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自体血小板治疗视盘小凹黄斑病变的长期疗效

Long-term outcomes of autologous platelet treatment for optic disc pit maculopathy.

作者信息

Gklavas Konstantinos, Athanasiou Alexandros, Neubauer Jonas, Lilou Evangelia, Pohl Lisa, Bartz-Schmidt Karl Ulrich, Dimopoulos Spyridon

机构信息

Centre for Ophthalmology, Eberhard-Karls University, Tübingen, Germany.

Institute for Ophthalmic Research, Eberhard-Karls University, Tübingen, Germany.

出版信息

Graefes Arch Clin Exp Ophthalmol. 2023 Nov;261(11):3177-3185. doi: 10.1007/s00417-023-06159-1. Epub 2023 Jul 4.

Abstract

PURPOSE

Optic disc pits (ODPs) are rare congenital cavitary abnormalities of the optic nerve head, which can lead to serous macular detachments. The aim of this study was to evaluate the long-term efficacy of pars plana vitrectomy (PPV) combined with autologous platelet concentrate (APC) for the treatment of optic disc pit maculopathy (ODP-M).

METHODS

A retrospective analysis was performed on eleven eyes of ten patients with ODP-M, who received PPV combined with APC. Nine eyes operated primary, four of which had a repeat surgery also with injection of APC and two eyes underwent a rescue surgery, after they have been operated in another eye center without APC. Morphological and functional results were the main outcome parameters, determined by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA), respectively.

RESULTS

The mean duration of visual loss before surgery was 4.7 ± 3.89 months (range 0-12 months). The mean BCVA increased significantly from 0.82 ± 0.33 logMAR (range 0.4-1.3) preoperatively to 0.51 ± 0.36 logMAR (range 0-1.2) at the last examination (p = 0.0022). A significant morphological improvement was also noticed with decrease of the mean foveal thickness from 935.82 ± 248.48 µm (range 559-1400 µm) preoperatively to 226.45 ± 76.09 µm (range 110-344 µm) at the final examination (p < 0.0001). The patients were followed-up for a mean 65.36 ± 48.81 months (range 1-144 months). Two eyes developed postoperatively a retinal detachment. Cataract surgery was performed in 5 eyes during the follow-up period.

CONCLUSION

Our study demonstrated that PPV with APC can improve functional and morphological outcomes, both as a primary and a rescue therapy, without any recurrence over a long follow-up period. To the best of our knowledge, this was the longest observation period regarding the use of APC in treatment of ODP-M.

摘要

目的

视盘小凹(ODP)是视神经乳头罕见的先天性空洞异常,可导致浆液性黄斑脱离。本研究的目的是评估玻璃体切除术(PPV)联合自体浓缩血小板(APC)治疗视盘小凹黄斑病变(ODP-M)的长期疗效。

方法

对10例ODP-M患者的11只眼进行回顾性分析,这些患者接受了PPV联合APC治疗。9只眼为初次手术,其中4只眼再次手术时也注射了APC,2只眼在另一家未使用APC的眼科中心手术后接受了挽救手术。形态学和功能结果是主要观察指标,分别通过光学相干断层扫描(OCT)和最佳矫正视力(BCVA)确定。

结果

术前视力丧失的平均持续时间为4.7±3.89个月(范围0-12个月)。平均BCVA从术前的0.82±0.33 logMAR(范围0.4-1.3)显著提高到最后一次检查时的0.51±0.36 logMAR(范围0-1.2)(p = 0.0022)。还观察到形态学有显著改善,平均黄斑厚度从术前的935.82±248.48 µm(范围559-1400 µm)降至最后检查时的226.45±76.09 µm(范围110-344 µm)(p < 0.0001)。患者平均随访65.36±48.81个月(范围1-144个月)。2只眼术后发生视网膜脱离。随访期间5只眼进行了白内障手术。

结论

我们的研究表明,PPV联合APC作为初次治疗和挽救治疗均可改善功能和形态学结果,在长期随访中无任何复发。据我们所知,这是关于APC治疗ODP-M的最长观察期。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ad17/10587340/814b1c6f31d9/417_2023_6159_Fig1_HTML.jpg

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