切除黄斑部视网膜下新生血管膜治疗年龄相关性黄斑变性

Treatment of age related macular degeneration by surgical removal of subfoveal neovascular membrane with vitrectomy

目的 观察玻璃体切除术联合黄斑部视网膜下新生血管膜（ｎｅｏｖａｓｃｕｌａｒ ｍｅｍｂｒａｎｅ，ＮＶＭ）切除治疗年龄相关性黄斑变性（ａｇｅｒｅｌａｔｅｄ ｍａｃｕｌａｒｄｅｇｅｎｅｒａｔｉｏｎ，ＡＲＭＤ） 的疗效。方法 选择病程在２ 年之内的ＡＲＭＤ患者，ＮＶＭ ≤３ ＰＤ。完成闭合式玻璃体切除术后，于黄斑部颞上方切开视网膜，分离并切除ＮＶＭ。术毕３０％ ＳＦ６ 填充玻璃体腔，患者保持俯卧位。结果 ＡＲＭＤ３０ 例（３０ 只眼） 中，１７只眼（５６－７％） 术后视力提高，最佳视力达２０／６０；８ 只眼（２６－７ ％） 术后视力无改善；５ 只眼（１６－７％ ）术后视力下降。并发症：１ 只眼发生视网膜脱离，３ 只眼ＮＶＭ 复发，３ 只眼出现以视网膜切开口为中心的视网膜皱褶。透射电镜观察显示ＮＶＭ 主要由新生的毛细血管组成。结论 玻璃体切除术联合黄斑部视网膜下ＮＶＭ 切除治疗ＡＲＭＤ有一定的疗效，但大多数患者的视力提高不明显。

Objective To investigate the therapeutic effect of surgical removal of subfoveal neovascular membrane with vitrectomy in treatment of age related macular degeneration Methods 30 patients (30 eyes) with the macular degeneration were selected The duration of the disease was limited less than 2 years and the size of the neovascular membrane was limited to ≤3 disc diameters The neovascular membrane was removed through the retinotomy superiotemporal to the macula after closed vitrectomy The vitreous cavity was replaced by 30% SF 6 after gas/fluid exchange and the patients took prone position postoperatively Results The visual acuity was improved in 17 (56 7%, the best one 20/60), unchanged in 8 (26 7%) and decreased in 5 (16 7%) of the 30 eyes after operation The post operative complications were as follows: retinal detachment in 1 eye, centripetal retinal pucker to the retinotomy in 3 eyes and recurrence of neovascular membrane in 3 eyes Transmission electron microscopy showed that the specimens were mainly composed of neo capillary vessels Conclusions Certain therapeutic effects can be seen after the operation However, the improvement of visual acuity in most of the cases is not very significant