Petersen J, Meyer-Riemann W, Ritzau-Tondrow U, Bahlmann D
Schwerpunkt für Netzhaut-Glaskörper-Chirurgie, Abteilung Augenheilkunde der Universtität, Göttingen, Germany.
Graefes Arch Clin Exp Ophthalmol. 1998 Apr;236(4):241-7. doi: 10.1007/s004170050071.
Surgical removal of subretinal hemorrhaging and membranes in eyes with age-related macular degeneration is feasible from a technical point of view, but no advantage over the spontaneous course of the disease has been proven. Visual acuity usually does not improve much. A realistic aim of surgical intervention may be diminution of the central scotoma size, which has not been studied.
In a prospective study visual fields were measured preoperatively and 6 weeks and 6 months postoperatively in eyes operated on for subretinal hemorrhages and membranes in exudative age-related macular degeneration. The OCTOPUS 1-2-3 program glx, which tests the visual field of 60 degrees diameter at 59 points, was used. Changes in the total size of areas with sensitivity loss of 10-20 dB (= relative scotoma) and > 20 dB (= absolute scotoma) were interpreted as surgical effect. Patients with postoperative retinal detachment or neovascular recurrence were excluded. 30 eyes of 29 patients were enrolled (mean age 75.3 years, 11 male, 18 female) and divided into 3 groups: 14 eyes with massive subretinal hemorrhage of diameters > 30 degrees; 12 eyes with hemorrhages of 10 degrees-30 degrees; 4 eyes with mere neovascular membranes < 10 degrees.
(1) The visible area of damage is diminished by surgery (P < 0.01). The reduction for lesions > 30 degrees is 80%; for lesions between 10 degrees and 30 degrees the improvement is 43%. For lesions < 10 degrees there is no significant change. (2) The absolute scotoma size diminishes in all three groups (P = 0.05). The reductions are 63%, 57% and 21%, respectively. (3) Areas of absolute scotoma do not regain full function but are converted to relative scotoma depth, at best. Therefore, in the > 30 degrees group an overall increase (P < 0.01) of the relative scotoma size is observed. (4) The mean sensitivity in the 60 degrees field enhances by 1.6 dB (average over 30 eyes, P = 0.04). (5) Mean preoperative visual acuities were 0.03, 0.12 and 0.17, respectively, with no significant change after surgery. The power of testing is sufficient (0.93) to reject an increase of acuity from 0.12 to 0.2 in group 2.
For hemorrhagic subretinal lesions of diameter > 10 degrees a relevant reduction of central scotoma size is achieved by surgery. The final benefit for the patients depends on the frequency of surgical complications and neovascular recurrence.
从技术角度来看，手术切除年龄相关性黄斑变性患者眼内的视网膜下出血和膜是可行的，但尚未证实其相对于疾病自然病程具有优势。视力通常改善不大。手术干预的一个现实目标可能是减小中心暗点的大小，但尚未对此进行研究。
在一项前瞻性研究中，对因渗出性年龄相关性黄斑变性而行视网膜下出血和膜手术的眼睛，在术前、术后6周和6个月测量视野。使用OCTOPUS 1-2-3程序glx，该程序在59个点测试直径60度的视野。将敏感度损失10-20 dB（=相对暗点）和>20 dB（=绝对暗点）区域的总面积变化解释为手术效果。排除术后发生视网膜脱离或新生血管复发的患者。纳入了29例患者的30只眼（平均年龄75.3岁，男11例，女18例），并分为3组：14只眼有直径>30度的大量视网膜下出血；12只眼有10度-30度的出血；4只眼仅有<10度的新生血管膜。
（1）手术可使可见损伤面积减小（P<0.01）。直径>30度病变的减小率为80%；10度至30度病变的改善率为43%。对于<10度的病变，无显著变化。（2）所有三组的绝对暗点大小均减小（P=0.05）。减小率分别为63%、57%和21%。（3）绝对暗点区域最多只能转化为相对暗点深度，无法恢复全部功能。因此，在>30度组中，观察到相对暗点大小总体增加（P<0.01）。（4）60度视野中的平均敏感度提高了1.6 dB（30只眼的平均值，P=0.04）。（5）术前平均视力分别为0.03、0.12和0.17，术后无显著变化。检验效能足以（0.93）排除第2组中视力从0.12提高到0.2的情况。
对于直径>10度的出血性视网膜下病变，手术可使中心暗点大小显著减小。对患者的最终益处取决于手术并发症和新生血管复发的发生率。
