加齢黄斑症の臨床所見と経過

Clinical findings and courses of age-related maculopathy

　少なくとも1眼に加齢黄斑症のある453例906眼を遡及的に検索した。男314例，女139例で，年齢は48〜91歳，平均69±8.9歳であった。診断時の所見として，早期加齢黄斑症151眼，漿液性網膜色素上皮剥離21眼，加齢黄斑変性510眼（滲出型489眼，萎縮型21眼）があった。経過中に早期加齢黄斑症の2眼が黄斑変性に，1眼が萎縮型に移行した。滲出型の約60％に滲出持続や線維化進行があり，35％で視力が低下した。いわゆるclassic型の新生血管を含む眼は予後不良であった。約20％の症例がMacular Photocoagulation Study Groupの治療基準に合致した。フルオレセイン蛍光造影で病巣の境界が不鮮明な眼の75％に，インドシアニングリーン（ICG）蛍光造影で新生血管が検出された。ICG造影に基づく治療で，約60％の眼で視力が維持された。

We reviewed 906 eyes of 453 patients who had age-related maculopathy in one eye at least. The series comprised 314 males and 139 females. Their ages ranged from 48 to 91 years, average 69±8.9 years. The initial fundus lesions comprised early-stage age-related maculopathy 151 eyes, serous detachment of retinal pigment epithelium 21 eyes, and age-related macular degeneration 510 eyes including exudative type 489 eyes and atrophic type 21 eyes. During the course of observation, early-stage age-related maculopathy progressed to macular degeneration in 2 eyes and to macular atrophy in 1 eye. The exudative lesion either persisted or progressed to fibrosis in 60% of eyes belonging to exudative type. The visual acuity deteriorated in 35% of eyes of this type. Only 20% of eyes in the whole series satisfied the criteria for laser treatment set by the Macular Photocoagulation Study Group. Well-defined neovascularization was detected by indocyanine green (ICG) angiography in 75% of eyes that showed poorly defined neovascularization by fluorescein angiography. Visual acuity was preserved in 60% of eyes by ICG-guided laser photocoagulation.