经瞳孔温热疗法治疗老年性黄斑变性合并中心凹下脉络膜新生血管

Transpupillary thermal therapy for age-related macular degeneration accompanied with subfoveal choroidal neovascularization

目的 观察经瞳孔温热疗法 (TTT)治疗老年性黄斑变性 (AMD)合并中心凹下脉络膜新生血管 (CNV)的疗效。 方法 采用半导体 810红外激光对荧光素眼底血管造影 (FFA)和吲哚青绿血管造影 (ICGA)检查确诊的 AMD合并 CNV患者 4 7例 5 1只眼进行治疗。其中 ,隐匿型 CNV4 0例 4 2只眼 ,经典型 CNV7例 9只眼 ;初诊时平均视力为 0 .12。根据病灶大小选择光斑直径分别为 0 .8、1、2、3.0 mm ;能量相应为 12 0、16 0、2 6 0、36 0 m W;时间 6 0 s。治疗后每 1个月随访复查 1次 ,如有需要 ,进行重复治疗 ,治疗次数 1～ 3次。治疗后随访 3～ 33个月 ,平均随访时间 10个月。随访时检查视力、眼底出血和渗出吸收、CNV闭合情况。 结果 治疗眼治疗后均无即刻视力下降或其他不适。末诊时平均视力为 0 .16 ,与初诊视力相比 ,6 8.6 2 %无变化 ,2 5 .5 3%增加 ,7.84 %降低。FFA联合 ICGA检查显示 :治疗后 3个月时 ,隐匿型 CNV闭合率为 4 2 .86 % ,经典型 CNV闭合率为 2 2 .2 2 % ;6个月时 ,隐匿型 CNV闭合率为 73.81% ,经典型CNV闭合率为 6 6 .6 7%。检眼镜检查显示 :治疗后 3个月 ,隐匿型 CNV4 2只眼中 ,出血和 (或 )渗出部分或全部吸收 ,并有厚薄不等的机化瘢痕形成 ;经典型 CNV 9只眼中 7只眼出血和渗出减轻 ;1只眼有新?

Objective To investigate the therapeutic efficacy of transpupillary thermal therapy (TTT) for age-related macular degeneration (AMD) accompanied with subfoveal choroidal neovascularization (CNV). Methods Fifty-one eyes of 47 patients whose illness had been diagnosed as AMD by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were treated with diode 810 laser. There are 42 eyes of 39 patients had occult CNV and 9 eyes of 8 patients had classic CNV, and the average visual acuity in their fist diagnosis was 0.12. According to the focus size, the diameters of beam spot varied from 0.8, 1.2, 2.0, and 3.0 mm; and the power was 120, 160, 260 and 360mW correspondingly, with the duration of 60 seconds. The follow-up examination was performed once a month after the treatment, and repetitious treatment would be taken once to thrice if necessary. The follow-up period was 3~33 months with the mean of 10 months. Visual acuity, haemorrhage in ocular fundus, absorption of exudation, and the closure of CNV were examined in the follow-up examination. Results No immediate decrement of visual acuity or any other discomforts were found in all of the treated eyes soon after the treatment. The average visual acuity of 51 eyes was 0.16 in the last diagnosis, which remained no change in 68.62%; increased in 23.53% and decreased in 7.84% compared with that in the first diagnosis. The results of FFA and ICCG demonstrated that at the 3rd months after the treatment, the closure rate was 42.86% in occult CNV and 22.22% in classic CNV; and at the 6th month, the closure rate was 73.81% in occult CNV and 66.67% in classic CNV. The results of ophthalmoscopy showed that at the 3rd month after the treatment, partial or complete absorption of hemorrhage and/or exudates with various thickness of organized scarring tissue was found in 42 eyes with occult CNV; decrement of hemorrhage and exudates was observed in 7 out of 9 eyes with classic CNV; and new hemorrhage occurred in 1 eye. At the 6^(th) month, in 27 eyes with occult CNV, new hemorrhage occurred in 3 including 2 eyes with occult CNV, new hemorrhage occurred in 3 including 2 eyes with faster absorption and remaining unchanged for 12 months; in 5 eyes with classic CNV, new hemorrhage occurred in 2, which was absorbed after treated again and remained stable in the 16-month followed-up. In 19 eyes with occult CNV which had been followed up for more than 6 months, hemorrhage disappeared in 5 and new hemorrhage occurred in 5. In the followed-up over 6 months, new hemorrhage occurred in 8 eyes with the recurrent rate of 15.6%. Conclusion TTT is effective for AMD with either classic or occult CNV. In the long-term followed-up, CNV recurs in 15.6% of the treated eyes which may be improved after the further treatment.