Department of Ophthalmology, Kagoshima University School of Dental and Medical Sciences, Kagoshima, Japan.
Retina. 2010 Jun;30(6):856-64. doi: 10.1097/IAE.0b013e3181c969cb.
The purpose of this study was to study the effect of pars plana vitrectomy (PPV) for age-related macular degeneration with vitreous hemorrhage on choroidal neo-vascularization (CNV).
A retrospective interventional case series in which 92 eyes with age-related macular degeneration with vitreous hemorrhage that received PPV were studied. Among them, 60 eyes without pre- or posttreatment other than PPV were selected. Choroidal neovascularization was expressed as the incidence of bleeding 6 months before and after PPV. The status of CNV after PPV was compared and classified as worsened, remained, regressed, disappeared, or unclassified. The influence of posterior vitreous detachment was examined.
The incidence of bleeding was reduced dramatically after PPV (1.11 +/- 0.44 in preoperative 6 months vs. 0.03 +/- 0.18 in postoperative 6 months, P < 0.0001). The status of CNV improved in most cases; 40 of 54 classifiable eyes (74.1%) were categorized as "regressed" or "disappeared." Postoperative visual acuity was significantly better than preoperative visual acuity (P < 0.0001). The status of CNV subsided more in those eyes without posterior vitreous detachment than in those with posterior vitreous detachment (odds ratio, 1.02; 95% confidence interval, -0.01-2.08; P = 0.054).
The activity of CNV was reduced after PPV in eyes with age-related macular degeneration with vitreous hemorrhage. Visual acuity significantly improved, with only rare severe complications. The involvement of vitreomacular traction in the patho-physiology of CNV in age-related macular degeneration is possible.
本研究旨在探讨经睫状体平坦部玻璃体切除术（PPV）治疗玻璃体积血性年龄相关性黄斑变性（AMD）对脉络膜新生血管（CNV）的影响。
本研究为回顾性干预性病例系列研究，纳入 92 例玻璃体积血性 AMD 患者，均接受 PPV 治疗。其中，选择了 60 例除 PPV 外无治疗的患者。CNV 以 PPV 治疗前 6 个月和治疗后 6 个月的出血发生率表示。比较和分类评估 PPV 后 CNV 的状态，分为加重、持续、消退、消失或未分类。并检测后玻璃体脱离的影响。
PPV 后出血发生率显著降低（术前 6 个月为 1.11±0.44，术后 6 个月为 0.03±0.18，P<0.0001）。大多数情况下，CNV 状态得到改善；54 只可分类眼（74.1%）中，40 只被归类为“消退”或“消失”。术后视力明显优于术前视力（P<0.0001）。无后玻璃体脱离眼的 CNV 状态消退较有后玻璃体脱离眼更明显（比值比，1.02；95%置信区间，-0.01~2.08；P=0.054）。
玻璃体积血性 AMD 患者经 PPV 治疗后，CNV 活性降低。视力显著改善，仅极少数出现严重并发症。玻璃体黄斑牵引可能参与 AMD 脉络膜新生血管的病理生理过程。
