经瞳孔温热疗法治疗老年性黄斑变性中心凹下新生血管

Transpupillary thermotherapy for subfoveal choroidal neovascularization of age-related macular degeneration

目的探讨经瞳孔温热疗法(transpupillary thermotherapy,TTT)治疗老年性黄斑变性中心凹下新生血管的安全性及疗效.方法应用810nm激光对53例(62眼)经FFA或ICG确诊的AMD黄斑中心凹下CNV进行TTT治疗.每个光斑的照射时间为60s,激光能量为120～150mW/mm光斑直径.以矫正视力、眼底及FFA改变评价疗效.末次治疗后随诊3～15月,平均7.5月.结果末诊时,62眼共接受151次TTT治疗,平均治疗2.4次.视网膜出血完全吸收者46眼(74.19%),大部分吸收者5眼(8.06%),部分吸收者5眼(8.06%),复发性出血者6眼(9.68%).视力提高者16眼(25.81%),不变者42眼(67.74%),下降者4眼(6.45%);其中视力低于0.1者30眼(48.39%),0.1～0.3者27眼(43.55%),＞0.3者5眼(8.06%).结论 TTT是一种安全的治疗AMD黄斑中心凹下CNV的方法,能有效地促进视网膜出血吸收和CNV癍痕化,使大部分患者的视力保持稳定,但对视力的提高作用不明显.

Objective To investigate the safety and efficacy of transpupillary thermotherapy(TTT)for subfoveal choroidal neovascularization(CNV)in patients of age-related macular degeneration(AMD). Methods 53 cases(62eyes)of AMD with subfoveal CNV diagnosed by FFA or ICG were treated by TTT with diode 810nm laser.The power of laser was set 120～150mW/mm diameter of light spot with a duration of 60 seconds for each spot.Visual acuity,retinal and FFA changes were used to evaluate the effect.The follow-up time was 3～15 months after the last treatment(averaged 7.5 months). Results At the last follow-up,the 62 eyes received 151 times of TTT with the mean of 2.4 times for each eye.Retinal hemorrhage absorbed totally in 46 eyes(74.19%),mostly in 5 eyes(8.06%)and partly in 5 eyes(8.06%),recurrent hemorrhage occurred in 6 eyes(9.68%).Visual acuity improved in 16 eyes(25.81%),stabilized in 42 eyes(67.74%)and decreased in 4 eyes(6.45%).Visual acuity was lower than 0.1 in 30 eyes(48.39%),0.1～0.3 in 27 eyes(43.55%)and >0.3 in 5 eyes(8.06%). Conclusions TTT is a safe method for subfoveal CNV of AMD.It could improve retinal hemorrhage absorption and CNV cicatrisation and make most patients keep stable vision,but no obvious effect on visual improvement.