Butros S, Cucera A, Lang G E
Augenklinik, Universitätsklinik Ulm.
Klin Monbl Augenheilkd. 2011 Nov;228(11):999-1002. doi: 10.1055/s-0031-1273430. Epub 2011 Aug 26.
The aim of this study was to evaluate retrospectively the clinical outcome of retinal photocoagulation of age-related juxtapapillary choroidal neovascularisation (CNV) with macular oedema. Juxtapapillary CNV represents a rare form of extrafoveal CNV in age-related macular degeneration (AMD).
In 15 eyes of 14 patients with age-related juxtapapillary choroidal neovascularisation, CNV was treated with several rows of frequency doubled Nd:YAG laser (532 nm) irradiation to protect the fovea. Classification of the CNV was performed with fluorescein angiography. Best corrected visual acuity was determined before and after photocoagulation. Follow-up time was 1 - 32 months.
In 13 eyes the juxtapapillary CNV was occult (87 %), one eye had a classic, one eye a minimally classic form. In 13 eyes (87 %) the centre of the fovea showed macular oedema in spite of the extrafoveal location of the CNV. Of these 13 eyes, in 10 eyes (77 %) visual acuity increased after photocoagulation. 7 eyes (53 %) had an increase in visual acuity of 1 or 2 lines, 3 eyes of ≥ 4 lines. 2 eyes showed a stable visual acuity, in 1 eye visual acuity deteriorated after photocoagulation. In 2 eyes without foveal involvement of macular oedema, CNV was located in the papillo-macular bundle and threatened the centre of the fovea. Postoperative visual acuity in theses eyes was stable after 1 and 5 months.
The therapeutic benefit of photocoagulation of juxta- and extrafoveal classic CNV has already been proven. According to our results, photocoagulation is an effective therapeutic approach in the treatment of age-related juxtapapillary CNV especially, in the occult form, when the fovea is threatened by or involved in the macular oedema.
本研究旨在回顾性评估年龄相关性视乳头旁脉络膜新生血管(CNV)合并黄斑水肿的视网膜光凝治疗的临床效果。视乳头旁CNV是年龄相关性黄斑变性(AMD)中一种罕见的黄斑外CNV形式。
14例年龄相关性视乳头旁脉络膜新生血管患者的15只眼,采用多排倍频Nd:YAG激光(532nm)照射治疗CNV以保护黄斑中心凹。通过荧光素血管造影对CNV进行分类。在光凝治疗前后测定最佳矫正视力。随访时间为1至32个月。
13只眼的视乳头旁CNV为隐匿性(87%),1只眼为典型性,1只眼为轻微典型性。尽管CNV位于黄斑外,但13只眼(87%)的黄斑中心凹出现了黄斑水肿。在这13只眼中,10只眼(77%)光凝治疗后视力提高。7只眼(53%)视力提高了1或2行,3只眼提高了≥4行。2只眼视力稳定,1只眼光凝治疗后视力下降。在2只未累及黄斑中心凹水肿的眼中,CNV位于视乳头黄斑束并威胁黄斑中心凹。这两只眼光凝治疗后1个月和5个月视力稳定。
黄斑旁和黄斑外典型CNV光凝治疗的益处已得到证实。根据我们的结果,光凝治疗是治疗年龄相关性视乳头旁CNV的有效治疗方法,尤其是在隐匿性形式中,当黄斑中心凹受到黄斑水肿威胁或累及黄斑水肿时。