黄斑下脉络膜新生血管膜的手术治疗及随访观察

目的探讨黄斑下脉络膜新生血管膜手术治疗后的远期效果。方法经睫状体平部行闭路式玻璃体切除术后，切开视网膜，取出黄斑下脉络膜新生血管膜瘢痕组织。７例（７只眼）手术前、后均行视力、矫正视力、眼底及眼底血管荧光素造影检查，并进行长期随诊观察。结果随诊观察１年以上，６只眼黄斑下脉络膜新生血管膜消失，１只眼脉络膜新生血管膜复发。６只眼手术后视力均有不同程度增进，其中２只眼视力提高到０．５以上；１只眼视力减退，黄斑机化组织形成；１只眼发生继发性黄斑前膜。结论黄斑下脉络膜新生血管膜手术切除后，大多数眼视力有所提高，视力提高大小与黄斑下脉络膜新生血管膜瘢痕组织对色素上皮及神经上皮的损害程度有关，手术操作对色素上皮及神经上皮的影响亦有一定关系。     

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)     

年龄相关性黄斑变性和病理性近视合并脉络膜新生血管的比较

目的　比较年龄相关性黄斑变性 (age relatedmacu lardegeneration ,AMD)和病理性近视合并黄斑区典型性脉络膜新生血管 (choroidalneovascularization ,CNV)的临床特点、自然病程和视力预后。方法　对未接受过激光或手术治疗的AMD组 4 1例 5 4眼和近视组 4 0例 4 3眼的临床资料进行回顾性分析研究。AMD组 2 4例 32眼随访 12～ 72月 (中位数36月 ) ;近视组 2 4例 2 7眼随访 13～ 72月 (中位数 5 4月 )。结果　初诊时 2组视力差异无统计意义 (P =0 .5 37) ;均以中心凹下CNV为主 (P =0 .92 5 ) ;AMD组CNV较大 (0 .90±0 5 3)DD ,近视组较小 (0 .5 4± 0 .31)DD(P =0 .0 0 0 1)。末诊时近视组视力较AMD组为好 (P =0 .0 19)。 2组比较 :AMD组以纤维瘢痕为主 (P =0 .0 0 1) ,近视组以色素增殖和萎缩为主 (P =0 .0 0 0 1)。结论　AMD合并黄斑区典型性脉络膜新生血管的直径较大 ,晚期以纤维瘢痕为主 ,自然视力预后差。病理性近视合并黄斑区典型性脉络膜新生血管的直径较小 ,晚期以色素增殖和脉络膜视网膜萎缩为主 ,病程相对自限 ,但自然视力预后也是差的。两者都需要有效的治疗措施。而在治疗病理性近视合并黄斑区典型性脉络膜新生血管时更应强调治疗方法的安全性。     

湿性年龄相关性黄斑变性OCT特点与视力的相关研究

目的 研究湿性年龄相关性黄斑变性OCT图像特征与患者视力的相关性.方法 纳入湿性年龄相关性黄斑变性患者106例106只眼,记录患者最佳矫正视力(EDTRS视力),并对患者眼底进行光学相干断层扫描分析,统计黄斑区视网膜厚度、黄斑区总容积、测量脉络膜新生血管膜厚度,脉络膜新生血管与黄斑中心凹距离.结果 患者视力与脉络膜新生血管病变的最大线性距离、黄斑区总容积、CNV厚度、CNV距中心凹距离呈明显相关关系(P＜0.05).结论 湿性年龄相关性黄斑变性患者中心视力与脉络膜新生血管病变的位置、大小、视网膜水肿程度明密切相关.     

经瞳孔温热疗法治疗老年黄斑变性所致黄斑中心凹下脉络膜新生血管的长期观察(英文)

目的:评价经瞳孔温热疗法(TTT)治疗年龄相关性黄斑变性(AMD)所致黄斑中心凹下脉络膜新生血管(CNV)的长期疗效。方法:AMD所致黄斑中心凹下脉络膜新生血管14例14眼。平均年龄67.1岁。记录详尽的眼科检查结果,拍摄彩色眼底相,并行黄斑部光学相干断层成像(OCT)检查。在初诊及随后的复诊中行眼底荧光素血管造影和吲哚青绿血管造影。TTT的治疗参数为:时间1min,光斑大小2 ~3mm,激光能量650 ~800mW。随诊时间5 ~64mo,平均28.6mo。结果:在14眼中,典型性CNV有10眼,典型为主性有2眼,1眼为少量典型性,1型隐匿性CNV有1眼。共4例患者出现治疗后出血,均在短期内吸收。有1眼在治疗后立刻出现了黄斑无灌注区。多数患眼在随诊中可见渗出逐渐减少。在平均28.6mo的随诊中,14只患眼,有5眼视力提高,8眼保持稳定,1眼视力下降。结论:经瞳孔温热疗法在AMD患者中能封闭黄斑中心凹下的CNV,促进网膜下积液的迅速吸收,从而稳定患者的视力。它可以作为一种治疗典型和典型为主性黄斑中心凹下脉络膜新生血管的激光治疗手段。     

近视性黄斑出血24例的临床观察

目的：观察和探讨近视性黄斑出血的临床特点。 方法：对确诊为近视性黄斑出血的24例患者的30只眼作视力、眼前节、眼底、A/B超声仪、眼底荧光血管造影(fundus fluorecein angiography，FFA)等检查，中西药物治疗并随访观察3～18个月(平均12个月)。 结果：作FFA检查的26只眼中22只眼为单纯型黄斑出血，其中19只眼伴有漆裂样纹，出血多在1～3个月吸收；另外4只眼FFA检查发现为脉络膜新生血管出血，视力预后均较差，且均伴有后葡萄肿。 结论；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，后者反复出血视力预后较差。 （中华眼底病杂志，1996，12：220-222）     

ICGA引导激光治疗AMD的临床观察

评价ICGA引导激光治疗AMD的疗效。方法 :本组 2 7例 ( 30只眼 )AMD患者。根据FFA、ICGA的结果 ,对不同的AMD患者采取不同的方法 :( 1)黄斑区有脉络膜新生血管膜 (CNV)形成及渗漏点 ,采取拱环外直接光凝 ;( 2 )新生血管广泛合并有视网膜水肿者 ,用格栅状光凝 ;( 3)可见明显滋养血管的 ,则直接光凝 ,封闭该血管。结果 :随访 3～ 10个月 :( 1)显效 4例占 18 6 % ,视力提高 0 4～ 0 8,黄斑区CNV消失 (早期AMD患者 ) ;( 2 )有效 10例占37% ,视力提高 0 15～ 0 3 ,眼底黄斑部CNV基本消失或有明显减轻 ;( 3)无变化有 10例占 37% ,视力在 0 0 1～ 0 1,眼底CNV变化不明显 ;( 4 )退步有 2例占 7 4% ,视力由 0 1下降到指数 /眼前 ,CNV增加 ,伴有视网膜水肿。结论 :( 1)ICGA能发现FFA中不能显示的滋养血管 ,直接光凝滋养血管 ,就可治疗黄斑下的新生血管膜。 ( 2 )在出血或渗出遮盖的情况下 ,ICGA检查 ,则能早期发现隐匿性CNV。 ( 3)本组 2 7例 ,均是根据FFA和ICGA结果进行激光治疗 ,总有效率达 5 5 6 %。病程短者较病程长者效果好。     

年龄相关性黄斑变性黄斑部循环改变与脉络膜新生血管形成

目的探讨年龄相关性黄斑变性(age-relatedmaculardegeneration,AMD)黄斑部循环改变与脉络膜新生血管(choroidalneovascularization,CNV)形成的关系。方法对12例(24眼)首诊为萎缩型AMD,在随访中转变为渗出型AMD(16眼)的眼底荧光素血管造影(fundusfluorescenceangiography,FFA)及吲哚青绿血管造影(indocyaninegreenangiography,ICGA)图像进行回顾性分析,对比观察脉络膜循环变化。结果24只萎缩型AMD黄斑区脉络膜毛细血管层均有局限性灌注不良,16眼(67%)CNV在原脉络膜毛细血管灌注不良区域内生成。结论脉络膜灌注不良是CNV形成的主要原因。     

氪激光低能量光凝治疗年龄相关性黄斑变性合并脉络膜新生血管患者的临床效果

目的 探讨氪激光低能量光凝治疗年龄相关性黄斑变性(AMD)合并脉络膜新生血管(CNV)患者的疗效。方法 湿性AMD患者17例(17只眼),经荧光素眼底血管造影(FFA)或吲哚氰绿血管造影(ICGA)检测,确诊为黄斑中心凹下CNV。患者年龄50—74岁,平均61岁。在黄斑病变区相应视野中心暗点内,应用氪激光行低能量光凝治疗。术后4周CNV仍有活动者再次行光凝治疗。每例患者治疗前和复诊时均检查视力、眼前节、眼底及视野,并行眼底照相和FFA、ICGA检测。患者术后定期随访1-8年,平均3．5年。结果 术后所有患者的治疗眼均未出现即刻视力下降现象,局部出血和渗出明显消退。FFA检测证实CNV关闭或缩小,渗漏减少,其中9例患者随诊3年以上未见复发。术后6只眼视力增进,8只眼视力不变,3只眼视力减退。视野复查见中心暗点无明显变化。结论应用氪激光低能量光凝治疗AMD合并黄斑中心凹下CNV患者具有疗效好、复发者少等优点。(中华眼科杂志,2004,40：808-811）     

黄斑玻璃膜疣预防性激光治疗效果分析

目的 分析预防性激光治疗对大的黄斑玻璃膜疣的效果.方法 黄斑部有多个(>10个),大的(直径>63μm)玻璃膜疣者23例.其中7例对侧眼为湿性年龄相关性黄斑变性,对玻璃膜疣眼进行激光治疗.另外16例为舣眼玻璃膜疣,随机选择一只眼行激光治疗.氪黄激光"C"型光凝该23只眼的黄斑区.随访最佳矫正视力、彩色眼底像和眼底荧光造影(FFA).结果 激光治疗后,14只眼玻璃膜疣减少,7只眼玻璃膜疣无明显变化,2只眼玻璃膜疣增加.最佳矫正视力提高7只眼,不变6只眼,下降10只眼,最佳矫正视力术前术后统计分析无显著性差异.激光治疗眼并未出现脉络膜新生血管等并发症.结论 氪黄激光对大的黄斑玻璃膜疣预防性激光治疗可以促进玻璃膜疣吸收,并使其视力保持稳定.     

Treatment of juxtafoveal choroidal neovascularization with photodynamic therapy using verteporfin in eyes with age-related macular degeneration.

To report the results of treating juxtafoveal choroidal neovascularization with photodynamic therapy using verteporfin in eyes with age-related macular degeneration. Seven patients with predominantly classic juxtafoveal choroidal neovascularization were treated by photodynamic therapy using verteporfin. Three of the 7 patients had a gain in visual acuity and 2 had a stabilization of vision. The remaining 2 patients had a decrease in visual acuity. Subfoveal extension of the choroidal neovascularization was not observed in any patient and all choroidal neovascularization lesions after treatment were found to be nonperfused on fluorescein angiography. The encouraging results based on this small pilot study suggest that photodynamic therapy should be considered for treatment of select juxtafoveal choroidal neovascularization due to age-related macular degeneration.     

Pars plana vitrectomy for regression of choroidal neovascularization with age-related macular degeneration

OBJECTIVE: In age-related macular degeneration, the posterior vitreous surface often remains attached to a higher degree than expected for the patient's age, suggesting the involvement of the posterior vitreous membrane in the pathophysiology of choroidal neovascularization. Thus, we performed simple pars plana vitrectomy and artificial posterior vitreous detachment in order to induce regression of choroidal neovascularization. METHODS: Vitrectomy was performed in 12 eyes of 11 patients with age-related macular degeneration in whom the posterior vitreous surface remained attached, and in whom there was evidence of highly active choroidal neovascularization. The posterior vitreous membrane was artificially detached during surgery, but photocoagulation and/or a subretinal procedure for choroidal neovascularization was not performed. Patients underwent fluorescein and indocyanine green angiography both pre- and postoperatively to assess the status of choroidal neovascularization. RESULTS: Six months after surgery, 6 of the 12 eyes showed regression of choroidal neovascularization, and in 2 eyes it had disappeared completely. Subretinal exudative changes in 8 eyes had improved. Visual acuity testing showed improved vision in 4 eyes, unchanged vision in 4 eyes, and worsening of vision in 4 eyes. The final best corrected visual acuity was 10/20 or better in one eye, 10/ 20 to 20/200 in 7 eyes, and 20/200 or worse in 4 eyes. CONCLUSION: The results of the present study suggest the involvement of the posterior vitreous membrane in the pathophysiology of age-related macular degeneration. Furthermore, the minimally invasive pars plana vitrectomy may represent a new treatment for age-related macular degeneration.     

Subthreshold transpupillary thermotherapy for subfoveal occult choroidal neovascularization secondary to age-related macular degeneration

PURPOSE: To describe the long term outcome of patients with subfoveal, occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with subthreshold transpupillary thermotherapy. METHODS: 82 eyes of 82 consecutive patients with subfoveal occult CNV secondary to AMD were treated with subthreshold transpupillary thermotherapy. Best corrected visual acuity, fundus photography, fluorescein and indocyanine green angiography were performed. RESULTS: All patients have been followed for at least 24 months. At the final follow-up visit, 75.6% of patients had stable or improved visual acuity and 24.4% had worsened visual acuity. No overtreatment side effects were found. CONCLUSION: Subthreshold transpupillary thermotherapy seems effective in stabilizing visual acuity in patients affected by occult, subfoveal CNV even on a long-term basis.     

Selection for inferior limited macular translocation on the basis of distance from the fovea to the inferior edge of the subfoveal choroidal neovascularization

PURPOSE: To assess the visual outcome of inferior limited macular translocation in eyes selected based on the distance from the fovea to the inferior edge of the subfoveal choroidal neovascularization. DESIGN: Interventional case series. METHODS: We performed inferior limited macular translocation in 12 consecutive eyes (12 patients) with age-related macular degeneration or polypoidal choroidal vasculopathy, in which the choroidal neovascularization did not extend for more than half of one disk diameter inferior to the fovea. RESULTS: In all eyes, the choroidal neovascularization was moved to an extrafoveal location. In seven of the 12 eyes, postoperative vision was 20/40 or better. The visual acuity improved by 2 or more lines in 11 eyes. CONCLUSION: Selection for inferior limited macular translocation on the basis of distance from the fovea to the inferior edge of the choroidal neovascularization may be associated with a greater likelihood of visual acuity improvement.     

Transpupillary thermotherapy (TTT) for age-related macular degeneration

Purpose. To review the results of transpupillary thermotherapy (TTT) on choroidal neovascular membranes associated with age-related macular degeneration (AMD). Materials and Methods. 35 eyes of 35 patients with AMD and choroidal neovascularization and exudation were treated with TTT and had fundus photographs and fluorescein angiography (FA) before and at least six months after TTT. 28 eyes had predominantly occult lesions as seen on FA, while 7 demonstrated primarily classic lesions. All were treated with 650 mw power or less using the 810 nm diode laser (3000 micron spot, duration of 60 seconds). Visual acuity, lesion size, and amount of subretinal fluid were determined by results of examination and review of photographs and fluorescein angiograms. Results. A 50% reduction in subretinal fluid was achieved in 67% of treated eyes overall, with stabilization of vision (less than three lines of visual acuity lost) in 86%. Complications from treatment were infrequent (9%) and involved hemorrhage noted in the region of treatment upon follow-up. Conclusion. TTT promotes resolution of subretinal fluid and appears to stabilize visual acuity in patients with exudative AMD.     

Transpupillary thermotherapy (TTT) for age-related macular degeneration

PURPOSE: To review the results of transpupillary thermotherapy (TTT) on choroidal neovascular membranes associated with age-related macular degeneration (AMD). MATERIALS AND METHODS: 35 eyes of 35 patients with AMD and choroidal neovascularization and exudation were treated with TTT and had fundus photographs and fluorescein angiography (FA) before and at least six months after TTT. 28 eyes had predominantly occult lesions as seen on FA, while 7 demonstrated primarily classic lesions. All were treated with 650mw power or less using the 810 nm diode laser (3000 micron spot, duration of 60 seconds). Visual acuity, lesion size, and amount of subretinal fluid were determined by results of examination and review of photographs and fluorescein angiograms. RESULTS: A 50% reduction in subretinal fluid was achieved in 67% of treated eyes overall, with stabilization of vision (less than three lines of visual acuity lost) in 86%. Complications from treatment were infrequent (9%) and involved hemorrhage noted in the region of treatment upon follow-up. CONCLUSION: TTT promotes resolution of subretinal fluid and appears to stabilize visual acuity in patients with exudative AMD.     

经瞳孔温热疗法(TTT)治疗年龄相关黄斑变性的隐匿型黄斑部视网膜下新生血管膜的疗效观察

目的:探讨TTT激光治疗年龄相关的黄斑变性（ARMD）的隐匿型视网膜下新生血管膜的初步疗效。方法:15例15眼患ARMD隐匿型CNV的患者行TTT治疗,根据CNV的大小选择不同的光斑大小和能量,均照射一分钟。结果:15例患者术后FFA均显示渗漏减少或消失,眼底检查显示出血、渗出、水肿减轻,但15例患者视力均无明显改善。结论:TTT对治疗本组隐匿型ARMD的CNV是有效的而无害的,但需要更多的病例来评价治疗效果。     

Subthreshold transpupillary thermotherapy for subfoveal occult choroidal neovascularization secondary to age-related macular degeneration

Purpose. To describe the long term outcome of patients with subfoveal, occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with subthreshold transpupillary thermotherapy. Methods. 82 eyes of 82 consecutive patients with subfoveal occult CNV secondary to AMD were treated with subthreshold transpupillary thermotherapy. Best corrected visual acuity, fundus photography, fluorescein and indocyanine green angiography were performed. Results. All patients have been followed for at least 24 months. At the final follow-up visit, 75.6% of patients had stable or improved visual acuity and 24.4% had worsened visual acuity. No overtreatment side effects were found. Conclusion. Subthreshold transpupillary thermotherapy seems effective in stabilizing visual acuity in patients affected by occult, subfoveal CNV even on a long-term basis.     

Factors prognostic of visual outcome in patients with subretinal hemorrhage

We reviewed the charts of 29 patients with large subretinal hemorrhages involving the center of the fovea to evaluate factors that might be prognostic of visual outcome. The average final visual acuity was 20/480 with a mean follow-up of three years. Patients with thick hemorrhages (causing an obvious elevation of the fovea) had worse final visual acuity than patients with thin hemorrhages (P = .02). The diameter of the hemorrhage was not a significant predictor of outcome. Patients with aging macular degeneration had poorer final visual acuity (mean, 20/1,700, P = .002), and patients with choroidal ruptures had better final visual acuity, (mean 20/35, P less than .001) than the remainder of the patients. We found that the presence of aging macular degeneration was a more important predictor of the outcome of legal blindness than the thickness of the hemorrhage (P = .03). Although the prognosis in patients with subfoveal blood is generally poor, some patients have excellent return of vision.