Wolf S, Lappas A, Weinberger A W, Kirchhof B
Augenklinik der Medizinischen Fakultät der RWTH Aachen, Germany.
Graefes Arch Clin Exp Ophthalmol. 1999 Jan;237(1):51-7. doi: 10.1007/s004170050194.
At present no satisfying treatment for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) is available. Visual results after successful surgical removal of subfoveal CNV are disappointing. This has been explained by a primary dysfunction of the retinal pigment epithelium (RPE) in the macular region and the surgical trauma to the RPE in patients with AMD. Therefore, Machemer and Steinhorst developed a technique for macular translocation after surgical removal of subfoveal CNV. We report our first experiences with this technique in patients with subfoveal CNV secondary to AMD.
Seven patients aged between 71 and 83 years with subfoveal CNV were included in the study. Visual acuity of the fellow eyes was below 20/400. All patients underwent pars plana vitrectomy. Retinal detachment was produced by subretinal infusion of balanced salt solution and a 360 degrees retinotomy at the base of the vitreous was performed. After removal of the CNV, retinal rotation and reattachment, the retina bordering the retinotomy was coagulated with endolaser photocoagulation. Silicone oil was used as temporary tamponade.
In all patients the subfoveal CNV was removed and the macula was translocated by a 15 degrees-45 degrees rotation onto functional RPE. The mean duration of follow-up was 11 +/- 3 months. Initial visual acuity ranged from 20/80 to hand movements. Final visual acuity was 20/100 to 20/400. Initially all patients complained of tilted vision. During follow-up the rotation of the image regressed and was well tolerated by all patients. Complications included the development of retinal detachment in three patients after silicone oil removal, development of a macula pucker, and a significant increase of lens opacity in the phakic eyes.
In our series rapid improvement of visual function was observed in one patient only, even if the macula appeared ophthalmoscopically and angiographically normal. Vitreoretinal complications occurred frequently during follow-up.
目前尚无令人满意的治疗年龄相关性黄斑变性（AMD）继发的黄斑下脉络膜新生血管（CNV）的方法。成功手术切除黄斑下CNV后的视力结果令人失望。这已被解释为黄斑区视网膜色素上皮（RPE）的原发性功能障碍以及AMD患者RPE的手术创伤。因此，Machemer和Steinhorst开发了一种在手术切除黄斑下CNV后进行黄斑移位的技术。我们报告了我们在AMD继发黄斑下CNV患者中应用该技术的首次经验。
7例年龄在71至83岁之间的黄斑下CNV患者纳入本研究。对侧眼视力低于20/400。所有患者均接受了玻璃体切除术。通过视网膜下注入平衡盐溶液造成视网膜脱离，并在玻璃体基部进行360度视网膜切开术。切除CNV、视网膜旋转并重新附着后，用激光光凝凝固视网膜切开术边缘的视网膜。硅油用作临时填塞物。
所有患者的黄斑下CNV均被切除，黄斑通过15度至45度的旋转移位至功能性RPE上。平均随访时间为11±3个月。初始视力范围为20/80至手动。最终视力为20/100至20/400。最初所有患者均抱怨有视物倾斜。在随访期间，图像旋转消退，所有患者均能良好耐受。并发症包括3例患者在硅油取出后发生视网膜脱离、黄斑皱褶形成以及有晶状体眼晶状体混浊显著增加。
在我们的系列研究中，仅1例患者视力功能迅速改善，即使黄斑在检眼镜和血管造影检查中看起来正常。随访期间玻璃体视网膜并发症频繁发生。
