Basic and clinical approach for analysis and treatment of the age related neovascular maculopathy

根据对老年性黄斑变性患者的临床观察资料，制作动物眼实验模型。建立了视网膜色素上皮(RPE)的人工损伤模型，并用玻璃体手术的方法将RPE移植到人工损伤的兔眼。组织化学显示两种模型均显示粘液功能恢复。在人工损伤RPE的视网膜中证实了RPE的再生，并通过向玻璃体腔内注射碱性成纤维细胞生长因子来刺激RPE的再生。玻璃体手术已被引入到治疗伴有大量视网膜下病变的老年性黄斑变性以及激光光凝治疗。通过对摘除的视网膜下病变的分析，揭示了该病的扩散方式和病变内容。每个标本以纤维血管组织为主，有新鲜血肿和陈旧血肿。所有标本均见受损的视网膜色素上皮(RPE)细胞。几例术后黄斑区无RPE，但视力有明显提高。为了进一步改善视功能，可能需要使用生长因子或视网膜移植进行新的补充治疗。

According to the informations obtained from clinical observation of the patients with age telated macular degeneration, experimental models using animal eyes were made. An artificial damage of retinal pigment epithlium (RPE) was established and the transplantation of RPE to the rabbit eyes with such artificially damaged retina was perfgomed with vitreous surgery. The functional recovery in vison was histochemically shown in both models. Regeneration of RPE was proved in the retina with artificially damaged RPE and was stimulated by the administration of basic fibroblast growth factor into the vitreous cavity.Vitreous surgery has been introduced to the treatment of the age related macular degeneration with massive subretinal lesion as well as treatment with laser photocoagulation. By means of analysis of the removed subretinal lisions, the manner of extention of this disease was revealed and the contents of lesion were also revealed. Each specimen mainly consists of fibrovascular tissue with fresh and old hematomas. The damaged retinal pigment epithelium (RPE) cells were also found in all specimens. Several cases showed remarkable improvement in visual acuity although those cases have no RPE at macular area after the surgery. New supplemental treatments using growth factor or retinal transplantation may be necessary in order to obtain further improvement in the visual function.