光动力疗法治疗脉络膜新生血管性疾病的初步临床观察

Photodynamic therapy for choroidal neovascularization:a preliminary clinical observation

目的:观察使用维替泊芬光动力疗法(photodynamic thera-py,PDT)治疗年龄相关性黄斑变性(age-related maculardegeneration,AMD)、病理性近视和特发性脉络膜新生血管(choroidal neovascularization,CNV)等3种主要的CNV相关疾病的临床效果。方法:对96例(109眼)经临床确诊的上述CNV患者进行PDT治疗,随访1～24(平均9.4)mo。采用最佳矫正视力、荧光素血管造影、吲哚青绿血管造影、光学相干断层成像等指标,观察治疗前后患者的视功能、CNV病灶大小及渗漏情况、以及视网膜水肿变化等,评价PDT治疗CNV的疗效。结果:本组病例包括AMD42例(54眼),病理性近视17例(18眼),特发性CNV患者37例(37眼)。AMD、病理性近视和特发性CNV的平均治疗次数分别为1.2,1.5和1.2次;视力稳定和提高者各组分别为83.3%,83.3%和86.5%;CNV渗漏停止或减少者各组分别为90.7%,83.3%和89.2%:视网膜水肿减轻者各组分别为77.8%,88.9%和86.5%。除3例AMD患者出现眼部严重不良反应外,未发现其他严重不良反应。结论:PDT可有效地改善或稳定AMD、病理性近视和特发性CNV患者的视功能,控制病变进展,近期随访结果安全有效。

AIM：To evaluate the clinical effects of photodynamic therapy（PDT） for choroidal neovascularization（CNV） in age-related macular degeneration（AMD）,pathological myopia（PM） and idiopathic CNV.METHODS：96 cases（109 eyes） diagnosed as CNV were treated with PDT,and the mean follow-up time was 9.4 months（from 1 to 24 months）.By clinical observation of the best corrected visual acuity（BCVA）,fundus fluores-cein angiography（FFA）,indocyanine green angiography（ICGA） and optic coherence tomography（OCT）,the changes of visual function,the size and leakage of CNV lesion,as well as intra-and subretinal fluid before and after PDT were compared to evaluate the therapeutic effects of PDT.RESULTS：42 cases（54 eyes） of AMD,17 cases（18 eyes） of PM and 37 cases（37 eyes） of idiopathic CNV were included in the study.The mean times of PDT treatment for AMD,PM and idiopathic CNV were 1.2,1.5 and 1.2 respectively.After PDT,in AMD,PM and idiopathic CNV group,the rates of BCVA which improved or kept stable were 83.3%,83.3% and 86.5% respectively;the rates of decrease or disappearance of fluorescein leakage were 90.7%,83.3% and 89.2% respectively;the rates of reduction of intra-and subretinal fluid were 77.8%,88.9% and 86.5% respectively.Three AMD cases had serious adverse responses.CONCLUSION：PDT could improve or stabilize the visual function of AMD,PM and idiopathetic CNV patients,as well as control the progression of disease.It is safe and effective for CNV patients in the short and medium follow-up period.