经瞳孔温热疗法治疗渗出型老年性黄斑变性合并中心凹下脉络膜新生血管

Exudative age-related macular degeneration accompanied with choroidal neovascularization treated by transpupillary thermal therapy

目的观察经瞳孔温热疗法（TTT）治疗渗出型老年性黄斑变性（AMD）合并中心凹下脉络膜新生血管（CNV）的疗效。方法回顾分析经TTT治疗的渗出型AMD患者41例44只眼的临床资料。所有患者均经荧光素眼底血管造影（FFA）检查确诊。其中，隐匿性CNV24例26只眼，典型性CNV12例12只眼，微小典型性CNV5例5只眼。采用810nm导体激光进行TTT治疗。根据病灶大小选择光斑直径范围1.0～3．00mm，能量范围160～400mW，时间60S。治疗次数1～3次，平均治疗1.8次，治疗后随访3～24个月，平均随访10．80个月。末次随访者40例42只眼。分别以治疗后1、3个月及末次随访时视力、眼底、FFA及光相干断层扫描（OCT）检查结果作为患眼视功能及病灶变化的观察指标，对比观察治疗前后视力改变、眼底出血渗出吸收、CNV闭合情况。结果末次随访的42只眼中，视力不变或提高者35只眼，占83．34％；视力较治疗前减退者7只眼，占16．67％。OCT检查显示，治疗后1、3个月和末次随访时黄斑区渗液者减少率分别为79．50％、86．40％和88．10％。治疗后3个月，所有患眼黄斑容积较治疗前显著减少，差异有统计学意义（t=1．96，P一0．01）；但治疗后1个月和末次随访时黄斑容积较治疗前相比，差异无统计学意义（t=1．17，0．92；P=0．19，0．83）。FFA检查显示，末次随访时隐匿性、典型性和微小典型性CNV的闭合率分别为79．16％、46．15％和60．00％。仅6只眼渗漏较治疗前增加，其中，典型性CNV5只眼，微小典型性CNV1只眼。结论TTT治疗渗出型AMD合并典型性、隐匿型及微小典型性CNV均有一定效果。

Objective To observe the therapeutic effects of transpupillary thermal therapy （TTT） on exudative age related macular degeneration （AMD） accompanied with subfoveal ehoroidal neovascularization （CNV）. Methods The clinical data of 44 eyes of 41 patients with exudative AMD diagnosed by fundus fluorescein angiography （FFA） who had undergone 810 nm diode laser were retrospectively analyzed. In the 44 eyes of 41 patients, there were 26 eyes of 24 patients had occult CNV, 12 eyes of 12 patients had classic CNV, and 5 eyes of 5 patients had small classie CNV. According to the focus sizes, the diameters of beam spot was 1.2 3.0 mm, the power of laser was 160 400 roW, and the duration was 60 s. The frequency of photocoagulation was once to thrice with the mean of 1.48. The follow up duration was 3-24 months with the mean of 10.8 months. Visual acuity, haemorrhage in ocular fundus, absorption of exudation, and the closure of CNV were examined in the follow up examination. Results A total of 42 eyes of 40 patients were examined at the last time in the follow up duration, in which the visual acuity kept still or improved in 35 eyes of 33 patients （83.34%） and reduced in 7 eyes of 7 patients （16.67%）. The results of OCT revealed that 1 and 3 months after the treatment and at the last time of follow-up duration, the decrease rate of exudative liquid at the macular area was 79.5%, 86.4%, and 88. 1%, respectively. Three months after the treatment, the macular volume decreased significantly than that before the treatment （P = 0. 01）. The results of FFA demonstrated that at the last time in the folow-up duration, the closure rate of occult CNV, classic CNV, and small classic CNV was 79. 16%, 46. 15%, and 60%, respectively. The exudates increased in 6 eyes of 5 paitnets, including 5 eyes of 4 patients with classic CNV and 1 eye of 1 patient with small classic CNV. Conclusion TTT is effective for AMD accompanied with occult CNV, classic CNV, and small classic CNV.