Change in visual function after macular translocation with 360 degrees retinectomy for neovascular age-related macular degeneration.
Change in visual function after macular translocation with 360 degrees retinectomy for neovascular age-related macular degeneration.
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360 度视网膜切除术治疗新生血管性年龄相关性黄斑变性黄斑移位后视功能的变化。
DOI：
10.1016/j.ophtha.2004.03.022
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Toth,CynthiaA
中科院分区：
文献类型：
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作者：
Mruthyunjaya,Prithvi;Stinnett,SandraS;Toth,CynthiaA
目的：测量年龄相关性黄斑变性（AMD）黄斑移位360°视网膜切除术（MT360）和硅油填充术后12个月视力和视力结局的变化。非比较病例系列。参与者60- 4例因新生血管性AMD导致双侧视力丧失的患者。方法符合条件的AMD患者手术眼有中心凹下脉络膜新生血管，6个月的中央视力丧失术前和术后12个月的评估包括近距离和远距离视力以及阅读速度的标准化测试。患者行MT360硅油填充术，2个月后行眼外肌手术和硅油取出术。主要观察指标与术前相比，MT360术后12个月远视力、近视力和阅读速度的变化。所有患眼均成功移位。中位远视力字母评分从术前的62个字母（Snellen相当于约20/125）改善至术后12个月的69个字母（约20/80）（P = 0.03）。中位近视力从术前最小分辨角（logMAR）单位的0.70对数（约20/100）改善至12个月时的0.44 logMAR单位（约20/55）（P<0.001）。中位阅读速度从术前的71字/分钟（wpm）提高到术后12个月的105字/分钟（P<0.001）。在12个月时，32名患者（52%）的远视力改善了1行或更多行。在术前远视力或近视力为20/80或更好的患者中，分别有74%和95%的患者保持在该视力范围内。在术前远视力或近视力低于20/80的患者中，分别有40%和48%的患者改善至20/80或更好。术后视网膜脱离5例（8%），黄斑受累2例，全部视网膜复位成功。结论黄斑移位联合360°视网膜切除硅油填充术能有效改善新生血管性AMD患者的视功能，术后12个月远、近视力和阅读速度均有明显改善。虽然这是一项复杂的手术干预，但术前近视力或远视力为20/80或更好的患者在术后12个月时极有可能保持20/80或更好的视力。黄斑移位联合360°视网膜切除术是治疗新生血管性AMD引起的第二只眼视力丧失的有效治疗选择。
OBJECTIVETo measure the change in vision and visual outcomes at 12 months after macular translocation with 360° retinectomy (MT360) and silicone oil tamponade in patients with bilateral vision loss resulting from subfoveal choroidal neovascular membranes in age-related macular degeneration (AMD).DESIGNA prospective, interventional, consecutive, noncomparative case series.PARTICIPANTSSixty-four patients with bilateral vision loss resulting from neovascular AMD.METHODSEligible 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 distance acuity and reading speed. Patients underwent MT360 with silicone oil tamponade, followed 2 months later by extraocular muscle surgery and silicone oil removal.MAIN OUTCOME MEASURESChange in distance acuity, near acuity, and reading speed at 12 months after MT360 compared with those values before surgery.RESULTSSixty-one patients were followed up for 12 months. All eyes were translocated successfully. Median distance acuity letter score improved from 62 letters (Snellen equivalent of approximately 20/125) before surgery to 69 letters (approximately 20/80) by 12 months after surgery (P = 0.03). Median near acuity improved from 0.70 logarithm of the minimum angle of resolution (logMAR) units (approximately 20/100) before surgery to 0.44 logMAR units (approximately 20/55) at 12 months (P<0.001). Median reading speed improved from 71 words per minute (wpm) before surgery to 105 wpm at 12 months after surgery (P<0.001). At 12 months, distance 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 either preoperative distance or near acuity of worse than 20/80, 40% and 48% of patients, 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.CONCLUSIONSMacular translocation with 360° retinectomy with silicone oil tamponade is effective in significantly improving visual function in patients with neovascular AMD, as demonstrated by the improvement in distance and near acuity and reading speed at 12 months after surgery in these patients. Although this is a complex surgical intervention, patients with 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 patients with vision loss in their second eye resulting from neovascular AMD.