Loewenstein A, Sunness J S, Bressler N M, Marsh M J, de Juan E
The Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Am J Ophthalmol. 1998 May;125(5):657-65. doi: 10.1016/s0002-9394(98)00014-2.
Submacular surgery is under investigation for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration, ocular histoplasmosis syndrome, and other causes. The aims of this study were to determine whether the macular area from which choroidal neovascularization was removed surgically remained functional and whether there was any qualitative difference between eyes with different disease conditions or between eyes of younger and older patients.
Our study included 19 patients (19 eyes) with choroidal neovascularization, seven cases caused by age-related macular degeneration and 12 caused by ocular histoplasmosis syndrome, pathologic myopia, or idiopathic causes. All tests were performed at least 6 months after surgical removal of choroidal neovascularization. All patients underwent fundus perimetry with the scanning laser ophthalmoscope for evaluation of dense and relative scotomas and fixation site.
After submacular surgery in 19 patients, 10 patients (one with age-related macular degeneration and nine with pathologic myopia, ocular histoplasmosis syndrome, or an idiopathic cause of choroidal neovascularization) fixated within an area that ophthalmoscopically and angiographically was an area of retinal pigment epithelial disturbance occupied by choroidal neovascularization preoperatively. Of 12 patients without age-related macular degeneration, seven of eight patients younger than 50 years of age compared with two of four patients 50 years or older fixated within the area of retinal pigment epithelial disturbance.
Our data suggest that in patients without age-related macular degeneration who undergo submacular surgery, the surgically disturbed area previously occupied by choroidal neovascularization can remain functional postoperatively. Furthermore, occasionally a patient with age-related macular degeneration undergoing submacular surgery still can fixate in the area from which the choroidal neovascularization was removed.
黄斑下手术正在研究用于治疗年龄相关性黄斑变性、眼组织胞浆菌病综合征及其他原因所致的黄斑下脉络膜新生血管。本研究的目的是确定手术切除脉络膜新生血管后的黄斑区域是否仍保持功能，以及不同疾病状态的眼睛之间或年轻与老年患者的眼睛之间是否存在任何质性差异。
我们的研究纳入了19例脉络膜新生血管患者（19只眼），其中7例由年龄相关性黄斑变性引起，12例由眼组织胞浆菌病综合征、病理性近视或特发性原因引起。所有检查均在手术切除脉络膜新生血管至少6个月后进行。所有患者均使用扫描激光眼底镜进行眼底视野检查，以评估浓密和相对暗点以及注视点。
19例患者接受黄斑下手术后，10例患者（1例年龄相关性黄斑变性患者以及9例病理性近视、眼组织胞浆菌病综合征或特发性脉络膜新生血管病因患者）的注视点位于术前眼底镜和血管造影显示为被脉络膜新生血管占据的视网膜色素上皮紊乱区域内。在12例非年龄相关性黄斑变性患者中，8例年龄小于50岁的患者中有7例与4例50岁及以上患者中的2例相比，其注视点位于视网膜色素上皮紊乱区域内。
我们的数据表明，在接受黄斑下手术的非年龄相关性黄斑变性患者中，先前被脉络膜新生血管占据的手术干扰区域术后仍可保持功能。此外，偶尔接受黄斑下手术的年龄相关性黄斑变性患者仍可在脉络膜新生血管被切除的区域内注视。
