Ziemssen Focke, Lüke Matthias, Bartz-Schmidt Karl U, Gelisken Faik
Department for Ophthalmology, University Eye Hospital, Eberhard-Karls University, Schleichstr. 12-16, 72076 Tuebingen, Germany.
Graefes Arch Clin Exp Ophthalmol. 2008 May;246(5):653-9. doi: 10.1007/s00417-007-0726-y. Epub 2007 Dec 11.
To report the change of contrast sensitivity (CS) after photodynamic therapy (PDT) vs full macular translocation (FMT) for neovascular age-related macular degeneration (AMD), and to relate this to other measures of visual function (distance and near acuity).
Fifty patients (50 eyes) with predominantly classic subfoveal choroidal neovascularisation (CNV) secondary to AMD were randomized to PDT or FMT. CS was measured with Pelli-Robson charts. Acuity scores of near visual function (NVS) were calculated after testing with visual acuity cards of the Swiss National Association of and for the Blind (SNAB). Best corrected distance visual acuity (DVA) was determined according to a standardized protocol with EDTRS charts. Primary end point was the change of CS at 12-month examination from baseline. The interaction of the CS with NVS and DVA was analysed.
Mean CS showed a decrease in both treatment groups (FMT: -2 letters, PDT: -3 letters, p=0.969) at 12-month examination from baseline. While mean NVS improved by seven letters in the FMT group, a decrease of more than ten letters was seen in the PDT group (p<0.05). We found no agreement between CS and high-contrast acuity (NVS, DVA). In FMT patients, the parameters at baseline (CS, NVS, DVA) correlated poorly with the corresponding 12-month results, therefore providing no informative basis to predict the later functional development. In contrast, PDT patients showed strong baseline-to-outcome coherence with baseline measures also associated with better final values.
Although FMT can initiate recovery of near and distance acuity over the period of 1 year in selected patients with classic CNV, CS did not differ between FMT and PDT. We found no close connection of CS with DVA or NVS, especially after FMT. Knowledge about the unequal variation of visual parameters can provide more comprehensive information when advising patients on different therapeutic options. That also applies in particular to vascular endothelial growth factor inhibitors, which seem to promise an even higher extent of gain in CS and to reach the peak of recovery at an earlier time.
报告光动力疗法（PDT）与完全黄斑转位术（FMT）治疗新生血管性年龄相关性黄斑变性（AMD）后对比敏感度（CS）的变化，并将其与其他视觉功能指标（远视力和近视力）相关联。
50例（50只眼）主要为继发于AMD的典型黄斑下脉络膜新生血管（CNV）患者被随机分为PDT组或FMT组。使用佩利-罗布森图表测量CS。用瑞士国家盲人协会（SNAB）的视力卡片测试后计算近视力功能（NVS）的视力得分。根据标准化方案用EDTRS图表确定最佳矫正远视力（DVA）。主要终点是12个月检查时CS相对于基线的变化。分析CS与NVS和DVA的相互作用。
在12个月检查时，与基线相比，两个治疗组的平均CS均下降（FMT组：-2个字母，PDT组：-3个字母，p = 0.969）。FMT组的平均NVS提高了7个字母，而PDT组下降了超过10个字母（p < 0.05）。我们发现CS与高对比度视力（NVS、DVA）之间没有一致性。在FMT患者中，基线参数（CS、NVS、DVA）与相应的12个月结果相关性较差，因此无法为预测后期功能发展提供有用依据。相比之下，PDT患者从基线到结果显示出很强的一致性，基线测量也与更好的最终值相关。
尽管FMT可以在1年内使部分患有典型CNV的患者的远近视力恢复，但FMT和PDT之间的CS没有差异。我们发现CS与DVA或NVS没有密切联系，尤其是在FMT之后。在为患者提供不同治疗选择建议时，了解视觉参数的不同变化可以提供更全面的信息。这尤其适用于血管内皮生长因子抑制剂，其似乎有望在CS方面获得更高程度的改善，并在更早的时间达到恢复峰值。
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