组合光斑光动力疗法治疗孤立性脉络膜血管瘤的疗效和安全性观察

Combination facula photodynamic therapy for circumscribed choroidal hemangioma

目的观察组合光斑光动力疗法（PDT）治疗孤立性脉络膜血管瘤的疗效和安全性。方法为回顾性系列病例研究。经眼底镜、荧光素眼底血管造影、眼底彩色照相及B超检查，确诊孤立性脉络膜血管瘤患者10例，均只行一次组合光斑PDT治疗。术前最佳矫正视力为眼前数指至0．3，B超检查肿瘤最大直线距离为5．5—9．9mm，平均6．8mm；最大厚度1．1—3．8mm，平均2．7mm，4例伴视网膜脱离。PDT治疗为注射用维替泊芬6mg／m^2体表面积，10min推注完毕，5min后行689nm激光照射，激光参数50J／cm^2，时间83s，光斑大小3～5mm，治疗2—3个光斑，根据肿瘤大小及形状治疗光斑可以部分重叠，术后随访3．0～15．0个月，平均8．5个月。结果组合光斑PDT治疗后最后一次随访视力为眼前数指至1．0，7例患者提高2行以上，3例稳定。其中2例B超检查提示肿瘤测不出。8例肿瘤最大厚度0．5—2．7mm，平均1．9mm，最大直线距离4．2—8．3mm，平均6．4mm，2例视网膜脱离消失，有视网膜色素上皮改变。结论组合光斑PDT治疗孤立性脉络膜血管瘤安全有效，可以使瘤体萎缩，视网膜脱离消失或减轻，视力提高。

Objective To assess the clinical effect of combination facula photodynamic therapy （PDT） on patients with circumscribed choroidal hemangioma. Methods It was a retrospective case series. Ten cases of circumscribed choroidal hemangioma were diagnosed by ophthalmoscopy, fundus fluorescein angiography and B-scanning ultrasound examination. Clinical data of these cases were retrospectively analyzed. All of these patients had undergone combination facula PDT. The best corrected visual acuity before PDT was FC to 0. 3. The maximum diameter of the tumor was 5.5-9. 9 mm and averaged 6. 8 mm. The maximum thickness of the tumor was 1.1-3. 8 mm and averaged 2. 7 mm. Four patients suffered from retinal detachment. The intravenous injection of visudyne （6 mg/m^2） was performed in 10 minutes. Five minutes later,laser irradiation （wave length 689 nm） was performed with the parameters of 50 J/cm^2, 83 s, and 2 to 3 spots. The follow-up period was 3.0 to 15.0 months （ mean 8.5 months）. Results The visual acuity in the last examination after treatment was FC-1.0 ,which was 2-line increased in 7 patients and was steady in 3 patients. B-scanning ultrasound examination showed that the hemangioma was undetectable in 2 patients, and in the other 8 patients, the hemangioma had the diameter of 4. 2 to 8. 3 mm （ average 6.4 mm） and the thickness was 0. 5 to 2. 7 mm （ average 1.9 mm）. Retina detachment disappeared in 2 patients . Conclusions Combination facula PDT may lead to the shrinking of choroidal hemangioma, disappearance of subretinal fluid,reattaehment of retina and the increase or saving of the visual acuity. It is a effective and safe treatment for the mactdar circumscribed choroidal hemangioma. （Chin J Ophthalmo1,2008,44：790-793 ）