Widder R A, Brunner R, Walter P, Bartz-Schmidt K U, Godehardt E, Heimann K, Borberg H
Klinik und Poliklinik für Augenheilkunde, Universität zu Köln.
Klin Monbl Augenheilkd. 1999 Jul;215(1):43-8; discussion 48-9. doi: 10.1055/s-2008-1034668.
Membrane differential filtration (MDF) is known to optimize rheological parameters by eliminating high molecular weight proteins und lipoproteins from the blood and was shown to influence ocular perfusion parameters. Following the hypothesis that these changes may influence the natural course of age-related macular degeneration (AMD) we tested their efficacy in improving visual function in these patients in a randomized trial.
20 patients (36 eyes) were randomized into two groups. Ten patients (18 eyes) were treated with MDF and ten (18 eyes) served as controls. The first group was treated five times over a period of 21 weeks. In both groups 8/18 of the eyes showed subfoveolar subretinal neovascularisations. Main parameter of the study was visual acuity. Macular visual evoked potentials were also recorded. Plasmaviscosity, whole blood viscosity and erythrocyte aggregation were measured.
The ten patients, treated repeatedly over a period of 21 weeks, showed a mean improvement 1.1 (SD 1.9) lines after 21 weeks, while the control group showed a deterioration of visual acuity (0.6 lines, SD 1.7). The macular visual evoked potentials showed an increase of 0.28 microV (SD 1.12) for the therapy group and a deterioration of 0.57 microV (SD 1.31) in the control group. The rheological parameters were lowered in all patients.
We conclude that repetitive treatment with MDF is able to improve visual function in patients with AMD. Further research is necessary to show how to optimize the selection of patients and how to create an individual treatment strategy.
已知膜性差异过滤(MDF)可通过清除血液中的高分子量蛋白质和脂蛋白来优化流变学参数,并且已证明其会影响眼部灌注参数。基于这些变化可能会影响年龄相关性黄斑变性(AMD)自然病程的假设,我们在一项随机试验中测试了其改善这些患者视觉功能的疗效。
20例患者(36只眼)被随机分为两组。10例患者(18只眼)接受MDF治疗,10例(18只眼)作为对照组。第一组在21周内接受5次治疗。两组中18只眼中的8只均显示黄斑下视网膜下新生血管形成。研究的主要参数是视力。还记录了黄斑视觉诱发电位。测量了血浆粘度、全血粘度和红细胞聚集性。
在21周内接受反复治疗的10例患者,21周后平均视力提高了1.1(标准差1.9)行,而对照组视力下降(0.6行,标准差1.7)。治疗组黄斑视觉诱发电位增加了0.28微伏(标准差1.12),而对照组下降了0.57微伏(标准差1.31)。所有患者的流变学参数均降低。
我们得出结论,MDF反复治疗能够改善AMD患者的视觉功能。有必要进一步研究以表明如何优化患者选择以及如何制定个体化治疗策略。