一眼湿性型另一眼干性型老年黄斑变性的临床观察和分析

CLINICAL OBSERVATION AND ANALYSIS IN AGE-RELATED MACULAR DEGENERATION WITH ONE EYE OF WET FORM AND THE OTHER OF DRY FORM

经眼底检查和荧光血管造影确诊的22例(44眼)老年黄斑变性,均一眼为湿性型,另一眼为干性型,年龄52～70岁,平均61.1岁。在于性型眼中,54.5%(12/22)的眼视力在1.0～1.5,最差视力为0.2,在湿性型眼中,50.0%(11/22)的眼的视力在指数—0.1,最好视力为0.7,经荧光血管造影放大的负片,观察病灶在FAZ中的分布情况,在干性型眼中,72.1%(16/22)的眼FAZ正常,18.2%(4/22)的眼FAZ区散在着高荧光点,9.1%(2/22)的眼占1/2FAZ,在湿性型眼中,59.1%(13/22)占全部FAZ,9.1%(2/22)的眼占3/4 FAZ,31.8%(7/22)的眼占1/4～1/2 FAZ。应用计算机极坐标方法测定病灶面积,湿性组的平均面积为5.048mm^2,干性组为1.034mm^2,经团体t检验,二组病灶的平均面积的差异有非常显著性意义(p<0.01)。比较二组明视ERG b波振幅,湿性组的平均振幅为101.74μv,干性组的为126.35μv,经团体t检验,二组的平均振幅差异有显著性意义(p<0.05)。结果表明:湿性型眼的病变面积较大,累及FAZ,视力受严重损害;干性型眼的病灶分散在黄斑部,病灶面积较小,多数FAZ是正常的,视功能损害程度各不相同或可能很小。本文对老年黄斑变性的二种类型的形态特征,视功能的异常性,病变的进展及可能的转化进行了讨论。

Twenty two cases(44 eyes) of age-related macular degeneration with one eye of wet form and the other of dry form were included in this study. The range of the lesion was determined on magnified negative film of fluorescein angiography. In the dry group 72.7% eyes had normal FAZ and in the wet group 59.1% eyes revealed the lesion involving whole FAZ. The area of the lesion was measured by polar coordinates computational method, the mean area was 5.048mm^2 in the wet form and 1.034mm^4 in the dry form, there was statistically significant difference between the mean areas of the two groups(P<0.01). The mean amplitude of photopic ERG b-wave was 101.74μv in the wet form and 126.35μv in the dry form. The morphological characteristics, the abnormalities of the visual function and possible changes in the two groups of this disease were discussed.