Uppal Gurmit, Milliken Andrew, Lee John, Acheson James, Hykin Phil, Tufail Adnan, da Cruz Lyndon
Moorfields Eye Hospital, London, UK.
Clin Exp Ophthalmol. 2007 Jul;35(5):448-57. doi: 10.1111/j.1442-9071.2007.01528.x.
We propose a case selection algorithm to assess suitability for macular translocation for subfoveal neovascular membrane (CNV) secondary to age-related macular degeneration. The algorithm is based on preoperative assessment of residual foveal function, as assessed by a slit-lamp fixation task and duration of visual loss, in patients with poor acuity. We validate our slit-lamp fixation task against an objective analysis (Nidek MP-1 Microperimetry) and proceed to examine surgical outcomes as selected by the algorithm.
A prospective series of 27 consecutive patients with CNV underwent translocation at Moorfields Eye Hospital, London between May 2003 and May 2006.
Validation of the slit-lamp fixation task revealed 100% concordance in classification of fixation between the slit-lamp task and the microperimeter. At an average follow up of 12.2 months, the mean Early Treatment of Diabetic Retinopathy Study distance acuity improved from logMAR 0.88 to 0.68 (P < 0.03). Sixty-six per cent of patients achieved an acuity of < or =logMAR 0.8 (6/30), 22% an acuity of < or =logMAR 0.3 (6/12) and 33% gained three lines of acuity. The mean MN Read reading acuity improved from logMAR 1.23 to 0.91 (P < 0.01). Forty-four per cent of patients achieved an acuity of > or =logMAR 0.7 (N10), 15% an acuity of > or =logMAR 0.4 (N5) and 44% gained three lines of acuity.
We have demonstrated a simple case selection algorithm that is based on residual foveal function and suggests good outcomes. The strongest indicators of foveal function are fixation characteristics and duration of visual loss. In contrast to previous studies, our algorithm suggests good outcomes independently of preoperative visual acuity and CNV characteristics.
我们提出一种病例选择算法，以评估年龄相关性黄斑变性继发的黄斑下新生血管膜（CNV）患者是否适合进行黄斑转位术。该算法基于对视力较差患者的残余黄斑功能进行术前评估，评估方法为裂隙灯注视任务和视力丧失持续时间。我们将裂隙灯注视任务与客观分析（尼德克MP - 1微视野计）进行对比验证，并进而检查该算法选择的手术结果。
2003年5月至2006年5月期间，伦敦摩尔菲尔德眼科医院对27例连续性CNV患者进行了前瞻性系列研究，这些患者均接受了黄斑转位术。
裂隙灯注视任务的验证显示，裂隙灯任务与微视野计在注视分类方面的一致性为100%。平均随访12.2个月时，糖尿病视网膜病变早期治疗研究（ETDRS）平均远视力从logMAR 0.88提高到0.68（P < 0.03）。66%的患者视力达到≤logMAR 0.8（6/30），22%的患者视力达到≤logMAR 0.3（6/12），33%的患者视力提高了3行。MN阅读平均视力从logMAR 1.23提高到0.91（P < 0.01）。44%的患者视力达到≥logMAR 0.7（N10），15%的患者视力达到≥logMAR 0.4（N5），44%的患者视力提高了3行。
我们展示了一种基于残余黄斑功能的简单病例选择算法，该算法提示手术效果良好。黄斑功能的最强指标是注视特征和视力丧失持续时间。与以往研究不同，我们的算法提示手术效果良好，且与术前视力和CNV特征无关。
