Castellarin A A, Nasir M, Sugino I K, Zarbin M A
University of Medicine and Dentistry, New Jersey Medical School, Department of Ophthalmology, Newark 07103-2499, USA.
Retina. 1998;18(2):143-9. doi: 10.1097/00006982-199818020-00008.
The authors sought to evaluate the progression of presumed choriocapillaris atrophy after surgical excision of a subfoveal choroidal neovascular membrane (CNV) in an 80-year-old man with age-related macular degeneration.
The CNV was excised using a conventional three-port vitrectomy with subretinal dissection. The excised tissue was studied with light and electron microscopy. Preoperative and serial postoperative fluorescein angiograms (FA) and fundus photographs were obtained to study the dissection bed.
Seven days after surgery, the FA showed hyperfluorescence in the area previously occupied by the CNV. Six weeks after surgery, this area showed retinal pigment epithelium (RPE) depigmentation, atrophy, or both on clinical examination, and the FA showed presumed choriocapillaris nonperfusion. Seven months after surgery, the area of the RPE depigmentation or atrophy and the corresponding area of presumed choriocapillaris nonperfusion had enlarged. The area of depigmentation or atrophy continued to enlarge for 1 year after surgery. Histologically, the excised CNV specimen disclosed RPE cells but no choriocapillaris.
Presumed choriocapillaris nonperfusion after CNV excision may be due to RPE removal at surgery and may progress postoperatively.
作者试图评估一名80岁患有年龄相关性黄斑变性的男性患者，在进行黄斑下脉络膜新生血管膜（CNV）手术切除后，推测的脉络膜毛细血管萎缩的进展情况。
使用传统的三端口玻璃体切除术并进行视网膜下剥离来切除CNV。对切除的组织进行光镜和电镜研究。获取术前和术后系列荧光素血管造影（FA）及眼底照片以研究剥离床。
术后7天，FA显示先前被CNV占据的区域出现高荧光。术后6周，该区域在临床检查中显示视网膜色素上皮（RPE）色素脱失、萎缩或两者皆有，且FA显示推测的脉络膜毛细血管无灌注。术后7个月，RPE色素脱失或萎缩区域以及相应的推测脉络膜毛细血管无灌注区域扩大。色素脱失或萎缩区域在术后1年内持续扩大。组织学上，切除的CNV标本显示有RPE细胞，但无脉络膜毛细血管。
CNV切除后推测的脉络膜毛细血管无灌注可能是由于手术中RPE被移除，且可能在术后进展。
