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与年龄有关的黄斑变性(老年性黄斑变性)是西方国家60岁以上成年人视力丧失的首要原因。本病早期表现为黄斑玻璃膜疣和视网膜色素上皮轻度萎缩,视力可无改变或轻度下降。此期没有专门有效的药物或外科治疗能纠正其视力下降。大多数与年龄有关的黄斑变性(AMD)病人只有轻度视力障碍。有些病人玻璃膜疣及视网膜色素上皮萎缩区融合,并会引起中心视力的严重丧失。约10%AMD 病人视力降至20/200或更差,其病眼只有一些萎缩性改变。而90%的病人视力更严重下降的原因是异常的新生血管从脉络膜长入视网膜(脉络膜新生血管化或新生血管膜)。不经治疗,新生血管膜在黄斑形成瘢痕组织并由此导致中心视力的永久丧失。早期脉络膜新生血管形成引起感觉视网膜浆液性脱离,视网膜下出血和呈灰绿色的视网膜色素上皮脱色改变,硬性渗出(脂质沉着)在此期也很常见。这时作荧光血管造影可见强荧光充盈新生血管膜及渗漏勾画出了新生血管区域的轮廓。如果在新生血管长入中心黄斑区或瘢痕组织形成前就发现,可用激光作光凝治疗。以最近的荧光血管造影为指导,用强激光对整个新生血管区作光凝。在新生血管长入黄斑中心或瘢痕组织形成以前就作激光治疗可使严重视力障碍的危险降低50%以上。应对有发生新生血管危险的病人进行监视,对有新生血管形成早期体征和症状的病人应给予充分评价。
Age-related macular degeneration (AMD) is the leading cause of vision loss in adults over the age of 60 in Western countries. Early manifestation of the disease macular drusen and retinal pigment epithelial mild atrophy, visual acuity can be no change or mild decline. No special and effective drugs or surgical treatment of this period can correct their vision loss. Most age-related macular degeneration (AMD) patients have only mild visual impairment. Some patients with drusen and retinal pigment epithelial atrophy fusion, and will cause a serious loss of central vision. Approximately 10% of AMD patients have visual acuity of 20/200 or worse, with only atrophic changes in the affected eye. The reason for the more severe decline in 90% of patients is that abnormal neovascularization grows into the retina (choroidal neovascularization or neovascular membrane) from the choroid. Without treatment, neovascular membranes form scar tissue in the macula and thus result in the permanent loss of central vision. Early choroidal neovascularization causes sensory retinal serous detachment, subretinal hemorrhage, and gray-green retinal pigment epithelial decoloration, and hard exudates (lipid deposits) are also common in this period. Fluorescent angiography at this time shows a strong fluorescence-filled neovascular membrane and leakage outlined the outline of the neovascular area. If the neovascularization into the macular or scar tissue center was found, the laser can be used for photocoagulation. With the recent fluorescent angiography as a guide, with a strong laser photocoagulation of the entire neovascular area. Laser treatment of neovascularization before growing into the macula or scar tissue can reduce the risk of severe visual impairment by more than 50%. Surveillance should be performed on patients at risk of developing neovascularization, and patients with early signs and symptoms of neovascularization should be adequately evaluated.