Vitreoretinal Service, Department of Ophthalmology and Visual Sciences, The University of Iowa Hospitals & Clinics, Iowa City, Iowa 52242, USA.
Ophthalmology. 2010 Jul;117(7):1381-6. doi: 10.1016/j.ophtha.2009.11.007. Epub 2010 Feb 21.
To determine whether vitrectomy alters the long-term progression of age-related macular degeneration (AMD).
Retrospective case-control study.
Forty-four eyes of 22 patients with AMD who underwent vitrectomy in 1 eye were included in the study. The progression of AMD at follow-up in the 22 eyes that underwent vitrectomy was compared with the 22 fellow, nonvitrectomized eyes.
The charts and photographs of subjects with Age-Related Eye Disease Study category 3 AMD in both eyes who previously underwent vitrectomy surgery for an epiretinal membrane or macular hole were reviewed. Subjects were excluded if they had had a vitrectomy in both eyes, had <2 years of follow-up, had previous choroidal neovascularization (CNV), retinal detachment, diabetic retinopathy, angioid streaks, high myopia, vascular occlusions, or extensive macular scarring in either eye, or insufficient hospital records or photographs to determine the extent of AMD. Clinical notes throughout the follow-up interval were reviewed. Two vitreoretinal specialists independently graded pre- and postvitrectomy fundus photographs of all eyes in a masked fashion.
The development or progression of geographic atrophy of the retinal pigment epithelium and the development of CNV.
Twenty-two patients were included. The average follow up interval was 5.5 years (range, 2-15). Choroidal neovascularization developed in 5 control eyes and in 2 vitrectomized eyes, and atrophy developed in 7 control and 4 vitrectomized eyes. The difference between vitrectomized eyes and fellow eyes for the combined end points of RPE geographic atrophy or CNV was significant (P = 0.02).
In this pilot study, we did not detect that vitrectomy increased the progression of AMD. In fact, it was associated with a reduced progression to geographic atrophy or CNV. Additional studies are needed to confirm or refute this association.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
确定玻璃体切除术是否会改变年龄相关性黄斑变性（AMD）的长期进展。
回顾性病例对照研究。
纳入了 22 名接受了 1 只眼玻璃体切除术的 AMD 患者的 44 只眼。在接受玻璃体切除术的 22 只眼中，对 AMD 的进展情况进行了随访，并与未接受玻璃体切除术的 22 只对侧眼进行了比较。
对双眼均患有年龄相关性眼病研究（Age-Related Eye Disease Study）类别 3 AMD 且之前因视网膜内膜或黄斑裂孔接受过玻璃体切除术的患者的图表和照片进行了回顾。排除标准为双眼均接受过玻璃体切除术、随访时间<2 年、有先前脉络膜新生血管（choroidal neovascularization，CNV）、视网膜脱离、糖尿病性视网膜病变、脉络膜血管样条纹、高度近视、血管阻塞或任何一眼广泛的黄斑瘢痕、或双眼的医院记录或照片不足以确定 AMD 的严重程度。在整个随访期间对临床记录进行了审查。两名玻璃体视网膜专家对所有眼的术前和术后眼底照片进行了独立的、盲法的分级。
视网膜色素上皮（retinal pigment epithelium，RPE）的局灶性萎缩和 CNV 的发生或进展。
纳入了 22 名患者。平均随访时间为 5.5 年（范围：2-15 年）。5 只对照眼和 2 只玻璃体切除眼发生了脉络膜新生血管，7 只对照眼和 4 只玻璃体切除眼发生了萎缩。玻璃体切除眼和对侧眼的 RPE 局灶性萎缩或 CNV 的联合终点差异有统计学意义（P=0.02）。
在这项初步研究中，我们没有发现玻璃体切除术会加速 AMD 的进展。事实上，它与 RPE 局灶性萎缩或 CNV 进展减少相关。需要进一步的研究来证实或反驳这种关联。
作者无任何与本文讨论的材料相关的专有或商业利益。
