Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-gas exchange for displacement of thick submacular hemorrhage in age-related macular degeneration
Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-gas exchange for displacement of thick submacular hemorrhage in age-related macular degeneration
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DOI：
10.1016/s0002-9394(00)00734-0
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发表时间：
2001-02-01
影响因子：
4.2
通讯作者：
Postel, EA
中科院分区：
文献类型：
--
作者：
Haupert, CL;McCuen, BW;Postel, EA
目的：评估一种新的手术方法，用于治疗年龄相关性黄斑变性患者的大而厚的黄斑下出血。方法：对 11 名患有年龄相关性黄斑变性和厚黄斑下出血（定义为引起立体眼底照片上可检测到的视网膜抬高）的 11 名患者的 11 只眼睛进行回顾性检查，这些患者接受了玻璃体切除术、视网膜下注射组织纤溶酶原激活剂（25 或 50 杯）和术后俯卧位的液-气交换。结果指标包括黄斑中心凹出血移位情况、术后最佳视力和最终术后视力。 结果：11 名患者（7 名男性和 4 名女性；平均年龄 76 岁）的 11 只受影响的眼睛中，术前视力范围为 20/200 至手部运动。通过手术，所有 11 例患者的视网膜下出血均从中央凹转移。术后平均随访时间为 6.5 个月（范围：1 至 15 个月）。术后最佳视力范围为 20/30 至 5/200，其中 9 例（82%）有改善，2 例无变化。八只眼睛 (73%) 测量为 20/200 或更好，其中四只眼睛 (36%) 测量为 20/80 或更好。最终术后视力范围为20/70至光感，8例（73%）改善，1例无变化，2例恶化。术前和术后最佳视力之间存在统计学显着差异（P=0.004），但术前和最终视力之间没有显着差异（P=0.16）。三只眼睛 (27%) 再次出现出血，导致一只眼睛严重视力丧失。 结论：该技术可将黄斑下出血从中央凹转移出来，并可以改善年龄相关性黄斑变性患者的视力。然而，27%的眼睛再次出血，并导致一只眼睛严重失明。需要进行随机、前瞻性临床试验来确定该技术与其他拟议治疗方法相比的疗效。 （美国眼科杂志 2001 年；131：208-215。(C) 2001 年，Elsevier Science Inc. 保留所有权利）。
PURPOSE: To evaluate a new procedure for displacement of large, thick submacular hemorrhage in patients with age-related macular degeneration.METHODS: Retrospective review of 11 eyes of 11 patients with age-related macular degeneration and thick submacular hemorrhage (defined as causing retinal elevation detectable on stereo fundus photographs) treated with vitrectomy, subretinal injection of tissue plasminogen activator (25 or 50 mug), and fluid-gas exchange with postoperative prone positioning. Outcome measures included displacement of hemorrhage from the fovea, best postoperative visual acuity, and final postoperative visual acuity.RESULTS: In the 11 affected eyes of 11 patients (seven men and four women; mean age, 76 years), preoperative visual acuity ranged from 20/200 to hand motions. With surgery, subretinal hemorrhage was displaced from the fovea in all 11 cases. Mean postoperative follow-up was 6.5 months (range, 1 to 15 months). Best postoperative visual acuity varied from 20/30 to 5/200, with improvement in nine (82%) cases and no change in two cases. Eight eyes (73%) measured 20/200 or better, with four of these eyes (36%) 20/80 or better. Final postoperative visual acuity ranged from 20/70 to light perception, with improvement in eight (73%) cases, no change in one case, and worsening in two cases. A statistically significant difference was found between preoperative and best postoperative visual acuity (P=.004) but not between preoperative and final visual acuity (P=.16). Hemorrhage recurred in three (27%) eyes, causing severe visual loss in one eye.CONCLUSIONS: This technique displaces submacular hemorrhage from the fovea and can improve vision in patients with age-related macular degeneration. However, recurrence of hemorrhage occurred in 27% of eyes and caused severe visual loss in one eye. A randomized, prospective clinical trial is necessary to determine the efficacy of this technique in comparison with other proposed treatments. (Am J Ophthalmol 2001;131: 208-215. (C) 2001 by Elsevier Science Inc. All rights reserved).