单侧湿性老年黄斑变性对侧眼的长期随诊

对３０例单侧湿性老年黄斑变性患者的对侧眼进行了５年以上的长期随诊。眼底检查及眼底荧光血管造影，半数患者显示正常，其余患者有黄斑玻璃膜疣和／或色素上皮改改变；４例分别于５、６、１０、与１１年后发生视网膜下新生血管。初诊时黄斑玻璃膜疣与色素上皮改变４各１例，眼底大致正常者２例，提示单侧湿性老年黄斑变性的另一只眼可能在很长时期以后发病。     

黄斑部脉络膜新生血管膜取出术

目的　探讨玻璃体视网膜手术治疗脉络膜新生血管膜的临床效果。方法　对 3 0例 3 1眼行玻璃体切割、脉络膜新生血管膜取出及气 -液交换术。其中老年性黄斑变性 15例、近视性 10例、特发性 2例、血管样条纹病变 2例和真菌性眼内炎 1例 2眼。结果　随访 3～ 18个月 ,视力增加 3行以上者 5眼(16% ) ,视力稳定在± 2行以内者 2 5眼 (81% ) ,视力下降 3行以上者 1眼(3 % )。术后视力提高的 5眼中 ,中心凹处均有色素上皮残留。结论　脉络膜新生血管膜取出术可稳定或改善大部分脉络膜新生血管膜患者的视力 ,视力预后与色素上皮的损伤部位有关。     

玻璃体视网膜手术治疗老年黄斑变性的疗效评价

为探讨玻璃体切除术及视网膜下手术治疗湿性型老年黄斑变性（ＡＭＤ）的疗效和估价，对２６眼因ＡＭＤ玻璃体出血混浊施玻璃体切除术；６眼黄斑中心凹处新生血管膜形成、出血行视网膜下手术。结果为玻璃体切除术组，术后全部看清眼底，发现黄斑区视网膜下出血１３眼，有新生血管膜及疤痕１０眼，两者同时存在３眼，术后视力提高２２眼，不变及减退各２眼，视力在０．０５以上仅８眼；视网膜下手术组，成功取出视网膜下新生血管膜３眼，出血冲洗干净３眼，术后视力进步４眼，不变及减退各１眼。结论：玻璃体切除术虽然能清除玻璃体出血及混浊，但不能阻止ＡＭＤ病变的发展和治疗视网膜下病变及恢复视功能；视网膜下手术能清除部分视网膜下病灶，亦不能恢复色素上皮和感光细胞功能。因此，视网膜移植可能是治疗湿性型ＡＭＤ的新途径     

视网膜黄斑前膜的手术治疗

应用玻璃体切割术切除了１５只眼的视网膜黄斑前膜，其中特发性７只眼，继发性８只眼，术后随诊６～２７个月，１４只眼视力增进，占９３％，其中半数以上增进３行以上，视力的增进与手术时机的选择有关，术后除１只眼出现旁中心暗点外，无其它并发症。     

湿性老年黄斑变性长期随诊与电子计算机图像测量

对随诊5年以上的37例（42只眼）湿性老年黄斑变性，研究了视力、眼底及眼底荧光血管造影的表现。用电子计算机图像分析仪对视网膜下新生血管及色素上皮的改变进行了测量。结合文献作了简要的讨论。 （中华眼底病杂志，1994，10：1-3）     

年龄相关性黄斑变性合并脉络膜新生血管患者的自然病程和视力预后

目的 了解年龄相关性黄斑变性(AMD)合并脉络膜新生血管患者的自然病程和视力预后。方法 对29例(35只眼)未接受激光、放射或手术等治疗的湿性AMD患者,进行全面眼部检查和有计划的定期随诊,包括视力、眼前节检查,直接和间接检眼镜检测,在裂隙灯下用 90D前置镜检查眼底,眼底照相和荧光素眼底血管造影等。结果 随诊5～16年(平均8年),最佳矫正视力在0．1以下者,初诊时为10只眼(眼前手动4只眼),占28．5％;末诊时为23只眼(眼前手动14只眼),占65．7％。初诊时黄斑出血25只眼,玻璃体积血4只眼,随诊中有23只眼反复出血,最多达4次。末诊时仍有7只眼黄斑出血。初诊时7只眼存在黄斑区机化膜,末诊时35只眼均有面积大小不等的机化膜形成。结论 经过长期观察,AMD合并脉络膜新生血管患者的自然病程漫长,黄斑区反复出血,视力预后恶劣。     

老年黄斑变性的临床观察和荧光血管造影

老年黄斑变性已日益为临床多见,并已成为老年人致盲的主要原因之一。本文,我们对已经眼底检查和荧光血管造影确诊的53例(101只眼)老年黄斑变性进行分析,其中男性38例,女性15例,年龄50-77岁,平均年龄为61.3岁,双眼患病的有48例,单眼的有5例,52只眼属右眼,49只眼属左眼,本病分成二型:干性型和湿性型。本文中,70只眼是干性型,其眼底表现为黄斑部色素紊乱,散在的玻璃疣,中心凹光反射溅弱或消失,荧光血管造影可见视网膜色素上皮窗样缺损和晚期的残留荧光,其中有65只眼(92.9%)的视力在0.6以上。另外31只眼为湿性型,其眼底和荧光血管造影表现为多种多样,最多见的是眼底有黄色融合性玻璃疣,灰白色的视网膜轻度隆起,视网膜内出血,荧光血管造影为黄斑部有视网膜下新生血管膜,或伴有色素上皮及神经上皮脱离的高荧光区,及出血而致的遮蔽荧光,有17只眼(54.85)的视力在0.3以下,其中15只眼均有视网膜下新生血管。结果表明在本病早期不一定出现视力障碍,导致视力严重下降的主要原因是脉络膜新生血管长人视网膜下。因而特别强调对老年黄斑变性的早期诊断和及早发现视网膜下新生血管的重要性。     

高度近视性黄斑出血的临床表现与荧光素眼底血管造影

目的 观察和探讨高度近视性黄斑出血的临床特点。方法 对确诊为高度近视性黄斑出血的60例患者(65只眼)做视力、眼底、荧光素眼底血管造影(fundus fluorescein angiography,FFA)等检查,平均追踪时间15个月。结果 做FFA检查的65只眼中有62只眼（95%）伴有漆裂样纹。其中54只眼为单纯型黄斑出血，出血多在1—3个月吸收，预后较好；另外11只眼为脉络膜新生血管膜型，视力预后较差。结论 高度近视性黄斑出血可分为单纯型和脉络膜新生血管膜型。前者出血吸收快，后者视力预后较差。     

高度近视眼后极部眼底病理改变

目的：通过眼底荧光血管造影(FFA)和吲哚青绿血管造影(ICGA)观察21例高度近视眼底后极部漆裂纹状病变、黄斑出血、Fuchs斑，以探讨高度近视眼底后极部的病理改变。方法：回顾分析21例(42只眼)，屈光度为-6D以上的高度近视眼底。均行彩色眼底照相、FFA、ICGA检查。将病例分为黄斑无出血组、黄斑出血组。结果：无出血组29只眼在FFA检查中4只眼有漆裂纹，占13．79％，在ICGA检查中有漆裂纹者9只眼，占31．03％，其中ICGA所见漆裂纹比FFA中数目更多且更长。出血组13只眼中FFA显示有漆裂纹7只眼占53．85％，ICGA显示有漆裂纹9只眼，占69．23％，该组中有1只眼ICGA未发现有脉络膜新生血管膜与漆裂纹。另有3例黄斑出血的对侧眼有眼底后极部萎缩斑或Fucks斑。结论：高度近视眼黄斑出血是病程发展的自然过程，漆裂纹常预示有出血产生的可能。黄斑出血由于脉络膜新生血管向视网膜生长；也可能只有视网膜黄斑部毛细血管出血而非脉络膜新生血管形成。晚期新生血管膜机化，色素上皮细胞增殖、聚集形成Fuchs斑。     

自发性黄斑区出血性视网膜脱离的临床特征

目的 分析自发性黄斑区出血性视网膜脱离的临床特征，提高对本病的诊治水平。 方法 对1998年9月至2003年3月我院眼底病科临床确诊的黄斑区视网膜下出血，范围大于4 DD×5 DD的患者，共23例（23只眼）的连续临床资料进行回顾性分析。经荧光素眼底血管造影 （FFA）、吲哚青绿血管造影（ICGA）及B型超声波检查，进行病因分析，随诊观察视力及眼底变化。 结果 23例患者均表现为视力突然减退至0.2以下或光感。23只眼中7只眼确诊为老年性黄斑变性的脉络膜新生血管（CNV）；5只眼为息肉状脉络膜血管病变（PCV）；2只眼为视网膜大动脉瘤；9只眼病因不明。23只眼中3只眼积血吸收，黄斑中心凹无瘢痕形成，视力恢复0.4～0.8；12只眼黄斑出血区形成机化瘢和色素增生，视力数指/眼前～0.2；另外8只眼并发玻璃体积血，其中3只眼行玻璃体切割术，黄斑区大片机化及瘢痕，视力数指/66 cm～0.2；5例视力丧失。 结论 自发性出血性视网膜脱离多发生于老年人，视力突然下降或丧失。出血形态表现为局灶性或弥漫性，因黄斑区组织严重损害，大部分病例预后差。 (中华眼底病杂志, 2006, 22: 228-231)     

Surgical treatment of submacular hemorrhage associated with idiopathic polypoidal choroidal vasculopathy.

PURPOSE: To report the visual outcome of surgical treatment of submacular hemorrhage associated with idiopathic polypoidal choroidal vasculopathy. METHODS: Eight eyes of eight consecutive patients with thick submacular hemorrhages associated with idiopathic polypoidal choroidal vasculopathy were treated with pars plana vitrectomy and tissue plasminogen activator-assisted removal of subretinal blood (December 1995 to September 1997) or intravitreal 100% sulfur hexafluoride gas injection without tissue plasminogen activator (October 1997 to March 1998). RESULTS: Postoperatively, laser treatment was performed for active polypoidal lesions outside the foveal avascular zone in four eyes. A retinal pigment epithelial tear was seen outside the foveal avascular zone in three eyes, and one eye developed a retinal detachment. The best-corrected visual acuity improved (by 3 or more lines) or stabilized in seven of the eight eyes. Four eyes had a final best-corrected visual acuity of 20/40 or better, and three eyes had a final best-corrected visual acuity of 20/50 to 20/200. In one eye, the visual acuity decreased from 20/100 to 20/500 because of the development of a subfoveal neovascular membrane. The membrane was excised, and histologic examination showed fibrovascular tissue between the retina and retinal pigment epithelium (type 2 pattern). CONCLUSIONS: Surgical intervention may be of benefit in eyes with submacular hemorrhage associated with idiopathic polypoidal choroidal vasculopathy.     

The use of vitreoretinal surgical techniques in subfoveal choroidal neovascularization

Subfoveal choroidal neovascularization generally carries a poor visual prognosis. This review traces the evolving vitreoretinal surgical techniques for the treatment of this entity. Extensive retinotomies to expose large submacular scars caused frequent complications and poor visual results. More recently, small retinotomy techniques with manipulation of subfoveal membranes behind neurosensory retina have been described. Removal of subfoveal neovascularization with this latter approach is summarized. Visual results are variable. If foveal retinal pigment epithelium can be preserved, excellent central visual function can be regained. In the majority of subfoveal membranes, surgical removal creates retinal pigment epithelium defects, and acuity is limited. These approaches merit further evaluation.     

Comparison between indocyanine green angiography and outcome of surgical removal of choroidal neovascular membrane in age-related macular degeneration

Purpose: To review the outcome of surgical removal of choroidal neovascular membranes in age-related macular degeneration as classified by indocyanine green angiographic findings.Subjects and Method: Surgery was performed in 42 eyes. They were divided into four types by indocyanine green angiographic findings prior to surgery. Type I comprised 29 eyes showing hyperfluorescence throughout the angiographic phases. Type II comprised 3 eyes showing hyperfluorescence during the early phase only. Type III comprised 5 eyes showing hyperfluorescence in the late phase only. Type IV comprised 5 eyes without hyperfluorescence throughout the angiographic phases. The results were evaluated according to the visual acuity expressed as log MAR before and after surgery.Results: Visual acuity improved significantly in Types I, II, and III after surgery. Visual acuity did not improve in Type IV.Conclusion: The findings of indocyanine green angiography are thought to reflect the histological characteristics of the choroidal neovascular membrane. Neovascular membranes of Type IV may contain a smaller number of vessels and abundant fibrous tissue. Eyes of Type IV will have atrophies in the neurosensory retina, retinal pigment epithelium, and choriocapillaris. Surgical removal of the choroidal neovascular membrane in Type IV is not effective in improving visual acuity.     

Comparison between indocyanine green angiography and outcome of surgical removal of choroidal neovascular membrane in age-related macular degeneration]

PURPOSE: To review the outcome of surgical removal of choroidal neovascular membranes in age-related macular degeneration as classified by indocyanine green angiographic findings. SUBJECTS AND METHOD: Surgery was performed in 42 eyes. They were divided into four types by indocyanine green angiographic findings prior to surgery. Type I comprised 29 eyes showing hyperfluorescence throughout the angiographic phases. Type II comprised 3 eyes showing hyperfluorescence during the early phase only. Type III comprised 5 eyes showing hyperfluorescence in the late phase only. Type IV comprised 5 eyes without hyperfluorescence throughout the angiographic phases. The results were evaluated according to the visual acuity expressed as log MAR before and after surgery. RESULTS: Visual acuity improved significantly in Types I, II, and III after surgery. Visual acuity did not improve in Type IV. CONCLUSION: The findings of indocyanine green angiography are thought to reflect the histological characteristics of the choroidal neovascular membrane. Neovascular membranes of Type IV may contain a smaller number of vessels and abundant fibrous tissue. Eye of Type IV will have atrophies in the neurosensory retina, retinal pigment epithelium, and choriocapillaris. Surgical removal of the choroidal neovascular membrane in Type IV is not effective in improving visual acuity.     

Surgical management of subfoveal neovascularization in children.

OBJECTIVE: To report the authors' clinical experience with submacular surgery for subfoveal membranes in children and to evaluate the histopathologic findings of membranes in children with various etiologies of choroidal neovascularization. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twelve eyes of 12 consecutive children with subfoveal choroidal neovascularization treated by vitrectomy and excision of the choroidal neovascular complex. INTERVENTION: Vitrectomy, excision of the choroidal neovascular complex, and air-fluid exchange. MAIN OUTCOME MEASURES: Visual acuity and recurrence of choroidal neovascular membrane. RESULTS: Preoperative visual acuities ranged from 20/60 to 20/800 (median, 20/300). Postoperative visual acuities ranged from 20/25 to 20/400 (median, 20/80) after an average follow-up of 20 months (range, 7-62 months). Ten of 12 eyes improved from immediate preoperative visual acuity, and four eyes developed recurrence of neovascular membranes over a mean follow-up of 18 months. Histopathologic examination of six excised membranes showed that the most common components of the membranes were retinal pigment epithelium, fibrocytes, vascular endothelium, and collagen. CONCLUSION: Selected eyes of children with subfoveal neovascular membranes and no evidence of membrane regression may benefit from submacular surgery. The histopathologic findings were similar to adult choroidal neovascularization not associated with age-related macular degeneration.     

Submacular surgery to remove choroidal neovascularization associated with central serous chorioretinopathy

PURPOSE: To report the results of submacular surgery for removal of choroidal neovascularization associated with central serous chorioretinopathy. METHODS: Ten eyes of nine consecutive patients with central serous chorioretinopathy and subfoveal or juxtafoveal choroidal neovascularization underwent pars plana vitrectomy with removal of the choroidal neovascular membrane between January 1994 and January 1999.RESULTS: All 10 eyes (nine patients) were followed postoperatively for at least 6 months. The mean postoperative follow-up was 23 months (range, 6 to 56.5 months). The patients were followed for an average of 6.2 months from the time of symptoms to the removal of the choroidal neovascularization. Preoperative mean best-corrected visual acuity was 20/100 (range, 20/25 to 20/400), and postoperative best-corrected mean visual acuity was 20/60 + 2 (range, 20/20 to 20/400). Seven eyes had improved postoperative visual acuity, with an average of 3.4 lines gained. Of the three eyes that had worse acuity, an average of 1.3 lines of visual acuity was lost; final mean postoperative visual acuity was 20/80 + 1 (range, 20/25 to 20/400). Of the six eyes with symptoms of less than 3 months' duration, four had a final visual acuity of 20/50 or better. All three eyes with 20/300 or worse final visual acuity had loss of foveal retinal pigment epithelium after surgery; the remaining eyes had preserved retinal pigment epithelium with a visual acuity of 20/70 or better. Two eyes had intraoperative peripheral retinal tears, and two eyes had recurrence of the choroidal neovascular complex. CONCLUSIONS: The anatomic and visual results in eyes with choroidal neovascularization associated with central serous chorioretinopathy are modestly encouraging and suggest that submacular surgery for choroidal neovascularization in patients with central serous chorioretinopathy is a treatment option that may salvage good macular function in some eyes.     

Acute posterior multifocal placoid pigment epitheliopathy associated with diffuse retinal vasculitis and late haemorrhagic macular detachment.

A 20-year-old healthy man suffered rapid loss of bilateral central vision with placoid lesions at the level of the retinal pigment epithelium and choriocapillaris scattered in the posterior pole of the fundus. In addition, acute vasculitis of the retinal veins was remarkable and widespread throughout the posterior pole and midperiphery. These inflammatory signs subsided in several weeks and were succeeded by recovery of the normal visual acuity with residual pigment derangements in the deep retina. Sixteen months after the onset of the disease choroidal neovascular membranes developed in the macular region of the left eye, followed by haemorrhagic macular detachment and marked visual loss. Significant increases in the serum cold agglutinin titre occurred as isolated laboratory findings concurrently with the acute stage of the disease and the late macular complication, though no clinical or other laboratory sign suggested viral infection.     

Slow leakage from the retinal pigment epithelium (ooze) in age-related macular degeneration

The authors describe a condition called retinal pigment epithelial (RPE) ooze in patients with age-related macular degeneration. Patients with ooze have a neurosensory retinal detachment, a slowly progressive indiscrete leakage of fluorescein dye from the level of the retinal pigment epithelium, and no other signs of choroidal neovascularization. Sixteen patients with RPE ooze were followed for a mean of 4.5 years without treatment. Nine patients had a single round or oval area of leakage. In seven of these patients, choroidal neovascular membranes developed, with moderate to poor visual outcomes. The other seven patients had multiple smaller areas of leakage from the level of the RPE. None of these patients had a choroidal neovascular membrane, and all had resolution of the subretinal fluid with good final visual acuities. Patients with discrete round or oval RPE oozes appear to be at a high risk for the development of more definite choroidal neovascular membranes and vision loss.     

Transplantation of autologous retinal pigment epithelium in eyes with foveal neovascularization resulting from age-related macular degeneration: a pilot study.

PURPOSE: To describe the indications, surgical technique, and clinical results of 14 eyes in 13 patients with age-related macular degeneration and foveal choroidal neovascularization, in which subretinal surgery was combined with simultaneous transplantation of autologous retinal pigment epithelial cells. METHODS: Between March 1999 and February 2000, in a prospective study, 14 eyes (13 patients) with age-related macular degeneration underwent subretinal surgery because of foveal choroidal neovascularization with simultaneous transplantation of retinal pigment epithelium harvested from the nasal subretinal area of the same eye. Preoperatively, 1 month postoperatively, 3 months postoperatively and at 3-month intervals thereafter, examinations were performed including best-corrected visual acuity, visual field, biomicroscopy of anterior and posterior segment, tonometry, fluorescein and indocyanine angiographies, autofluorescence, scotometry, and fixation tests. RESULTS: Postoperatively, after median observation of 17 months (range, 12 to 24 months) best-corrected visual acuity was improved 2 or more lines in eight eyes (57.1%), remained the same (+/- 1 line) in five eyes (35%), and decreased by more than 2 lines in one eye (7.1%). Pairwise t test showed significant improvement after 1 month (P = .0031, P = .0062) as well as 1 year (P = .0066, P = .0105). Satisfactory reading vision between Jaeger 1 and 4 was achieved in three eyes (21.2%). No significant intraoperative or postoperative complications occurred in any eye. No recurrence of choroidal neovascularization was observed during the observation period. CONCLUSIONS: In eyes with age-related macular degeneration and foveal choroidal neovascularization, autotransplantation of retinal pigment epithelium was performed in addition to conventional removal of the choroidal neovascularization without significant intraoperative or postoperative complications. Visual acuity improvement of 2 or more lines in 57% of the eyes was achieved. No recurrent choroidal neovascularization formation was observed during the observation period. The results of this pilot study suggest that autologous transplantation of retinal pigment epithelium combined with submacular surgery might be a reasonable treatment option for patients with foveal choroidal neovascularization secondary to age-related macular degeneration.     

中心性渗出性脉络膜视网膜病变的相干光断层扫描结果分析

目的 探讨中心性渗出性脉络膜视网膜病变(CEC)黄斑部视网膜下脉络膜新生血管(CNV)患者的相干光断层扫描(OCT)图像特征。方法 对20例(21只眼)CEC连续治疗患者进行OCT检查,并与荧光素眼底血管造影(FFA)和吲哚青绿眼底血管造影(ICGA)结果进行对比;同时对光动力治疗后患者的OCT图像形态变化进行分析,以评价OCT图像特征对CEC患者的临床治疗价值。结果 21只眼中,有16只眼CNV呈类圆形团块状,自视网膜色素上皮层向上突出,位于视网膜神经上皮下间隙,呈强或中等强度反射;5只眼的CNV呈纺锤形或不规则形,亦呈强或中等强度反射,位于色素上皮层平面。21只眼中有9只眼伴有浆液性神经上皮脱离,6只跟伴有出血性色素上皮脱离,14只眼伴有不同程度的视网膜水肿和增厚。17只眼经光动力治疗后,随访3～12个月,平均6个月,FFA检查显示荧光素渗漏消退或减弱的患者,OCT检查均显示CNV团块不同程度退缩,其形态亦发生变化。OCT图像特征与FFA和ICG检查结果有互补性。结论 OCT检查可以确定CEC患者病变中CNV团块的形态、大小及位置。CEC病变中CNV的OCT图像以突出于色素上皮层的类圆形团块为特征,其形态和大小可因治疗和观察时间而变化。