Boneva Stefaniya, Haritoglou Christos, Schultheiss Maximilian, Binder Susanne, Sebag J
Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland.
Augenklinik Herzog Carl Theodor, München, Deutschland.
Ophthalmologie. 2023 Oct;120(10):992-998. doi: 10.1007/s00347-023-01934-1. Epub 2023 Oct 6.
Age-related changes in vitreous molecular and anatomic morphology begin early in life and involve two major processes: vitreous liquefaction and weakening of vitreo-retinal adhesion. An imbalance in these two processes results in anomalous posterior vitreous detachment (PVD), which comprises, among other conditions, vitreo-macular adhesion (VMA) and traction (VMT). VMA is more common in patients with neovascular age-related macular degeneration (nAMD) than age-matched control patients, with the site of posterior vitreous adherence to the inner retina correlating with location of neovascular complexes. The pernicious effects of an attached posterior vitreous on age-related macular degeneration (AMD) progression involve mechanical forces, enhanced fluid influx and inflammation in and between the retinal layers, hypoxia leading to an accumulation of vascular endothelial growth factor (VEGF) and other stimulatory cytokines, and probably an infiltration of hyalocytes. It has been shown that vitrectomy not only mitigates progression to end-stage AMD, but existing choroidal neovascularization regresses after surgery. Thus, surgical PVD induction during vitrectomy or by pharmacologic vitreolysis may be considered in non-responders to anti-VEGF treatment with concomitant VMA.
玻璃体分子和解剖形态的年龄相关性变化在生命早期就开始了，涉及两个主要过程：玻璃体液化和玻璃体视网膜粘连减弱。这两个过程的失衡会导致异常的玻璃体后脱离（PVD），其中包括玻璃体黄斑粘连（VMA）和牵引（VMT）等情况。与年龄匹配的对照患者相比，VMA在新生血管性年龄相关性黄斑变性（nAMD）患者中更为常见，玻璃体后附着于视网膜内层的部位与新生血管复合体的位置相关。附着的玻璃体后皮质对年龄相关性黄斑变性（AMD）进展的有害影响包括机械力、视网膜层内和层间液体流入增加和炎症、缺氧导致血管内皮生长因子（VEGF）和其他刺激细胞因子积聚，以及可能的玻璃体细胞浸润。研究表明，玻璃体切除术不仅能减轻AMD进展至晚期的程度，而且术后现有的脉络膜新生血管会消退。因此，对于抗VEGF治疗联合VMA无反应的患者，可考虑在玻璃体切除术中诱导手术性PVD或通过药物性玻璃体溶解诱导PVD。
