Joseph Daniel P, Uemura Akinori, Thomas Matthew A
Barnes Retina Institute and Department of Ophthalmology, Washington University School of Medicine, 1600 South Brentwood Boulevard, 8th Floor, St. Louis, MO 63144, USA.
Retina. 2003 Aug;23(4):463-8. doi: 10.1097/00006982-200308000-00003.
To report visual outcome, rate of recurrence, and complications for patients who underwent subretinal surgery as treatment of classic juxtafoveal choroidal neovascularization (CNV).
This study was a noncomparative case series of 46 patients who underwent subretinal surgery for juxtafoveal CNV that appeared to be pure classic without angiographic or clinical evidence of occult neovascularization between 1993 and 2000, with best-corrected preoperative and postoperative Snellen visual acuity reported.
The mean follow-up period +/- SD was 20.4 +/- 12.9 months (range, 6-57 months). Etiologic categories included ocular histoplasmosis syndrome (37%), age-related macular degeneration (20%), idiopathic (15%), myopic degeneration (11%), mixed features of ocular histoplasmosis syndrome and myopia (11%), and other miscellaneous causes (6%). Thirty-three percent (15) of 46 eyes that underwent surgery had previously been treated with thermal laser photocoagulation at least once. Most patients (89%) had membranes with the posterior edge located 200 microm or closer to the center of the foveal avascular zone. The median preoperative visual acuity was 20/70 compared with the median postoperative visual acuity of 20/40. Significant improvement of visual acuity, measured as an increase of two or more lines of vision, occurred in 26 eyes (56%). In 10 (22%) of the remaining eyes, postoperative visual acuity was within one line of the preoperative visual acuity. Visual acuity decreased by two to five lines in seven eyes (15%). Severe vision loss, defined as a decrease of six or more lines, occurred in three eyes (7%). Recurrence was observed in 26 patients (56.5%).
The results indicated that subretinal surgery for juxtafoveal CNV improved or stabilized vision in most cases (78%), but in the absence of controls with a limited number of eyes and variable follow-up, it is impossible to determine with certainty if this improvement or stabilization is greater than what might be seen with laser photocoagulation or observation.
报告接受视网膜下手术治疗典型黄斑中心凹旁脉络膜新生血管（CNV）患者的视力预后、复发率及并发症。
本研究为一项非对照病例系列研究，纳入了1993年至2000年间46例因黄斑中心凹旁CNV接受视网膜下手术的患者，这些患者的病变似乎为单纯典型性，无血管造影或临床隐匿性新生血管的证据，并报告了术前及术后最佳矫正Snellen视力。
平均随访时间±标准差为20.4±12.9个月（范围6 - 57个月）。病因分类包括眼组织胞浆菌病综合征（37%）、年龄相关性黄斑变性（20%）、特发性（15%）、近视性变性（11%）、眼组织胞浆菌病综合征与近视的混合特征（11%）以及其他杂类病因（6%）。46只接受手术的眼中，33%（15只）之前至少接受过一次热激光光凝治疗。大多数患者（89%）的视网膜下膜后缘位于距黄斑无血管区中心200微米或更近处。术前视力中位数为20/70，术后视力中位数为20/40。26只眼（56%）视力显著改善，即视力提高两行或更多行。其余10只眼（22%）术后视力与术前视力相差在一行以内。7只眼（15%）视力下降了两到五行。严重视力丧失定义为视力下降六行或更多行，3只眼（7%）出现此情况。26例患者（56.5%）观察到复发。
结果表明，黄斑中心凹旁CNV的视网膜下手术在大多数情况下（78%）改善或稳定了视力，但由于缺乏对照、病例数有限且随访时间不一，无法确切确定这种改善或稳定是否优于激光光凝或观察治疗。
