摘要目的:观察自体视网膜色素上皮（RPE）移植治疗老年性黄斑变性（AMD）继发严重陈旧性黄斑下出血（SMH）的疗效。方法:回顾性临床研究。2012年1月至2015年12月于上海交通大学医学院附属新华医院眼科检查确诊并接受玻璃体切割手术（PPV）联合自体RPE移植手术治疗的AMD继发大量陈旧性SMH患者11例11只眼纳入研究。其中，男性9例9只眼，女性2例2只眼。所有患眼均行最佳矫正视力（BCVA）、光相干断层扫描检查；同时行黄斑注视功能（MAIA）检查4只眼。BCVA检查采用国际标准视力表进行，统计时换算为最小分辨角对数（logMAR）视力。所有患眼均行PPV联合自体单层RPE移植或自体RPE-脉络膜全厚移植，并据此分为S组、C组，分别为5、6只眼。两组患者年龄（ t=-0.363）、性别构成比（ χ2=0.549）、SMH病程和厚度（ t=0.118、0.231）、平均抗血管内皮生长因子药物治疗次数（ t=0.129）、PPV次数（ t=-0.452）比较，差异均无统计学意义（ P>0.05）。手术后随访时间6~40个月，观察手术后患眼BCVA、MAIA、移植片状态及并发症发生情况。组间连续变量比较行独立样本 t检验；分类变量比较行 χ2检验。 结果:末次随访时，S组、C组患眼logMAR BCVA分别为1.62±0.34、1.03±0.20；C组优于S组，但差异无统计学意义（ t=1.532， P=0.160）。与手术前比较，S组、C组患眼BCVA提高者分别为4（80%，4/5）、6（100%，6/6）只眼；两组患眼BCVA提高的百分率比较，差异无统计学意义（ χ2=0.677， P=0.895）。S组、C组BCVA优于logMAR 1.0者分别为2（40%，2/5）、3（50%，3/6）只眼，差异无统计学意义（ χ2=0.572， P=0.423）。手术后移植片状态良好6只眼，状态不良5只眼；移植片状态良好者BCVA显著高于状态不良者，差异有统计学意义（ t=4.894， P=0.001）。行MAIA检查的4只眼中，移植片上不稳定弥漫性注视2只眼；注视点位于毗邻移植片区域的正常视网膜处2只眼。手术后发生继发性视网膜下出血3只眼；手术后眼压高1只眼。随访期间所有患眼均未发生眼内感染、继发性视网膜脱离、复发性脉络膜新生血管或低眼压等并发症。 结论:自体单层RPE移植和自体RPE-脉络膜全厚移植均有助于稳定甚至提高晚期AMD继发严重SMH患眼的视功能，其手术后视力与移植片状态密切相关。

abstractsObjective:To evaluate the functional and anatomical outcomes of autologous single retinal pigment epithelium (RPE) transplantation for severe obsolete submacular hemorrhage (SMH) in late age-related macular degeneration (AMD).Methods:A retrospective clinical study. From January 2012 to December 2015, 11 patients with AMD (11 eyes) with obsolete SMH who were diagnosed and treated by pars plana vitrectomy (PPV) combined with autologous RPE transplantation at the Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were included. Among them, there were 9 eyes in 9 males and 2 eyes in 2 females. All the eyes underwent the examinations of best corrected visual acuity (BCVA) and optical coherence tomography; 4 eyes underwent macular fixation function (MAIA) at the same time. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. All eyes were treated with PPV combined with autologous single-layer RPE transplantation or autologous RPE-choroidal full-thickness transplantation, and were divided into S group and C group, with 5 and 6 eyes respectively. The differences of age ( t=-0.363), gender composition ratio ( χ2=0.549), course and thickness of SMH ( t=0.118, 0.231), average times of anti-vascular endothelial growth factor drug treatments ( t=0.129), times of PPV ( t=-0.452) between the two groups were not statistically significant ( P>0.05). The follow-up period was 6-40 months after the operation, and the BCVA, MAIA, graft status and complications of the eyes after the operation were observed. The comparison of continuous variables between groups was performed by independent-sample t test; the comparison of categorical variables was performed by χ2 test. Results:At the last follow-up, the average logMAR BCVA of the eyes in group S and C were 1.62±0.34 and 1.03±0.20, respectively; group C was better than group S, however, the difference was not statistically significant ( t=1.532, P=0.160). There were 4 eyes (80%, 4/5) and 6 eyes (100%, 6/6) in S group and C group with BCVA better than preoperative, the difference was no statistical significance ( χ2=0.677, P=0.895). There were 2 (40%, 2/5) and 3 (50%, 3/6) eyes with logMAR BCVA better than 1.0 in S group and C group, and the difference was not statistically significant ( χ2=0.572, P=0.423). After the operation, 6 eyes of grafts were in good condition and 5 eyes were in poor condition; the BCVA of grafts in good condition was significantly higher than that of poor condition, the difference was statistically significant ( t=4.894, P=0.001). Among the 4 eyes that underwent MAIA examination, 2 eyes were unstable and diffusely fixed on the graft; the fixation point was located at the normal retina adjacent to the graft area in 2 eyes. Secondary subretinal hemorrhage occurred in 3 eyes after the operation; the intraocular pressure was high in 1 eye after the operation. During the follow-up period, no intraocular infection, secondary retinal detachment, recurrent choroidal neovascularization or low intraocular pressure occurred in all eyes. Conclusions:Both autologous single-layer RPE transplantation and autologous RPE-choroidal full-thickness transplantation can help stabilize or even improve the visual function of eyes with severe SMH secondary to advanced AMD. The visual acuity after surgery is closely related to the state of the graft.