Avery R L, Fekrat S, Hawkins B S, Bressler N M
Neuroscience Research Institute, University of California at Santa Barbara, USA.
Retina. 1996;16(3):183-9. doi: 10.1097/00006982-199616030-00001.
The authors describe the natural history of subfoveal subretinal hemorrhage (for which laser treatment was not indicated) in age-related macular degeneration.
A retrospective review of data was performed at a tertiary retinal referral center for 41 eyes from 40 patients with age-related macular degeneration examined during an 18-month period. All patients had at least 3 months of follow-up, as well as subfoveal subretinal hemorrhage that made up more than 50% of a neovascular lesion-as documented by fluorescein angiography-and therefore, did not meet criteria for laser treatment. The number of lines of visual acuity lost or gained in each eye during follow-up was calculated; presenting characteristics were evaluated as predictors of visual outcome.
A progressive loss of visual acuity from baseline was observed throughout the 3-year follow-up period in most eyes. At 36 months, a mean of 3.5 lines of visual acuity had been lost in the 16 eyes examined; 44% of eyes had lost 6 or more lines of visual acuity. The percentage of patients who sustained a spontaneous improvement of 3 or more lines of visual acuity decreased from 31% at 12 months to 21% at 36 months of follow-up. Univariate linear regression analysis demonstrated significant relationships of initial size of the hemorrhage, elevation of the retina by the hemorrhage, and size of the entire lesion with visual outcome at the 12-month and 36-month examinations (P < 0.05).
Although this study confirms that some eyes with subfoveal subretinal hemorrhage associated with age-related macular degeneration have poor prognoses, the visual acuity of other eyes did not deteriorate. These findings underscore the importance of evaluating the role of therapeutic interventions such as surgery to remove subretinal hemorrhage in randomized clinical trials.
作者描述年龄相关性黄斑变性中黄斑中心凹下视网膜下出血（未行激光治疗）的自然病程。
在一家三级视网膜转诊中心对40例年龄相关性黄斑变性患者的41只眼进行了为期18个月的数据回顾性研究。所有患者均至少随访3个月，且黄斑中心凹下视网膜下出血占新生血管病变的50%以上（荧光素血管造影证实），因此不符合激光治疗标准。计算随访期间每只眼视力丧失或提高的行数；评估呈现的特征作为视力预后的预测指标。
在3年的随访期内，大多数眼的视力从基线开始逐渐下降。在36个月时，16只接受检查的眼中平均视力下降了3.5行；44%的眼视力下降了6行或更多。视力自发提高3行或更多行的患者比例从随访12个月时的31%降至36个月时的21%。单因素线性回归分析表明，在12个月和36个月检查时，出血的初始大小、出血导致的视网膜抬高以及整个病变的大小与视力预后存在显著关系（P<0.05）。
尽管本研究证实一些与年龄相关性黄斑变性相关的黄斑中心凹下视网膜下出血的眼预后较差，但其他眼的视力并未恶化。这些发现强调了在随机临床试验中评估手术等治疗干预措施以清除视网膜下出血的作用的重要性。
