老年黃斑變性

簡介:

       老年黃斑變性為黃斑區結構的衰老性改變。主要表現為視網膜色素上皮細胞對視細胞外節盤膜吞噬消化能力下降,結果使未被完全消化的盤膜殘余小體潴留于基底部細胞原漿中,并向細胞外排出,沉積于Bruch膜,形成玻璃膜疣。由于黃斑部結構與功能上的特殊性,此種改變更為明顯。玻璃膜疣也見于正常視力的老年人,但由此繼發的種種病理改變后,則導致黃斑部變性發生。

分類:

       老年性黃斑變性分為干性和濕性兩種,在最新調研中50歲以上人群的患病率占15.5%,其中濕性占11.9%,就是指有新生血管的;干性占88.1%,就是沒有出血,有視力下降,但比較緩慢,沒有濕性那么嚴重。 與干性相比,濕性AMD進展得更為迅速,而且導致更嚴重的中心視力喪失。濕性老年性黃斑變性的脈絡膜血管異常增生,這些新生血管是相當不健康的,它們突破玻璃膜,進入視網膜下面,這種不健康新生血管相當容易破裂出血,出血以后形成的疤痕是老年性黃斑變性終末期的改變

①干性型:早期可見黃斑區色素紊亂,中心凹反光不清,有散在的玻璃疣。發病晚期,黃斑部可有金屬樣反光,視網膜色素上皮萎縮呈地圖狀,可見囊樣變性。

②濕性型:多有融合的邊界不清的玻璃疣,黃斑有暗黑色圖形,或不規則的病灶,隆起范圍可在1-3個PD,大量視網膜下出血,可進入玻璃體內,形成玻璃體出血晚期病變區呈灰白色瘢痕。

眼底熒光血管造影表現:

       呈現透見熒光時,表現視網膜色素上皮萎縮,色素沉著處可有遮蔽熒光,早期有花邊狀或網狀新生血管,后期有熒光素滲漏(濕性型)

治療及預防

1、預防為主,早期治療

       老年黃斑變性,黃斑區玻璃疣是在本病病程的最早期階段,病變最輕,但它潛伏的危險性很大,此時最不可麻痹大意。少年黃斑變性的患者,早期中心視力有所下降,但眼底改變不明顯,此時應及時發現早期用藥,堅持治療。在任何疾病的過程中,病程最早期,病變最輕階段,都是最好的治療時機,有更多的機會阻止病程進展。

2、急重病例,標本共治

       當黃斑區出現血性色素上皮脫離,神經上皮脫離以及積血進入玻璃體,是病程急劇進展,視功能嚴重受損的征象,這種病例常反復發作,直至視力嚴重損傷或完全喪失。對于這種嚴重病例,必須全力積極治療,我們會根據病情的不同階段,運用不同的治療方法。

魏氏中醫眼科運用中醫藥治療黃斑變性具有很大優勢

       黃斑變性的治療,目前現代醫學沒有特效的治療方法,臨床也常根據病程的階段,使用抗氧化劑,維生素類,止血劑,以及視神經營養藥或細胞激活制劑。對脈絡膜有新生血管的施行光凝術。此時,光凝雖然可以封閉已經存在的新生血管,但對周圍血液循環也會造成不同程度的損傷進而導致局部視網膜萎縮,造成視野缺損。并且不能阻止新的新生血管的形成,目前臨床常用雷珠單抗用于抑制新生血管的再生。但其容易引起血管出血的問題也要引起關注和警惕。所以以上的治療大多為對標治療。容易反復。中醫中藥有著獨特的藥理作用,不會對視網膜組織造成損傷,標本兼治。分別采取塞流止血,益氣通絡,清熱涼血,活血化瘀,有漿液性滲出者,則健脾化痰,祛濕理氣。晚期出血吸收緩慢,化瘀行氣,軟堅散結,對于大量的瘢痕形成,兼以滋補肝腎,軟堅散結,對于早期視力下降輕者,黃斑色素紊亂改變為主,調補肝腎,益氣養血通絡。幾十年來魏氏中醫眼科充分利用現代的科學儀器,擴大望診范圍,利用眼底鏡,、裂隙燈、眼底血管造影,OCT,視野計等檢查手段,對眼內的組織結構、病理改變以及視功能的損傷程度等進行客觀,全面的把握,參照現代醫學的研究成果,做到中西互參,從從宏觀上把握,微觀上分析,西醫診斷、中醫治療,充分發揮中西醫結合優勢。

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