Brunner R, Widder R A, Fischer R A, Walter P, Bartz-Schmidt K U, Heimann K, Borberg H
Department of Ophthalmology, University of Cologne, Germany.
Transfus Sci. 1996 Dec;17(4):493-8.
The aim of the study was to test the clinical efficacy of haemorheological treatment with extracorporeal techniques in ocular diseases. We treated patients suffering from maculopathies of different origin: age-related (AMD, n = 17), uveitis-associated (n = 14) and myopia-associated maculopathy (n = 5). We also treated patients with uveal effusion syndrome (n = 3) and central retinal vein occlusion (n = 4) resistant to haemodilution or steroid therapy. The treatment consisted of plasma exchange, selective adsorption with a tryptophan-polyvinylalcohol adsorber and membrane differential filtration. Maculopathy patients underwent two treatments while the other patients received between 1 and 7 treatments. Pulsatile ocular blood flow was measured in 10 patients before and after therapy. The main parameter for evaluating clinical outcome was the change in visual acuity. Severe side-effects did not occur. The rheological parameters including plasma viscosity, whole blood viscosity and erythrocyte aggregation were statistically significantly lowered. Of 36 patients suffering from maculopathy, 25 showed an improvement of at least 1 line of visual acuity after therapy, 7/17 patients in AMD, 6/14 in uveitis and 0/5 in myopia improved 3 lines or more. All patients suffering from retinal vein occlusion improved at least 1 line and two showed an improvement of 3 lines or more. In uveal effusion syndrome, an improvement of 3 lines or more was reached in all patients. Plasma exchange, selective adsorption and membrane differential filtration are effective rheological treatment approaches to improving visual acuity in patients suffering from maculopathy except myopia-associated maculopathy. Efficacy in patients suffering from central retinal vein occlusion and uveal effusion syndrome was proven, even when the patients were resistant to previous haemodilution or steroid therapy. We conclude that a rheological approach should be considered before invasive methods such as laser coagulation, radiation therapy or surgery are applied.
本研究的目的是测试体外技术血液流变学治疗在眼部疾病中的临床疗效。我们治疗了患有不同病因黄斑病变的患者：年龄相关性（年龄相关性黄斑变性，n = 17）、葡萄膜炎相关性（n = 14）和近视相关性黄斑病变（n = 5）。我们还治疗了对血液稀释或类固醇治疗耐药的葡萄膜渗漏综合征患者（n = 3）和视网膜中央静脉阻塞患者（n = 4）。治疗包括血浆置换、用色氨酸 - 聚乙烯醇吸附剂进行选择性吸附和膜式差异过滤。黄斑病变患者接受了两次治疗，而其他患者接受了1至7次治疗。在10名患者治疗前后测量了搏动性眼血流。评估临床结果的主要参数是视力变化。未出现严重副作用。包括血浆粘度、全血粘度和红细胞聚集在内的血液流变学参数在统计学上显著降低。在36名黄斑病变患者中，25名在治疗后视力至少提高了1行，年龄相关性黄斑变性患者中的7/17、葡萄膜炎患者中的6/14以及近视患者中的0/5视力提高了3行或更多。所有视网膜静脉阻塞患者视力至少提高了1行，两名患者视力提高了3行或更多。在葡萄膜渗漏综合征中，所有患者视力提高了3行或更多。血浆置换、选择性吸附和膜式差异过滤是改善黄斑病变（近视相关性黄斑病变除外）患者视力的有效血液流变学治疗方法。即使患者对先前的血液稀释或类固醇治疗耐药，视网膜中央静脉阻塞和葡萄膜渗漏综合征患者的疗效也得到了证实。我们得出结论，在应用激光凝固、放射治疗或手术等侵入性方法之前，应考虑采用血液流变学方法。
