Furashova Olga, Engelmann Katrin
Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany.
Clin Ophthalmol. 2020 Feb 11;14:389-396. doi: 10.2147/OPTH.S240480. eCollection 2020.
To evaluate the outcome of macular surgery with ILM- and epiretinal membrane peel associated with significant dry age-related macular degeneration (AMD) as defined by the Age-Related Eye Disease Study (AREDS).
Institutional. Retrospective case-control study. A total of 42 pseudophacic eyes of 39 patients (7 with full thickness macular hole and 35 with epiretinal membrane) with coexisting dry AMD underwent pars plana vitrectomy (PPV) with internal limiting membrane (ILM) and epiretinal membrane peel. Preoperative and postoperative data including best corrected visual acuity (BCVA), AMD grade according to AREDS, central retinal thickness (CRT), development of choroidal neovascularization (CNV), and central retinal atrophy have been evaluated. Twenty-eight fellow eyes with dry AMD of the included 39 patients served as a control group.
A significant improvement in the visual acuity could be observed after surgery (initial BCVA 0.47±0.31 logarithm of the minimal angle of resolution (logMAR) vs 0.33±0.29logMAR 9 months postoperatively; =0.006). CRT decreased significantly after surgery (<0.001). In the surgery group, there were 4 eyes (9.5%) with CNV and 1 eye (2.5%) with new central retinal atrophy development after surgery. All these eyes had preoperative AREDS 3 (4 eyes) or AREDS 4 (1 eye) AMD category. In the control group, there was 1 eye (4%) with CNV and 4 eyes (14%) with new central retinal atrophy development during the follow-up of 9 months. These eyes had initially AREDS 2 (1 eye), AREDS 3 (3 eyes) or AREDS 4 (1 eye) AMD category.
Eyes with dry AMD of AREDS 3 and AREDS 4 with coexisting VMI abnormalities improve significantly after PPV with membrane peel. While there is a higher risk of CNV development after surgery (9.5%) in these eyes, the vitrectomy does not seem to accelerate central retinal atrophy progression compared to the fellow eyes course.
评估与年龄相关性眼病研究（AREDS）所定义的显著干性年龄相关性黄斑变性（AMD）相关的内界膜（ILM）和视网膜前膜剥除的黄斑手术效果。
机构性回顾性病例对照研究。39例患者共42只假晶状体眼（7例全层黄斑裂孔，35例视网膜前膜）合并干性AMD，接受了玻璃体切割联合内界膜（ILM）和视网膜前膜剥除术。评估了术前和术后数据，包括最佳矫正视力（BCVA）、根据AREDS的AMD分级、中心视网膜厚度（CRT）、脉络膜新生血管（CNV）的发生情况以及中心视网膜萎缩情况。纳入的39例患者中的28只对侧干性AMD眼作为对照组。
术后视力有显著改善（初始BCVA为0.47±0.31最小分辨角对数（logMAR），术后9个月为0.33±0.29 logMAR；P = 0.006）。术后CRT显著降低（P<0.001）。手术组中，术后有4只眼（9.5%）发生CNV，1只眼（2.5%）出现新的中心视网膜萎缩。所有这些眼术前均为AREDS 3（4只眼）或AREDS 4（1只眼）AMD类别。对照组中，在9个月的随访期间有1只眼（4%）发生CNV，4只眼（14%）出现新的中心视网膜萎缩。这些眼最初为AREDS 2（1只眼）、AREDS 3（3只眼）或AREDS 4（1只眼）AMD类别。
合并玻璃体黄斑界面异常的AREDS 3和AREDS 4干性AMD眼在接受剥膜的玻璃体切割术后有显著改善。虽然这些眼中术后发生CNV的风险较高（9.5%），但与对侧眼病程相比，玻璃体切除术似乎并未加速中心视网膜萎缩的进展。
