Macular Atrophic versus Subretinal Proliferative Changes in Myopic and Age-Related Macular Degeneration

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-07-12 DOI:10.1016/j.xops.2025.100885

Jost B. Jonas MD , Rahul A. Jonas MD , Mukharram M. Bikbov MD, PhD , Gyulli M. Kazakbaeva MD , Ya Xing Wang MD , Vinay Nangia MD , Songhomitra Panda-Jonas MD

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Abstract

Objective

To assess the prevalences of subfoveal retinal pigment epithelium (RPE) loss versus subfoveal tissue proliferation as causes of vision loss in patients with late-stage age-related macular degeneration (AMD) or myopic macular atrophy.

Design

Population-based studies conducted in Russia, China, and India and histological examination of enucleated human globes.

Participants

The Russian Ural Eye and Medical Study (n = 5899 participants; age: ≥40 years), Ural Very Old Study (n = 1526; age: 85+ years), Beijing Eye Study (n = 3468; age: ≥40 years), and Central India Eye and Medical Study (n = 4711) were conducted in rural and urban regions in Bashkortostan/Russia, Beijing/China, and Nagpur/India, respectively. The histological study part included human eyes enucleated because of reasons like malignant melanomas, or were post mortem enucleated.

Methods

The participants underwent a series of general medical and ophthalmological examinations including OCT of the macula. In the histological study part, the enucleated globes were histomorphometrically examined.

Main Outcome Measures

Presence of RPE loss and of subretinal proliferations.

Results

In all 4 population-based studies combined, late-stage AMD and myopic macular atrophy were detected in 291 eyes and 46 eyes, respectively. Retinal pigment epithelium cell loss was dominant in 136 (94%) out of 145 eyes with geographic atrophy and in 35 (76%) out of 46 eyes with myopic macular atrophy, whereas subretinal proliferations were predominantly present in 127 (87%) out of 146 eyes with neovascular AMD. Among all 337 eyes with late AMD or myopic macular atrophy, RPE loss was the main cause for vision loss in 190 (56%) eyes and subretinal proliferations in 147 (44%) eyes, with no significant difference (P > 0.05) between the study cohorts. In the histological specimen, subretinal proliferations included melanin-bearing cells in contact with a periodic acid–Schiff-positive membrane, resembling RPE cells.

Conclusions

Subretinal proliferations in the foveal region were the main reason for central visual acuity loss in 44% of all eyes with late AMD or myopic macular atrophy in 4 population-based studies. Subretinal foveal RPE cell proliferation and RPE loss are roughly equally important as a cause of vision loss in AMD and myopic macular atrophy.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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黄斑萎缩与视网膜下增生性变化在近视和年龄相关性黄斑变性

目的评估晚期老年性黄斑变性（AMD）或近视性黄斑萎缩患者视网膜色素上皮（RPE）缺损与中央凹下组织增生的患病率。设计：在俄罗斯、中国和印度进行了基于人群的研究，并对去核的人类球体进行了组织学检查。参与者：俄罗斯乌拉尔眼科和医学研究（n = 5899名参与者，年龄≥40岁）、乌拉尔高龄研究（n = 1526名，年龄≥85岁）、北京眼科研究（n = 3468名，年龄≥40岁）和印度中部眼科和医学研究（n = 4711名）分别在俄罗斯巴什科尔托斯坦、中国北京和印度那格浦尔的农村和城市地区进行。组织学研究部分包括因恶性黑色素瘤等原因去核或死后去核的人眼。方法对所有患者进行了包括黄斑OCT在内的常规医学和眼科检查。在组织学研究部分，对去核球进行组织形态学检查。主要观察指标：RPE丧失和视网膜下增生的表现。结果在所有4项基于人群的综合研究中，分别有291眼和46眼检测到晚期黄斑变性和近视黄斑萎缩。145只地理萎缩眼中136只（94%）和46只近视黄斑萎缩眼中35只（76%）的视网膜色素上皮细胞损失占主导地位，而146只新生血管性AMD眼中127只（87%）主要存在视网膜下增生。在337只患有晚期黄斑变性或近视黄斑萎缩的眼睛中，RPE丧失是190只（56%）眼睛视力丧失的主要原因，147只（44%）眼睛视网膜下增生，两组研究队列之间无显著差异（P > 0.05）。在组织学标本中，视网膜下增生包括与周期性酸希夫阳性膜接触的含黑色素细胞，类似于RPE细胞。结论在4项基于人群的研究中，44%的晚期黄斑变性或近视性黄斑萎缩患者的中央视力下降的主要原因是视网膜下窝区增生。视网膜下中央凹RPE细胞增殖和RPE丧失在AMD和近视黄斑萎缩中作为视力丧失的原因大致同样重要。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

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