黄斑转位术后施行眼外肌外旋矫正术:新的手术方式及其临床疗效研究

PURPOSE: To report a new extraocular muscle surgery procedure for large-angle extorsion, and clinical management of subjective tilt and diplopia after full macular translocation (MT360). Design: Consecutive retrospective case series. Participants: Seven patients with downward MT360 were evaluated after MT360, both before (preoperative) and after (postoperative) extraocular muscle surgery, with at least 6 months’follow-up. Methods: Information gathered included demographics, visual acuity, ocular motility, torsion by Maddox rod, ocular history, and symptoms of visual disturbance. Surgery on extraocular muscles was performed based on the magnitude of torsion measured after MT360 surgery. Main Outcomes Measures: Maddox rod testing of torsion after MT360, and both preoperative and postoperative extraocular muscle surgery. Results: Mean preoperative torsion was reduced from 45.4±11.3°to 8.3±4.8°(at 6 months after MT360) (P=0.03). Extraocular muscle surgery slightly reduced the mean hypertropia of the operated eye (preoperative, 20±10 prism diopters PD , vs. postoperative, 11±6 PD) (P=0.06). Mean exotropia was affected minimally by extraocular muscle surgery (preoperative, 22±31 PD, vs. postoperative, 20±24 PD). Three patients required a second extraocular muscle surgery (performed on the fellow eye) to correct residual extorsion and diplopia. Overall, 85%(6/7) of patients were free of both diplopia and tilt after 1 or 2 extraocular muscle surgeries. Conclusions: Although our patients continued to have significant horizontal/vertical strabismus postoperatively, the extraocular muscle surgery performed was successful in reducing the torsional misalignment enough such that the remaining diplopia could be successfully ignored or suppressed.

双眼严重老年性黄斑变性患者的视觉相关生活质量

To determine the quality of life (QOL) of patients with bilateral severe age- related macular degeneration (AMD) before macular translocation with 360°periph eral retinectomy. Prospective, consecutive, noncomparative case series. An obser vational study assessed vision-related and general health QOL using the 25-ite m National Eye Institute Visual Function Questionnaire (NEIVFQ-25) and the Medi cal Outcomes Study 12-item short form (SF-12) surveys, respectively. Mean QOL scores were correlated with patient age, duration of vision loss, and visual fun ction. Mean QOL scores in study patients were compared with mean QOL scores in g roups of patients with low vision, patients with AMD of varying severity, and re ference populations. National Eye Institute VFQ-25 and SF-12 QOL scores. Seven ty patients with a mean age of 76.4 years were studied. Mean distance visual acu ity (VA) was 62.4 (Early Treatment Diabetic Retinopathy Study letters), mean nea r VA was 0.81 (logarithm of the minimum angle of resolution), and mean reading s peed was 74.9 words per minute. Important NEI VFQ-25 quality of vision subscale s (general vision, difficulty with distance tasks, difficulty with near tasks) a nd vision-spe-cific subscales (dependency, role difficulties, mental health, s ocial function limitations) tended to correlate negatively with increasing patie nt age and duration of vision loss, but correlated positively with better VA and reading speed. The mean QOL scores for these important quality of vision and vi sion-spe-cific subscales were significantly worse than or similar to mean scor es in patients with low vision, and significantly worse than scores in patients with AMD of varying severity and a reference population. The mean SF-12 physica l composite score in study patients was similar to that seen in patients with AM D of varying severity, but significantly higher than that in patients with low v ision and a reference population. The SF-12 mental composite score in study pat ients was similar to those of all 3 comparison groups. Patients with bilateral s evere AMD have vision-related QOL similar to that of patients with low vision b ut significantly worse than those of patients with AMD of varying severity and p ersons without eye disease. This inability to perform visionrelated daily tasks is not related to general health problems.

360°视网膜切开联合黄斑转位治疗新生血管性老年黄斑变性后的视功能改变

Objective To measure the change in vision and visual outcomes at 12 months aft er macular translocation with 360°retinectomy (MT360) and silicone oil tamponad e in patients with bilateral vision loss resulting from subfoveal choroidal neov ascular membranes in age-related macular degeneration (AMD). Design A prospecti ve, interventional, consecutive, noncomparative case series. Participants Sixty -four patients with bilateral vision loss resulting from neovascular AMD. Metho ds Eligible patients had AMD with subfoveal choroidal neovascularization in the operative eye and a maximum of 6 months of central vision loss. Preoperative and 12-month postoperative evaluations included standardized testing of near and d istance acuity and reading speed. Patients underwent MT360 with silicone oil tam ponade, followed 2 months later by extraocular muscle surgery and silicone oil r emoval. Main outcome measures Change in distance acuity, near acuity, and readin g speed at 12 months after MT360 compared with those values before surgery. Resu lts Sixty-one patients were followed up for 12 months. All eyes were translocat ed successfully. Median distance acuity letter score improved from 62 letters (S nellen equivalent of approximately 20/125) before surgery to 69 letters (approxi mately 20/80) by 12 months after surgery (P=0.03). Median near acuity improved f rom 0.70 logarithm of the minimum angle of resolution (logMAR) units (approximat ely 20/100) before surgery to 0.44 logMAR units (approximately 20/55) at 12 mont hs (P < 0.001). Median reading speed improved from 71 words per minute (wpm) bef ore surgery to 105 wpm at 12 months after surgery (P < 0.001). At 12 months, dis tance acuity improved by 1 or more lines in 32 patients (52%). In patients with either preoperative distance or near acuity of 20/80 or better, 74%and 95%of patients, respectively, remained in this range of acuity. In patients with eithe r preoperative distance or near acuity of worse than 20/80, 40%and 48%of patie nts, respectively, improved to 20/80 or better. Postoperative retinal detachment developed in 5 patients (8%), with the macula involved in 2 patients, and all retinas were reattached successfully. Conclusions Macular translocation with 360 °retinectomy with silicone oil tamponade is effective in significantly improvin g visual function in patients with neovascular AMD, as demonstrated by the impro vement in distance and near acuity and reading speed at 12 months after surgery in these patients. Although this is a complex surgical intervention, patients wi th preoperative visual acuity of 20/80 or better at near or distance are highly likely to retain the 20/80 or better acuity at 12 months after surgery. Macular translocation with 360°retinectomy is an effective treatment option for patient s with vision loss in their second eye resulting from neovascular AMD.

360°周边视网膜切开联合黄斑转位术治疗黄斑地图状萎缩后视网膜色素上皮病变复发的研究

Objective: To assess the prevalence of recurrence of macular geographic atroph y (GA) of the retinal pigment epithelium (RPE) after macular translocation with 360°retinectomy (MT360) in one institution. Methods: A retrospective review of all cases of GA that were treated with MT360 in 1 institution. Demographic and c linical data including the duration of preoperative visual loss, preoperative an d postoperative visual acuity, and the prevalence of postoperative foveal RPE at rophy were recorded for these patients, and these data were compared with simila r data from patients who underwent MT360 for neovascular age-related macular degeneration (AMD) as part of the prospective Duke Macula r Translocation Study, Duke University Eye Center, Durham, NC. Results: Four eye s in 4 patients with GA secondary to AMD underwent MT360 and were compared with 63 eyes in 63 patients who underwent MT360 for neovascular AMD as part of the Du ke Macular Translocation Study. The mean duration of preoperative visual loss wa s higher in the GA group (11.3 months) than in the neovascular AMD group (1.7 mo nths) (P=.08). The prevalence of postoperative foveal RPE atrophy was significan tly higher in theGAgroup (n=3; 75.0%) than in the neovascularAMDgroup (n=5; 8.3 %) (P< .01); in the GA group, this corresponded to recurrence of the GA lesions . In contrast, the postoperative RPE atrophy seen in the neovascularAMD group wa s due to postoperative mechanical forces such as laser therapy or RPE tearing. T here was no significant difference in the mean preoperative or postoperative vis ual acuity in either group. Conclusions: Subfoveal RPE atrophy can reoccur follo wing MT360 in eyes with nonneovascularAMDandGA; RPE atrophy similar to this has not been found in a large consecutive series of patients with neovascular AMD af ter MT360. Further research is needed to assess if the potential for visual reco very in eyes with endstage nonneovascular AMD is outweighed by the possibility o f postoperative recurrence of GA.