光动力疗法治疗黄斑中心凹下脉络膜新生血管后激光照射区视网膜厚度的变化

Retinal thickness of laser radiating zone after photodynamic therapy

目的探讨光动力疗法（PDT）治疗黄斑中心凹下脉络膜新生血管（CNV）后激光照射区视网膜厚度的变化。方法对25例（27只眼）黄斑中心凹下CNV患者进行PDT治疗，激光光斑直径1．8—4．3mm（平均2．9mm），应用相干光断层扫描仪（OCT）测量黄斑中心凹和3mm激光照射区平均视网膜厚度，分别比较PDT治疗前和后24h、1周、1和3个月的视网膜厚度。结果PDT治疗前和后24h、1周、1和3个月的黄斑中心凹视网膜厚度分别为（278．07±85．31）、（324．52±96．08）、（242．74±67．40）、（234．26±51．04）μm和（239．73±52．81）μm；3mm激光照射区的平均视网膜厚度分别为（266．71±60．82）、（309．25±82．69）、（257．48±52．48）、（245．44±47．54）μm及（244．88±44．22）μm。PDT治疗前与治疗后24h、1和3个月比较，PDT治疗后24h与1周、1和3个月比较，差异有统计学意义（P〈0．01）。结论PDT激光照射区视网膜厚度在治疗后24h明显增厚，治疗后1周即恢复治疗前水平。提示PDT治疗后激光照射区视网膜水肿的发生可能与CNV渗透、激光照射引起的视网膜和脉络膜血管通透性增加及视网膜色素上皮细胞暂时性功能失代偿有关。（中华聪群杂志．2007．43：505—508）

Objective To observe changes of retinal thickness after photodynamic therapy （PDT） for patients with subfoveal choroidal neovascularization （CNV）, and evaluate the effect of retinal edema after PDT. Methods PDT was performed on 27 eyes of 25 patients with subfoveal CNV, the spot diameter of laser beam was 1.8 - 4.3 mm （ average 2.9 mm）, OCT was used to evaluate the changes of retinal thickness including the retinal thickness of macular fovea and 3 mm laser radiating zone 24 hour 1 week, 1 month, 3 month after PDT. Retinal thickness was compared before PDT and 24 h, 1 week, 1 month, 3 month after PDT respectively. Results Retinal thickness of fovea before PDT and 24 h, 1 week, 1 month, 3 month was （278.07 ±85.31） ,（324.52 ±96.08） ,（242.74 ±67.40） ,（234.26 ±51.04） μm and （239.73 ±52.81 ） μm respectively, the average retinal thickness of 3 nun laser radiating zone was （ 266.71 ± 60.82 ）, （ 309.25 ± 82. 69 ）, （ 257.48 ± 52.48 ）, （ 245.44 ± 47.54 ） μm and （ 244. 88 ± 44.22 ） μm respectively. There was statistical significance before PDT compared with 24 h, 1 month, 3 month after PDT （ P 〈 0. 01 ）. Conclusions The result of our study indicate that retinal thickness of laser radiating zone increases apparently 24 h after PDT and regresses during the first week. It suggest that retinal edema after PDT may due to the leakage from the CNV, increased permeability in choroid and retina of laser radiating zone, and transient dysfunction of retinal pigment epithelial cells. （Chin J Ophthalmol, 2007,43：505-508）