Ikeda T, Sawa H, Koizumi K, Yasuhara T, Yamasaki T
Department of Ophthalmology, Osaka Medical College, Japan.
Acta Ophthalmol Scand. 2000 Aug;78(4):460-4. doi: 10.1034/j.1600-0420.2000.078004460.x.
In age-related macular degeneration, the posterior vitreous surface often remains attached to a higher degree than expected for the patient's age, suggesting the involvement of the posterior vitreous membrane in the pathophysiology of choroidal neovascularization. Thus, we performed simple pars plana vitrectomy and artificial posterior vitreous detachment in order to induce regression of choroidal neovascularization.
Vitrectomy was performed in 12 eyes of 11 patients with age-related macular degeneration in whom the posterior vitreous surface remained attached, and in whom there was evidence of highly active choroidal neovascularization. The posterior vitreous membrane was artificially detached during surgery, but photocoagulation and/or a subretinal procedure for choroidal neovascularization was not performed. Patients underwent fluorescein and indocyanine green angiography both pre- and postoperatively to assess the status of choroidal neovascularization.
Six months after surgery, 6 of the 12 eyes showed regression of choroidal neovascularization, and in 2 eyes it had disappeared completely. Subretinal exudative changes in 8 eyes had improved. Visual acuity testing showed improved vision in 4 eyes, unchanged vision in 4 eyes, and worsening of vision in 4 eyes. The final best corrected visual acuity was 10/20 or better in one eye, 10/ 20 to 20/200 in 7 eyes, and 20/200 or worse in 4 eyes.
The results of the present study suggest the involvement of the posterior vitreous membrane in the pathophysiology of age-related macular degeneration. Furthermore, the minimally invasive pars plana vitrectomy may represent a new treatment for age-related macular degeneration.
在年龄相关性黄斑变性中，玻璃体后表面的附着程度往往高于患者年龄所预期的程度，这表明玻璃体后膜参与了脉络膜新生血管形成的病理生理过程。因此，我们进行了单纯的扁平部玻璃体切除术和人工玻璃体后脱离，以促使脉络膜新生血管消退。
对11例年龄相关性黄斑变性患者的12只眼进行了玻璃体切除术，这些患者的玻璃体后表面仍有附着，且有高度活跃的脉络膜新生血管形成的证据。手术过程中人工分离玻璃体后膜，但未对脉络膜新生血管进行光凝和/或视网膜下手术。患者在术前和术后均接受荧光素和吲哚菁绿血管造影，以评估脉络膜新生血管的状况。
术后6个月，12只眼中有6只眼的脉络膜新生血管消退，2只眼的脉络膜新生血管完全消失。8只眼的视网膜下渗出性改变有所改善。视力测试显示，4只眼视力提高，4只眼视力不变，4只眼视力下降。最终最佳矫正视力，1只眼为10/20或更好，7只眼为10/20至20/200，4只眼为20/200或更差。
本研究结果提示玻璃体后膜参与了年龄相关性黄斑变性的病理生理过程。此外，微创的扁平部玻璃体切除术可能代表了一种治疗年龄相关性黄斑变性的新方法。
