Arch Ophthalmol. 1996 Jun;114(6):677-88. doi: 10.1001/archopht.1996.01100130669006.
To document the incidence of choroidal neovascularization (CNV) in unaffected fellow eyes among individuals with ocular histoplasmosis and extrafoveal or juxtafoveal CNV in 1 eye; to determine whether the location and type of "histo spots" in the macula predict the site of future CNV development in second eyes; to describe changes over time in neovascular lesions present in fellow eyes at baseline; and to describe changes in visual acuity of fellow eyes with and without CNV at baseline.
DESIGN, PATIENTS, AND SETTING: Five-year prospective follow-up study of fellow eyes of 516 patients enrolled in 2 randomized clinical trials of laser photocoagulation of extrafoveal and juxtafoveal CNV. Best-corrected visual acuity and reading vision were measured, and both maculas were photographed at baseline and at 6-month intervals.
Cumulative incidence of CNV in fellow eyes free of neovascular maculopathy at the time of study enrollment, 5-year change in visual acuity of fellow eyes from baseline, and incidence of legal blindness (visual acuity < or = 20/200 in the better eye).
Photographically documented CNV developed in 35 (9%) of 394 eyes initially free of neovascular maculopathy; nevertheless, good visual acuity was maintained in most newly affected eyes until the end of the 5-year follow-up period. Histo spots of any type in the macula at baseline tripled the risk for later development of CNV in comparison to eyes without histo spots in the macula. Although the type of histo spots present in the central macula at baseline did not predict future CNV development, in 32 of 35 second eyes in which CNV developed and in 7 of 9 fellow eyes in which a second area of CNV developed during follow-up, CNV was preceded by an "atypical" histo spot in the same location. Among 122 patients who had bilateral neovascular maculopathy initially, 100 were examined 5 years later; 8 (8%) were legally blind, compared with 3 (1%) of 339 patients examined who had unilateral CNV initially. At the 5-year examination, 355 (81%) of 439 patients examined had a visual acuity of 20/20 or better in at least 1 eye, including 74 (55%) of 134 patients who had bilateral neovascular maculopathy.
Although the incidence of CNV in fellow eyes that initially were unaffected remained low throughout 5 years of follow-up, it persisted at a nearly constant rate. The risk of legal blindness was low, even for patients who had bilateral involvement. Perhaps most important, 81% of all patients followed up for 5 years retained a visual acuity of 20/20 in at least 1 eye, and 20% retained this visual acuity in both eyes. Retrospective review of photographs suggests that the ophthalmologist should pay special attention to areas of the central macula in which new "atypical" histo spots are observed, with the goal of treating CNV that may develop in the same area at a time when the benefits of laser treatment may be greatest.
记录在一只眼睛患有眼组织胞浆菌病且存在黄斑中心凹外或近中心凹脉络膜新生血管（CNV）的个体中，未受影响的对侧眼发生CNV的发生率；确定黄斑区“组织胞浆菌病斑”的位置和类型是否可预测对侧眼未来CNV的发生部位；描述基线时对侧眼中新生血管病变随时间的变化；以及描述基线时存在和不存在CNV的对侧眼的视力变化。
设计、患者和研究地点：对516例患者的对侧眼进行了为期5年的前瞻性随访研究，这些患者参与了两项关于黄斑中心凹外和近中心凹CNV激光光凝的随机临床试验。测量了最佳矫正视力和阅读视力，并在基线和每隔6个月时对双眼黄斑进行拍照。
研究入组时无新生血管性黄斑病变的对侧眼中CNV的累积发生率、对侧眼自基线起5年的视力变化，以及法定盲（较好眼视力≤20/200）的发生率。
在最初无新生血管性黄斑病变的394只眼中，有35只（9%）通过照相记录到发生了CNV；然而，在5年随访期结束前，大多数新受影响的眼睛仍保持良好视力。与黄斑区无组织胞浆菌病斑的眼睛相比，基线时黄斑区存在任何类型的组织胞浆菌病斑会使日后发生CNV的风险增加两倍。尽管基线时黄斑中心区存在的组织胞浆菌病斑类型不能预测未来CNV的发生，但在发生CNV的35只对侧眼中的32只以及随访期间出现第二个CNV区域的9只对侧眼中的７只中，CNV发生前在相同位置出现了“非典型”组织胞浆菌病斑。最初患有双侧新生血管性黄斑病变的122例患者中，100例在5年后接受了检查；其中8例（8%）为法定盲，而最初患有单侧CNV的339例接受检查的患者中有3例（1%）为法定盲。在5年检查时，439例接受检查的患者中有355例（81%）至少一只眼的视力为20/20或更好，其中包括134例患有双侧新生血管性黄斑病变的患者中的74例（55%）。
尽管在5年随访期间，最初未受影响的对侧眼中CNV的发生率一直较低，但仍以近乎恒定的速率持续存在。即使是双侧受累的患者，法定盲的风险也较低。也许最重要的是，所有接受5年随访的患者中有81%至少一只眼的视力保持在20/20，20%的患者双眼视力保持在20/20。对照片的回顾性分析表明，眼科医生应特别关注观察到新的“非典型”组织胞浆菌病斑的黄斑中心区，以便在激光治疗可能最有益时治疗可能在同一区域发生的CNV。
