Visual acuity and structural findings in old age-related macular degeneration

Background Although exudative age-related macular degeneration (AMD) leads to a substantial visual loss in most patients there is still significant variation in the end- stage visual acuity level. We analysed lesions in eyes with long-standing AMD in order to find contributing factors for this variation.Methods Sixty-one out of 121 patients examined for exudative AMD and still alive 4.8–9.2 (mean 6.8) years after the acute phase were re-examined. The lesion size, area of subretinal fibrosis, geographic atrophy, presence of a persistent exudative process, and shortest distance to normal looking retina were measured from digital fundus photographs taken at the re-examination and correlated with visual acuity.Results Lesion size, the presence of a continuing exudative process, or subretinal fibrosis were independent predictors for poor vision. Better vision in the other eye was connected with poor vision in the affected study eye.Conclusions In addition to lesion size, the presence of a continuing exudative process and subretinal fibrosis also have deleterious effects on long-term visual acuity after exudative AMD.Aila Riusala and Ilkka Immonen have full control of all primary data. They agree to allow Graefes Archive for Clinical and Experimental Ophthalmology to review the data if requested.The research was supported by grants to Aila Riusala from the Mary ja Georg C. Ehrnrooth, Paulo, Silmä- ja kudospankki- and Sokeain Ystävät Foundations, Helsinki, Finland and research funds of the Helsinki University Hospital, Helsinki, Finland.No proprietary or commercial interests were involved.     

老年黄斑变性中感光细胞的凋亡

目的 探讨细胞凋亡在老年黄斑病变性感光细胞死亡中的作用。方法 对１６只老年黄斑变性眼的黄斑部视网膜组织进行ＴＵＮＥＬ技术（ＴＤＴ－ｍｅｄｉａｔｅｄｂｉｏｔｉｎ－ｄＵＴＰｎｉｃｋ－ｅｎｄｌａｂｅｌｌｉｎｇ）和病理组织学研究。结果 本组中６只眼的黄斑病有细胞凋亡的特征性改变,分散排列的感光细胞核ＤＮＡ片断化。结论 细胞凋亡是老年黄斑变性中感光细胞死亡的一个重要机理。     

炎症与年龄相关性黄斑变性

年龄相关性黄斑变性(AMD)是中老年人常见的致盲性眼病之一,特征性改变是玻璃膜疣(drusen)形成和脉络膜新生血管(CNV),确切发病机制不清,衰老、营养失衡和遗传等多种因素参与其发病。近年来研究发现机体慢性炎症和补体活化等免疫机制在其发病中占有重要作用,从AMD患者病灶组织及玻璃膜疣中发现有巨噬细胞和补体成分沉积,玻璃膜疣的形成与补体成分在Bruch膜上的活化以及脉络膜巨噬细胞吞噬功能下调有关,CNV的形成与补体成分活化、炎症刺激以及脉络膜巨噬细胞聚集活化有关,补体因子H的基因多态性也与AMD的发生有关。脂褐素碎片可刺激视网膜色素上皮细胞活化并分泌炎性细胞因子或血管生长因子,促进CNV的形成;长期光氧化损伤可导致视网膜蛋白变性形成新抗原,并刺激机体产生自身抗体,导致补体活化和巨噬细胞聚集,参与玻璃膜疣的形成和CNV发生。综上证据表明慢性炎症和补体活化等免疫学改变在AMD发生中起着重要作用,这就提示抗炎治疗可作为AMD患者的有效辅助治疗措施。     

氧化损伤和老年性黄斑变性

本文复习和总结了氧化损伤与老年性黄斑变性的发病、疾病进展的关系,并对几种抗氧化剂在临床的应用及对老年性黄斑变性的预防作用进行了综述.     

干性年龄相关性黄斑变性的局部视网膜电流图研究

目的研究干性年龄相关性黄斑变性(Age—related macular degeneration AMD)患者的局部视网膜电流图(LERG)反应，探讨黄斑区视网膜功能损害的程度。方法对33例(60眼)干性AMD患者和18例(30眼)正常入应用稳态的闪烁光LERG和全视野暗适应闪光ERG检测。测量振幅和峰时。结果干性AMD患者LERG平均振幅显著下降，平均峰时明显延长，与正常对照组比较有显著差异。干性AMD患者全视野暗适应闪光ERG的a波、b波振幅和峰时与正常对照组无显著差异。结论干性AMD患者行LERG检测可直接了解其黄斑区视网膜外层功能，评估其病变程度有一定的临床意义。     

萎缩性黄斑变性的眼底自发荧光特征

背景年龄相关性黄斑变性（AMD）的早期诊断和治疗至关重要。以往对AMD的诊断主要参照荧光素眼底血管造影（FFA）和光学相干断层扫描（OCT）,但眼底自发荧光技术（FAF）无需注射造影剂,大大优化了诊断过程。目的观察萎缩性AMD的FAF特征。方法28例39眼萎缩性AMD按照陈松的分类方法进行分组,应用激光共焦扫描检眼镜HRA2获得所有患者的FAF平均图像,并与眼底照相或FFA结果进行比较。结果萎缩性AMD的FAF信号异常增高或降低区域与眼底的改变可能对应或不对应。萎缩性AMD萎缩前期FAF改变包括轻微改变、局灶性、片状、线性、花边样、网状和斑点状增强等7种形态。萎缩性AMD萎缩期地图状萎缩区呈边界清晰的低FAF区,其交界区表现为正常FAF、FAF带状增强或弥漫性增强;非地图状萎缩呈边界不清的低FAF区,其交界区FAF弥漫性增强。结论FAF成像技术为萎缩性AMD的诊断提供了一种新的非侵入性检查手段。     

One-year outcomes after photodynamic therapy in patients with age-related macular degeneration with poor baseline visual acuity

Background Photodynamic therapy with verteporfin (PDT) has been demonstrated in randomized controlled trials to be a safe and effective therapy for choroidal neovascular membranes (CNV) secondary to age-related macular degeneration (AMD). Limited information is available on the prognosis with PDT for patients who fell outside the inclusion criteria for the clinical trials, however. The purpose of this study is to describe the clinical course of patients with CNV lesions in AMD treated with PDT, with baseline visual acuities sufficiently poor to warrant exclusion from previous randomized trials.Methods Retrospective case series. Ten consecutive patients with CNV secondary to exudative AMD treated with PDT with baseline visual acuity less than 34 ETDRS letters were followed for 1 year. The main outcome was median change in visual acuity on the ETDRS chart.Results The median change in acuity over 12 months was + 13 letters. All patients lost <3 lines of ETDRS acuity, and eight of ten patients (80%) gained at least one line of vision, over 12 months.Conclusions In our series, patients with low visual acuity at baseline appeared to respond to PDT on both visual acuity and fluorescein angiographic measurements. PDT treatment may be considered for selected patients with these baseline characteristics.Proprietary relationships: Dr. Potter has acted as a consultant to Novartis Ophthalmics and QLT Inc.; neither company provided funds or input to this report.This material was presented in part at the Annual Meeting of the Association for Research in Vision and Ophthalmology, 2003.     

干性年龄相关黄斑变性的局部视网膜电流图研究

目的研究干性年龄相关性黄斑变性(AMD)患者的局部视网膜电流图(LERG)反应。探讨黄斑区视网膜功能损害的程度。方法对33例(60眼)干性AMD患者和18例(30眼)正常人应用稳态的闪烁光LERG和全视野暗适应闪光ERG检测，测量振幅和峰时。结果干性AMD患者LERG平均振幅显著下降，平均峰时明显延长，与正常对照组比较有显著差异。干性AMD患者全视野暗适应闪光ERG的a波、b波振幅和峰时与正常对照组无显著差异。结论干性AMD患者行LERG检测可直接了解其黄斑区视网膜外层功能．评估其病变程度有一定的临床意义。     

蛋白质组学分析在年龄相关性黄斑变性研究中的应用

年龄相关性黄斑变性是老年人群中主要的不可逆致盲眼病,其主要致病因素包括年龄增长、遗传变异和生活方式等,但具体致病机制尚未完全阐明。蛋白质组学技术作为近年来新兴的研究手段已经逐步应用于眼科领域。目前已经有大量研究对该疾病患者的血液、泪液、房水、玻璃体液、视网膜和脉络膜、玻璃疣以及视网膜色素上皮细胞标本进行了蛋白质组学分析...     

Binocular function in patients with age-related macular degeneration: a review

Normally sighted observers typically benefit from binocular viewing when monocular sensitivities are equivalent. Age-related macular degeneration (AMD) not only destroys the foveal vision, however, but it also affects the 2 eyes unequally, providing grounds for impairment of binocular function. The aim of the present article is to provide a review of the current research on the effect of AMD on binocular vision. The main findings to date reveal that a high proportion of patients show characteristics of binocular contrast inhibition at low and medium spatial frequencies. Yet binocular acuity gain is not different from that of age-matched control participants without AMD. Additional findings show that rivalry processes are severely disrupted in patients with AMD. The effects of the disease on other binocular functions have yet to be explored. Knowledge of binocular function in AMD may one day help clinicians decide on the most appropriate management and rehabilitation techniques.     

老年黄斑变性患者影响因素对照调查分析

目的 探讨老年黄斑变性(AMD)患者的影响因素.方法 采用病例-对照研究方法,对病例组44例和对照组32例进行AMD有关危险因素的调查分析.结果 与对照组比较,病例组在年龄、性别、家族史、BMI指数、玻璃体混浊、白内障方面差异没有统计学意义(P>0.05);但病例组在吸烟史和户外阳光较充足时对眼没有采取保护措施差异有统计学意义(P<0.05).与对照组比较,病例组经常吃新鲜水果、豆类及其制品的比例明显减少,差异有统计学意义(P<0.05);对其他食物摄入频率方面两组之间没有显著性差异(P>0.05).结论 不吸烟、避免强阳光对眼照射、经常吃新鲜水果和豆类食品对预防AMD发生有保护作用.     

Retinal pigment epithelium and choroid translocation in patients with exudative age-related macular degeneration: long-term results

BACKGROUND: To study the results of the translocation of a free autologous retinal pigment epithelium (RPE)-choroid graft after removal of a subfoveal choroidal neovascular membrane in patients with exudative age-related macular degeneration (AMD), and to determine whether preoperative variables may predict visual outcome at 1 year after surgery. METHODS: Prospective interventional case series of 84 eyes of 83 consecutive eligible patients with exudative AMD with a minimal follow-up of 1 year after surgery. Of this group, 45, 24 and 11 patients reached a follow-up of respectively 2, 3 and 4 years. Pre- and postoperative evaluation included ETDRS visual acuity (VA), fixation testing and color fundus photography. Preoperative fluorescein angiograms were assessed by masked readers for lesion size, size of hemorrhage and lesion composition according to the MPS criteria. The relationship between lesion composition adjusted for preoperative delay and VA, lesion size, percentage of blood, and visual outcome at 1 year after surgery was analyzed. RESULTS: The mean VA (logMAR) improved slightly at 1 and 2 years (0.89, Delta = -0.06), 3 years (0.79, Delta = -0.16) and 4 years (0.74, Delta = -0.21) after surgery. Five patients had a preoperative VA better than 20/80, compared to 19 out of 84, six out of 45, four out of 24 and two out of 11 after 1, 2, 3 and 4 years respectively. Fixation was located on the graft in 62 patients (74%) up to the last examination. Predominantly classic and occult lesions had a significant better prognosis than minimally classic or hemorrhagic (> or = 50% blood) lesions. Retinal detachment occurred in seven patients; two caused by rhegmatogenous detachment and five caused by proliferative vitreoretinopathy. In 11 eyes, a recurrent or persisting neovascular membrane was observed. CONCLUSION: An autologous free RPE-choroid graft may stabilize or improve vision in patients with exudative AMD up to 4 years after surgery.     

外泌体在年龄相关性黄斑变性发病机制中的作用研究进展

外泌体是细胞分泌的纳米级膜性小泡,分布于多种体液,包括外周血、尿液、唾液等.目前多步差速离心是较为有效的外泌体提取方法.外泌体来源多样,可来自各种类型细胞,携带其来源细胞的蛋白质及核酸,参与细胞间的信息交流,在免疫调节、炎症反应等许多病理生理过程中发挥重要功能.年龄相关性黄斑变性(AMD)是引起50岁以上人群严重视力障碍的主要疾病,其发病机制尚不明确,目前认为AMD的发生与多种因素相关.最新研究表明,视网膜色素上皮(RPE)细胞分泌的外泌体可能与AMD的发生有关,RPE细胞通过外泌体释放的αB晶体蛋白等相关蛋白的增加可能导致玻璃膜疣的形成,氧化应激下的外泌体蛋白参与了RPE细胞的凋亡和存活.外泌体中的补体调节因子CD46、CD59通过损伤外层视网膜及Bruch膜参与AMD病程的进展.此外,RPE细胞的外泌体可能与脉络膜血管生成有关.随着对外泌体的深入研究,未来可能为AMD的诊治提供新的途径.     

雷珠单抗治疗重度视力损害渗出型年龄相关性黄斑变性患者的疗效观察

目的观察玻璃体腔注射雷珠单抗治疗重度视力损害渗出型年龄相关性黄斑变性(AMD)患者的疗效。方法回顾性分析在我院确诊为渗出型AMD、最佳矫正视力(BCVA)<0.05并接受雷珠单抗玻璃体腔注射的46例患者(47只眼)的临床资料。所有患者均行玻璃体腔注射雷珠单抗治疗,治疗后随访1~8个月,平均随访(4.09±2.25)个月。对比分析玻璃体腔注射雷珠单抗治疗前后BCVA、黄斑中心视网膜厚度(CRT)、病变最厚处视网膜厚度(MRT)的变化及不良反应的发生情况。结果至末次随访时,47只眼中,视力提高29只眼,占61.7%;视力稳定15只眼,占31.9%;视力下降3只眼,占6.4%。治疗后,平均CRT由治疗前的(301.30±84.57)μm降低为(211.27±87.03)μm;与治疗前相比,平均CRT下降(90.03±33.99)μm,差异有统计学意义(t=4.336,P<0.01);MRT由(529.04±174.63)μm降低为(421.86±95.78)μm;与治疗前相比,平均MRT下降(107.17±42.46)μm,差异有统计学意义(t=3.984,P<0.01)。结论雷珠单抗治疗重度视力损害渗出型AMD患者具有较好的疗效。     

年龄相关性黄斑变性的药物治疗进展

年龄相关性黄斑变性（ ARMD）是发达国家中老年人群主要致盲眼病,其患病率逐年上升趋势。主要由视网膜色素上皮细胞和视网膜退行性变而引起的不可逆性的中心视力下降或丧失。近年来,对多种类型年龄相关性黄斑变性尤其是新生血管型的治疗已经进行了大量的多中心的临床实验观察,涌现出光动力疗法、激光光凝、黄斑下手术、经瞳孔温热治疗、放射治疗、中医药治疗等方法,本文就ARMD目前有关的药物治疗方法及其进展做一综述。     

Polypoidal choroidal vasculopathy coexisting with exudative age-related macular degeneration

Purpose To report two cases that had polypoidal choroidal vasculopathy (PCV) coexisting with choroidal neovascularization (CNV) of exudative age-related macular degeneration (AMD). Methods Both of the patients underwent color photographs, fluorescein and indocyanine green (ICG) angiography. Results On fundus examination, a grayish lesion in the foveal area, reddish-orange lesions and hemorrhagic retinal pigment epithelial detachments (PED) in the inferotemporal vascular arch were disclosed in the left eye of a patient, and macular scarring was observed in the fellow eye. ICG angiography revealed a typical branching vascular network and polyp-like aneurysmal dilations at terminals of branches in the inferotemporal vascular arcade and a well-demarcated hyperfluorescent area of CNV in the fovea in the left eye, and staining of macular scarring was present in the fellow eye. On fundus examination of the right eye of the other patient a gray–yellow lesion at the fovea, reddish-orange lesions in the extramacula were noted, and diffuse drusens were present in the fellow eye. ICG angiography revealed scattered polyp-like aneurysmal dilations without identifiable continuous branching vascular network in the extramacula, and a well-demarcated hyperfluorescence area of CNV in the fovea. Conclusions PCV can coexist with exudative AMD in some patients and the polypoidal lesions may less involve in the fovea than CNV. Evidence of AMD are present meanwhile in the fellow eyes these patients.     

年龄相关性黄斑变性的遗传学研究进展

年龄相关性黄斑变性（AMD）发病机制尚未明确,目前认为AMD是复杂疾病,受多基因和环境因素共同影响。迄今为止,采用基因组关联分析和连锁分析等方法已经发现多个AMD相关候选基因。其中包括ABCR基因、APOE基因、1q25-31：CFH基因、染色体10q26：PLEKHA1/LOC387715/HTRA1、C2,C3,FB基因、SERPING1基因、EFEMP1（Fibulin3）和Fibulin-5基因等。本文就AMD发病机制的分子遗传学研究进展进行综述。     

Familial aggregation of age-related macular degeneration in the Utah population

We examined familial aggregation and risk of age-related macular degeneration in the Utah population using a population-based case-control study. Over one million unique patient records were searched within the University of Utah Health Sciences Center and the Utah Population Database (UPDB), identifying 4764 patients with AMD. Specialized kinship analysis software was used to test for familial aggregation of disease, estimate the magnitude of familial risks, and identify families at high risk for disease. The population-attributable risk (PAR) for AMD was calculated to be 0.34. Recurrence risks in relatives indicate increased relative risks in siblings (2.95), first cousins (1.29), second cousins (1.13), and parents (5.66) of affected cases. There were 16 extended large families with AMD identified for potential use in genetic studies. Each family had five or more living affected members. The familial aggregation of AMD shown in this study exemplifies the merit of the UPDB and supports recent research demonstrating significant genetic contribution to disease development and progression.     

吸烟对年龄相关性黄斑变性发生和发展的影响

年龄相关性黄斑变性(AMD)的视力损失多由视网膜色素上皮细胞的凋亡和光感受器的退化引起。主动、被动吸烟会增加AMD发病率及向晚期AMD进展的风险,并且影响湿性AMD的治疗效果。吸烟可引起脉络膜血管收缩、血管阻力增加、血管内皮功能障碍、脉络膜和神经节细胞复合体变薄,导致脉络膜和视网膜血管反应性受损。香烟中的尼古丁可导致血...