Современные тенденции диагностики и прогнозирования результатов терапии ингибиторами ангиогенеза отслоек пигментного эпителия при неоваскулярной возрастной макулярной дегенерации с применением методов глубокого машинного обучения (обзор литературы)

Отслойка пигментного эпителия – отделение базальной мембраны ретинального пигментного эпителия от внутреннего коллагенового слоя мембраны Бруха, встречающееся в 80 % случаев у пациентов с неоваскулярной возрастной макулодистрофией. Исходом антиангиогенной терапии отслойки пигментного эпителия может быть прилегание пигментного эпителия, формирование разрыва пигментного эпителия либо сохранение отслойки. Разрыв пигментного эпителия 3–4-й степени может приводить к резкому снижению остроты зрения. Большинством ретроспективных исследований подтверждается отсутствие доказанной корреляции между анатомическими и функциональными исходами при терапии отслоек пигментного эпителия в случаях сохранения целостности монослоя пигментного эпителия, в связи с чем основное внимание исследователей сосредоточено на исследовании морфологических особенностей отслойки пигментного эпителия в течение терапии ингибиторами ангиогенеза. Современные технологии спектральной оптической когерентной томографии позволяют оценивать детальные количественные параметры отслойки пигментного эпителия, такие как высота, ширина, наибольший линейный диаметр, площадь, объём и отражательная способность внутри отслойки. Группы отечественных и зарубежных авторов выделяют различные биомаркеры, фиксируемые на снимках оптической когерентной томографии. Динамическая регистрация подобных биомаркеров расширяет возможности клиницистов в прогнозировании морфологических изменений отслоек пигментного эпителия в течение терапии ингибиторами ангиогенеза, а также в оптимизации режимов назначения лечения с целью предотвращения осложнений в виде разрыва пигментного эпителия, приводящего к снижению остроты зрения. Современные методы глубокого машинного обучения и применение нейросетей позволяют достигать более высокой точности в дифференцировке типов ретинальных жидкостей и автоматизации количественного определения жидкости под пигментным эпителием. Данные технологии позволяют достигать высокого уровня соответствия с ручной экспертной оценкой и повышать точность и скорость прогнозирования морфологических результатов лечения отслоек пигментного эпителия.

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