光动力治疗脉络膜新生血管预后多因素分析

Multi-factor analysis of visual acuity prognosis of photodynamic therapy for choroidal neovascularization

目的 探讨单次光动力疗法 (photodynamictherapy ,PDT)治疗脉络膜新生血管 (choroidalneovascularization ,CNV)影响术后视力的相关因素 ,为进一步提高光动力疗法治疗效果积累临床经验。方法 对 10 2例 (10 2眼 )CNV患者进行PDT治疗 ,观察术后矫正视力与病因分类、术前初始视力、病程、病变大小 (以荧光素眼底血管造影 (FFA)加以判断 )、FFA分型、治疗后FFA变化等因素的关系 ,运用SPSS统计软件 ,分别在术后 1和 3个月进行视力的多因素相关回归分析。结果 术后 1个月的矫正视力与治疗前初始视力、病变大小、病程长短和治疗后FFA变化显著相关 (P =0 .0 0 9、0 .0 32、0 .0 4 0、0 .0 4 9) ;术后 3个月视力与初始视力、病变大小和治疗后FFA变化相关 (P =0 .0 0 9、0 .0 34、0 .0 4 7) ;术后 1个月复查时 ,矫正视力是否提高与CNV的FFA分型、病程长短有关 (P =0 .0 38、0 .0 76 )。结论 病程短、CNV面积较小的患者治疗后更可能获得较好视力。典型性CNV患者术后视力提高的比例较大 ,对有适应证的患者尽早治疗可能获得较好的视力改善。

Objective To invertigate the influential factors of visual acuity after a single photodyna mic therapy(PDT) for choroidal neovascularization (CNV). Methods One hundred and two cases were observed.The pathogeny,t he preoperative visual acuity,the courses,the area of CNV,the FFA type of CNV an d the changes in the FFA were recorded.The SPSS statistics software was used to do multi-factor regression analysis of visual acuity at 1 month and 3 months af ter PDT.Results Post-operative visual acuity was related to th e preoperative visual aruity,the area of CNV,courses,and the changes in the FFA within 1 month postoperatively(P=0.009,0.032,0.040,0.049),and was related to the visu al acuity preoperatively,courses and the changes in the FFA at 3 months after PDT(P=0 .009,0.034,0.047).The visual acuity improvement post-operatively was related t o the FFA type of CNV and the course in 1 month postoperatively(P=0.038,0.0 7 6).Conclusion The smaller lesion,the better postoperative visio n;The p roportion of visual acuity improvement is relatively higher in patients presenti ng with of classic CNV than of occult CNV.We recommend that patients presenting of subfoveal CNV with good indication should be treat early as soon as possible.