Cesk Slov Oftalmol. 2022 Winter;79(1):42-46. doi: 10.31348/2023/5.
We present a case report of a patient with dry form of age-related macular degeneration (AMD) in whom we monitored the effect of rheohemapheresis (RhF) treatment over 6 years.
A 67-year-old man was examined in April 2014 at the Department of Ophthalmology at the University Hospital in Hradec Králové for metamorphopsia and decreased visual acuity of the left eye. The patient received general treatment for hypercholesterolemia with Lipfix 10 mg once a day (atorvastatin 10 mg). The cholesterol level in the blood was 3.41 mmol/l, the lipid profile was normal. The patient's previous ocular medical history was unremarkable. The patient reported ocular complaints over the course of the last year, the main symptom of which was image distortion on the Amsler grid on the left eye. Baseline best corrected visual acuity of the left eye was 6/10. Visual acuity in the right eye was 6/6. In both eyes, the findings on the anterior segment corresponded to the patient's age, with the exception of incipient cortical cataract. On the fundus of both eyes, the border of the optic nerve was demarcated, in the macula of the left eye there were a number of soft confluent drusen, in the central periphery there were no pathological changes. On the fundus of the right eye the finding was similar, but to a lesser degree. Optical coherence tomography on the macula of the left eye showed drusoid ablation of the retinal pigment epithelium (RPE), with accumulation of hyperreflectivities below the RPE. Pattern-reversal electroretinography (pERG): showed a slightly prolonged retention of the activity of the central region of the retina (p50 wave) and ganglion cells (N95 wave). Multifocal electroretinography (mfERG) in the central 30° of the retina was within normal limits. Electroretinography (ERG) demonstrated physiological photopic and scotopic rod activity. The patient was treated with 8 RhF procedures, two per week, with a 2-week interval, and the pulse was repeated 4 times.
We noted a gradual resorption of soft drusen in the patient, with attachment to the RPE line according to OCT examination at the following sixmonthly check-ups over the next 6 years. Visual acuity of both eyes was maintained at the baseline values at the last check-up in April 2020, the area of soft drusen was significantly reduced. The function of the rod, cone system and the central region of the retina mfERG fluctuated only to an insignificant degree during the entire follow-up period, with a tendency towards a slight increase in activity after RhF treatment.
We noted an improvement of the anatomical and functional findings in a patient with dry form of AMD during a 6-year follow-up period after RhF treatment. The visual acuity of the affected eye remained at the baseline values.
我们报告了一例干性年龄相关性黄斑变性（AMD）患者的病例，我们对其进行了雷射血液净化疗法（RhF）治疗 6 年的疗效监测。
2014 年 4 月，一名 67 岁男性患者因左眼视物变形和视力下降在赫拉德茨克拉洛韦大学医院眼科就诊。患者接受了降脂治疗（每天 Lipfix 10 mg，即阿托伐他汀 10 mg）以治疗高胆固醇血症。血液中的胆固醇水平为 3.41mmol/L，血脂水平正常。患者既往眼部病史无特殊。患者在过去一年中有眼部症状，主要症状是左眼 Amsler 网格图像变形。左眼最佳矫正视力基线为 6/10。右眼视力为 6/6。双眼眼前段检查结果与患者年龄相符，除皮质性白内障初期外。双眼视盘边界清晰，左眼黄斑区有多处软性融合软斑，周边中心无病理性改变。右眼发现类似病变，但程度较轻。左眼黄斑区光学相干断层扫描显示视网膜色素上皮（RPE）的 drusoid 消融，RPE 下方有高反射性物质堆积。图形反转视网膜电图（pERG）：中央视网膜区域（p50 波）和神经节细胞（N95 波）的活动保留时间略有延长。视网膜中央 30°的多焦视网膜电图（mfERG）正常。视网膜电图（ERG）显示明视和暗视杆状细胞活性正常。患者接受了 8 次 RhF 治疗，每两周一次，间隔 2 周，脉冲重复 4 次。
我们注意到患者的软性软斑逐渐吸收，根据 OCT 检查，在接下来的 6 年中，每隔 6 个月进行一次检查，发现软斑与 RPE 线相连。双眼视力在 2020 年 4 月最后一次检查时保持在基线水平，软性软斑面积明显减少。在整个随访期间，杆、锥细胞系统和视网膜中央 mfERG 的功能仅波动至无显著程度，RhF 治疗后活动有轻微增加的趋势。
我们在 RhF 治疗后 6 年的随访中观察到干性 AMD 患者的解剖和功能发现得到改善。受影响眼的视力保持在基线水平。
