Arch Ophthalmol. 1994 Apr;112(4):500-9.
To summarize findings from three randomized clinical trials of krypton laser treatment of juxtafoveal neovascular lesions regarding changes in visual acuity during 5 years of follow-up, rates of persistent and recurrent choroidal neovascularization, and status of macular lesions 5 years after enrollment. DESIGN, PATIENTS, AND PRIMARY OUTCOME MEASURES: Follow-up of patients enrolled in three randomized trials of choroidal neovascularization secondary to age-related macular degeneration (AMD), ocular histoplasmosis, or idiopathic causes ended in March 1991. All patients were eligible to complete at least 3 years of follow-up examinations. Data on visual acuity, reading vision, and anatomic outcomes during 5 years of follow-up were available for 276 (92%) of 300 patients with AMD, 236 (92%) of 256 patients with ocular histoplasmosis, and 38 (97%) of 39 patients with idiopathic choroidal neovascularization enrolled 5 or more years earlier who were still living.
Among eyes with AMD, the estimated relative risk (RR) of a loss of 6 or more lines of visual acuity from baseline to any examination from 6 months through 5 years after enrollment for untreated eyes in comparison with treated eyes was 1.20 (P = .04). Normotensive patients with AMD realized the greatest benefit from laser treatment (RR, 1.82) and hypertensive patients experienced little or no benefit (RR, 0.93). Untreated eyes with ocular histoplasmosis were at much greater risk of a 6-line decrease in visual acuity from the 1-year through the 5-year examination than were treated eyes (unadjusted RR, 2.60; RR, 4.26 after adjustment for visual acuity and hypertension at baseline; P < .001 for both). The treatment effect for eyes with idiopathic choroidal neovascularization was between the effects for eyes with AMD and eyes with ocular histoplasmosis.
The early beneficial effects of laser treatment on visual acuity persisted for at least 5 years in eyes with all three underlying conditions. Laser treatment of similar eyes with choroidal neovascularization in a juxtafoveal location is recommended for patients with these conditions, with the caveat that hypertensive patients with AMD may fare no better with laser treatment than without treatment.
总结氪激光治疗近黄斑部新生血管病变的三项随机临床试验结果，内容涉及随访5年期间的视力变化、脉络膜新生血管持续和复发率，以及入组5年后黄斑病变状况。设计、患者及主要观察指标：对年龄相关性黄斑变性（AMD）、眼组织胞浆菌病或特发性病因所致脉络膜新生血管的三项随机试验入组患者的随访于1991年3月结束。所有患者均有资格完成至少3年的随访检查。在5年随访期间，300例AMD患者中有276例（92%）、256例眼组织胞浆菌病患者中有236例（92%）、5年或更早入组且仍在世的39例特发性脉络膜新生血管患者中有38例（97%）可获得视力、阅读视力及解剖学结果的数据。
在AMD患者眼中，与接受治疗的眼睛相比，未治疗的眼睛在入组后6个月至5年的任何一次检查中，从基线视力下降6行或更多行的估计相对风险（RR）为1.20（P = 0.04）。血压正常的AMD患者从激光治疗中获益最大（RR，1.82），而高血压患者获益很少或未获益（RR，0.93）。未治疗的眼组织胞浆菌病患者在1年至5年检查期间视力下降6行的风险比接受治疗的眼睛高得多（未校正RR，2.60；在对基线视力和高血压进行校正后RR为4.26；两者P均<0.001）。特发性脉络膜新生血管患者眼睛的治疗效果介于AMD患者眼睛和眼组织胞浆菌病患者眼睛的治疗效果之间。
激光治疗对视力的早期有益作用在所有三种基础疾病的患者眼中至少持续了5年。对于患有这些疾病的患者，建议对近黄斑部位置有脉络膜新生血管的类似眼睛进行激光治疗，但需注意，AMD高血压患者接受激光治疗可能并不比不治疗效果更好。
