查。这些进展期AMD成像模式的最优化选择对于检测、量化和监测进展期AMD至关重要,并可能会影响相关临床诊疗的时效和成本。目前,进展期AMD成像面临的主要挑战是成像方案的选择和图像分析算法技术的研究。然而,国内外在检测、量化和监测进展期AMD的传统及当代先进的成像模式方面尚未达成共识。因此,本共识专家组就进展期AMD的各种成像模式进行了系统性讨论,在大量临床病例进行大样本分析的基础上,评估了各种成像模式的优缺点,并对每种成像模式在进展期AMD未来研究中的作用进行了系统总结。本共识专家组针对进展期AMD诊断和监测的不同阶段,结合经济效益成本分析,提出了各种适用技术的选择方法建议。

黄斑变性,进展期;地图样萎缩;诊断;视网膜成像检查;共识
ABSTRACT

Pathological changes of advancing age-related macular degeneration (AMD) is characterized by outer retinal atrophy and thinning, degeneration, proliferation or atrophy of the retinal pigment epithelium, and the presence of macular neovascularization including geographic atrophy and wet AMD, which can seriously impair visual function.Currently, imaging modalities for detecting, quantifying, and monitoring the fundus of advancing AMD include color fundus photography, fundus autofluorescence, near-infrared reflectance, optical coherence tomography, fundus fluorescein angiography, and indocyanine green angiography.Advanced imaging modalities such as optical coherence tomography angiography, multicolor fundus photography, widefield photography, and multispectral imaging have also been widely used for imaging advancing AMD.The optimal selection of these imaging modalities is critical for detecting, quantifying, and monitoring advancing AMD, and may affect the timeliness and cost of clinical diagnosis and treatment.The main challenges currently facing advancing AMD imaging include selecting the best imaging modality and developing image analysis algorithms.However, there is currently no consensus on the traditional and contemporary advanced imaging modalities for detecting, quantifying, and monitoring advancing AMD, both domestically and internationally.Therefore, the consensus expert group conducted a systematic discussion on the various imaging modalities for advancing AMD, evaluated their advantages and disadvantages based on a large sample analysis of numerous clinical cases, and systematically summarized the role of each imaging modality in future research on advancing AMD.In combination of economic efficacy cost analysis, the consensus expert group put forward suggestions on choosing optimal techniques for diagnosis and monitoring of advancing AMD at different stages.

Macular degeneration, advancing;Geographic atrophy;Diagnosis;Retinal imaging;Consensus
Shao Yi, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China, Email: mocdef.3ab6199eebeerf;
Chi Wei, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China, Email: nc.defudabe.usys.liamiewihc;
Zhang Shaochong, Shenzhen Eye Hospital, Jinan University, Shenzhen 518040, China, Email: mocdef.cabozzggnohcoahsgnahz
引用本文

《进展期年龄相关性黄斑变性成像模式及应用专家共识(2024)》专家组,国际转化医学会眼科专业委员会,中国医药教育协会眼科影像与智能医疗分会. 进展期年龄相关性黄斑变性成像模式及应用专家共识(2024)[J]. 中华实验眼科杂志,2024,42(02):97-107.

DOI:10.3760/cma.j.cn115989-20230522-00183

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1 《进展期年龄相关性黄斑变性成像模式及应用专家共识(2024)》制定背景
年龄相关性黄斑变性(age-related macular degeneration,AMD)是与衰老相关的黄斑区视网膜结构的退行性改变,其主要危害是中心视力进行性丧失。早期AMD对视力影响较小,主要表现为细胞外沉积物蓄积、色素移行进入视网膜、玻璃膜疣增大以及视网膜色素上皮(retinal pigment epithelium,RPE)发生色素减退和色素沉着。进展期AMD是病变的中晚期改变,其临床表现以外层视网膜萎缩和变薄、RPE丢失以及黄斑新生血管(macular neovascularization,MNV)为主 [ 1 ],包括地图样萎缩和湿性AMD等,严重危害患者的中心视力,表现为中心暗点和/或严重的视物变形,双眼先后发病者会导致患者视觉功能严重受损,使其无法阅读、识别人脸或驾驶汽车。进展期AMD分为新生血管性(湿性)和萎缩性(干性)AMD。临床实践发现,这些病变可以同时存在于同一眼中,分析进展期AMD的具体分类、严重程度和疾病预后是临床诊疗中的关键问题。
目前,检测、量化和监测进展期AMD的眼底成像模式包括彩色眼底照相(color fundus photography,CFP)、眼底自发荧光(fundus autofluorescence,FAF)、眼底近红外反射(near-infrared reflectance,NIR)、眼底光学相干断层扫描成像(optical coherence tomography,OCT)、荧光素眼底血管造影(fundus fluorescein angiography,FFA)和吲哚菁绿血管造影(indocyanine green angiography,ICGA)等。近年来发展的眼底成像模式,如眼底光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)、炫彩眼底成像(multicolor fundus photography,MFP)、广角照相成像(widefield photography,WFP)和多光谱成像(multispectral imaging,MSI)等也广泛用于进展期AMD的成像检查。这些成像模式的优化选择对于进展期AMD的诊断评价、量化分析和治疗监测至关重要,并可能会影响患者的成本-效益评价。
目前,关于上述多个视网膜成像模式在进展期AMD诊疗中的选择和联合应用方法尚未达成共识,进展期AMD的成像面对的主要挑战是成像方案的选择和图像分析算法技术的研究。鉴于此,进展期年龄相关性黄斑变性成像模式及应用专家共识(2024)(简称"共识")专家组就进展期AMD的各种成像模式进行了系统性分析和讨论,在认真复习国内外大量文献及对大量临床病例进行分析的基础上评估了各种成像模式的优缺点,对进展期AMD诊疗中各种成像模式的选择应用提出推荐意见。
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备注信息
A
邵毅,复旦大学附属眼耳鼻喉科医院,上海 200031,Email: mocdef.3ab6199eebeerf
B
迟玮,中山大学中山眼科中心,广州 510060,Email: nc.defudabe.usys.liamiewihc
C
张少冲,暨南大学附属深圳眼科医院,深圳 518040,Email: mocdef.cabozzggnohcoahsgnahz
D
http://www.guidelines-redistry.cn,PREPARE-2022CN581
E
http://www.guidelines-redistry.cn,PREPARE-2022CN581
F
所有作者均声明不存在利益冲突。本共识的制定未接受任何企业的赞助
G
所有参与本共识制定的专家均声明,坚持客观的立场,以专业知识、研究数据和临床经验为依据,经过充分讨论,全体专家一致同意后形成本共识,本共识为中国医药教育协会眼科影像与智能医疗分会部分专家起草
H
本共识的内容仅代表参与制定的专家对本共识的指导意见,供临床医师参考。尽管专家们进行了广泛的意见征询和讨论,但仍有不全面之处。本共识所提供的建议并非强制性意见,不是在各种情况下必须遵循的诊疗标准,与本共识不一致的做法并不意味着错误或不当。临床实践中仍存在诸多问题需要探索,正在进行和未来开展的临床研究将提供进一步的证据。随着临床经验的积累和眼科影像技术的进一步发展,未来需要对本共识定期补充、更新和修订,为患者带来更多临床获益
I
国家自然科学基金 (82160195、82271102、82201195)
江西省双千计划科技创新高端领军人才项目 (jxsq2023201036)
江西省重大(重点)研发专项计划 (20223BBH80014)
广东省自然科学基金 (2021A1515011090)
深圳市三名工程项目 (SZSM202311012)
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