Gandorfer A, Scheider A, Gündisch O, Kampik A
Augenklinik, Ludwig-Maximilians-Universität München.
Ophthalmologe. 1998 Jun;95(6):408-12. doi: 10.1007/s003470050289.
The surgical removal of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) causes a retinal pigment epithelial defect (RPED) corresponding to the area of diffuse RPE damage. We describe angiographic features of recurrent CNV in AMD after surgical membranectomy in order to elucidate the nature of persistence and recurrence.
After digitalization of the pre- and postoperative fluorescein angiographic images of eight patients with recurrent CNV in AMD we determined the morphology (well or ill-defined) and the area of the CNV and of the subretinal hemorrhage preoperatively and of the recurrent CNV and of the RPE defect postoperatively.
The nature of recurrences showed differences between preoperatively well- and ill-defined CNV. Four preoperatively well-defined CNV with surrounding subretinal hemorrhage showed recurrences in the entire area of the preoperative CNV excluding the retinotomy 8-9 weeks postoperatively. Four preoperatively ill-defined CNV with subretinal hemorrhage developed marginal recurrences at the rim of the RPED. There was no background fluorescence in the area of the RPED.
The nature of recurrences extending over the entire area of the preoperatively well-defined CNV without loss of background fluorescence only a few weeks after surgical removal of well-defined CNV suggests partial persistence. The removal of the subretinal well-defined CNV could leave sub-RPE parts in locations that preoperatively cannot be visualized angiographically. The marginal recurrence of preoperatively ill-defined CNV weeks to months postoperatively shows angiographic similarities to recurrent CNV after laser coagulation.
年龄相关性黄斑变性（AMD）中脉络膜新生血管（CNV）的手术切除会导致与弥漫性视网膜色素上皮（RPE）损伤区域相对应的视网膜色素上皮缺损（RPED）。我们描述了AMD患者手术切除膜后复发性CNV的血管造影特征，以阐明其持续存在和复发的本质。
对8例AMD复发性CNV患者术前和术后的荧光素血管造影图像进行数字化处理后，我们确定了术前CNV及视网膜下出血的形态（边界清晰或不清晰）和面积，以及术后复发性CNV和RPE缺损的形态和面积。
复发的本质在术前边界清晰和不清晰的CNV之间存在差异。4例术前边界清晰且伴有周围视网膜下出血的CNV在术后8 - 9周于术前CNV的整个区域（不包括视网膜切开处）出现复发。4例术前边界不清晰且伴有视网膜下出血的CNV在RPED边缘出现边缘性复发。RPED区域无背景荧光。
在手术切除边界清晰的CNV仅几周后，复发延伸至术前边界清晰的CNV的整个区域且无背景荧光缺失，这一现象提示部分持续存在。视网膜下边界清晰的CNV切除后，可能会在术前血管造影无法显示的位置留下RPE下部分。术前边界不清晰的CNV在术后数周数月出现的边缘性复发，在血管造影上与激光凝固术后复发性CNV相似。
