基线OCT生物标志物预测新生血管性年龄相关性黄斑变性的视力结果:一项荟萃分析。

IF 9.5 1区 医学 Q1 OPHTHALMOLOGY
Keean Nanji, Justin Grad, Amin Hatamnejad, Tyler McKechnie, Mark Phillips, Chui Ming Gemmy Cheung, Praveen J Patel, Rosa Dolz Marco, Enrico Borrelli, David H Steel, SrinVas R Sadda, Tien Yin Wong, Sobha Sivaprasad, Robyn Guymer, Charles C Wykoff, Varun Chaudhary
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引用次数: 0

摘要

目的:确定基线光学相干断层扫描(OCT)生物标志物预测新血管性年龄相关性黄斑变性患者在抗血管内皮生长因子治疗后6、12和24个月的视力(VA)和VA基线变化的效果估计和证据的确定性。临床相关性:了解OCT生物标志物的预后效用可以改善治疗决策。方法:采用随机效应模型进行meta分析。研究结果发表在早期治疗糖尿病视网膜病变研究(ETDRS)快报上。GRADE预后研究指南告知证据评估的确定性。结果用五个字母的最小重要差异(MID)来解释。结果:纳入29份报告(8,863只眼),评估80种生物标志物。两种生物标志物预测12个月时VA更好,但确定性“低”:存在完整的外限制膜(ELM) (+14.0;95%CI:+3.1 ~ +24.8),存在完整的椭球区(EZ) (+6.8;95%CI:+2.8 ~ +10.8)。三个生物标志物预测12个月时VA恶化,确定性“低”;视网膜内积液(IRF) (-5.6;95%CI:-9.7至-1.5),中央凹中心点存在IRF (-7.4;95%CI:-10.1至-4.7),以及视网膜下高反射物质(SHRM)的存在(-8.7;95%CI: -19.0 ~ 1.6)。没有其他生物标志物预测过MID的效应大小。然而,当解释具有统计学意义的生物标志物时,有值得注意的结果,相对于0个字母和“中等”确定性的阈值:色素上皮脱离、地理萎缩(GA)、IRF和视网膜下液(SRF)的存在预测了12个月时视力下降。SRF的存在预示着12个月时VA的积极变化。没有后玻璃体脱离预示着12个月时VA的阴性变化。最后,IRF在中央1mm、视网膜色素上皮升高和GA的存在预测了24个月时VA的阴性变化。结论:在“低”确定性的证据下,完整的ELM和EZ的基线存在预示着12个月时较好的VA,而IRF、IRF在中央凹中心点和SHRM的存在预示着12个月时较差的VA。需要提高生物标志物分类和混杂变量控制的标准化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Baseline OCT Biomarkers Predicting Visual Outcomes in Neovascular Age-Related Macular Degeneration: A Meta-Analysis.

Purpose: To determine the effect estimates and certainty of evidence for baseline optical coherence tomography (OCT) biomarkers predicting visual acuity (VA) and changes in VA from baseline at 6-, 12-, and 24-months following anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration.

Clinical relevance: Understanding the prognostic utility of OCT biomarkers can improve treatment decisions.

Methods: Meta-analyses were conducted using random-effects modelling. Results were reported in Early Treatment Diabetic Retinopathy Study (ETDRS) letters. GRADE guidelines for prognostic studies informed certainty of evidence assessments. Results were interpreted using a five-letter minimally important difference (MID).

Results: Twenty-nine reports (8,863 eyes) evaluating 80 biomarkers were included. Two biomarkers predicted better VA at 12 months with a 'Low' certainty: the presence of an intact external limiting membrane (ELM) (+14.0; 95%CI:+3.1 to +24.8) and the presence of an intact ellipsoid zone (EZ) (+6.8; 95%CI:+2.8 to +10.8). Three biomarkers predicted worse VA at 12 months with a 'Low' certainty; the presence of intraretinal fluid (IRF) (-5.6; 95%CI:-9.7 to -1.5), the presence of IRF in the foveal center point (-7.4; 95%CI:-10.1 to -4.7), and the presence of subretinal hyperreflective material (SHRM) (-8.7; 95%CI: -19.0 to 1.6).No other biomarker predicted an effect size that crossed the MID. However, there were noteworthy results when interpreting biomarkers with statistically significant findings relative to a threshold of 0 letters and 'Moderate' certainty: the presence of a pigment epithelial detachment, geographic atrophy (GA), and both IRF and subretinal fluid (SRF) predicted reduced vision at 12 months. The presence of SRF predicted a positive change in VA at 12 months. The absence of a posterior vitreous detachment predicted a negative change in VA at 12 months. Lastly, the presence of IRF in the central 1mm, retinal pigment epithelial elevation, and GA predicted negative changes in VA at 24 months.

Conclusion: With 'Low' certainty evidence, the baseline presence of an intact ELM and EZ predicted better VA at 12 months, and the presence of IRF, IRF in the foveal center point, and SHRM predicted worse VA at 12 months. Improved standardization in biomarker classification and control of confounding variables are needed.

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来源期刊
Ophthalmology
Ophthalmology 医学-眼科学
CiteScore
22.30
自引率
3.60%
发文量
412
审稿时长
18 days
期刊介绍: The journal Ophthalmology, from the American Academy of Ophthalmology, contributes to society by publishing research in clinical and basic science related to vision.It upholds excellence through unbiased peer-review, fostering innovation, promoting discovery, and encouraging lifelong learning.
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