光动力疗法治疗脉络膜血管瘤的临床分析

Clinical analysis of photodynamic therapy for choroidal hemangioma

目的观察光动力疗法（photodynamic therapy,PDT）治疗脉络膜血管瘤（choroidal hemangioma,CH）的疗效。方法回顾性分析接受PDT治疗的13例（13眼）CH患者的临床资料。其中,孤立性脉络膜血管瘤（circumscribed choroidal hemangioma,CCH）10例（10眼）,Sturge-Weber综合征弥漫性脉络膜血管瘤（diffused choroidal hemangioma,DCH）3例（3眼）。PDT治疗采用维替泊芬6mg.m-2体表面积剂量10min内匀速静脉注射,5min后激光照射,功率密度600mW.cm-2,曝光时间83~166s,能量强度50~100J.cm-2。照射1~3个光斑以完全覆盖整个CCH瘤体;治疗前后进行彩色眼底照相、荧光素眼底血管造影及眼部超声检查。结果 PDT治疗后3~6个月,10眼CCH中,3眼视力提高,达到0.4~0.8,瘤体均位于颞上或颞下血管弓旁;5眼患者视力无变化,其中2眼瘤体位于颞上或颞下血管弓旁,1眼位于视盘鼻下,2眼位于黄斑中部;2眼视力下降,瘤体位于黄斑中部。眼底检查部分患眼CCH橘红色病灶缩小,表面有少许色素。荧光素眼底血管造影检查荧光素渗漏减轻,部分消退。超声检查治疗前CCH瘤体平均厚度为（3.40±2.00）mm,治疗后平均厚度为（2.22±1.37）mm,差异有统计学意义（t=2.51,P〈0.05）。治疗前,CCH瘤体平均最大直径为（8.97±3.12）mm,治疗后平均最大直径为（7.27±3.40）mm,差异无统计学意义（t=2.20,P=0.07）。PDT治疗后,DCH3眼中,2眼视力无变化,1眼下降。PDT治疗前后眼底检查、荧光素眼底血管造影及超声检查瘤体厚度无明显变化。结论 PDT治疗CCH安全有效,可作为CCH的首选治疗方法,治疗后视功能恢复与CH瘤体的位置及厚度有关;单次PDT治疗DCH的疗效不确定,需要进一步探讨。

Objective To investigate the efficacy of photodynamic therapy（PDT）for choroidal hemangioma（CH）.Methods The clinical data of 13 CH patients（13 eyes）taking PDT treatment were retrospectively analyzed.There were 10 cases（10 eyes）with circumscribed choroidal hemangioma（CCH）and 3 cases（3 eyes）with Sturge-Weber diffused choroidal hemangioma（DCH）.Intravenous injection of verteporfin with 6 mg·m-2 body surface was taken for 10 minutes in PDT treatment.Laser exposure was taken 5 minutes later,power density was 600 mW·cm-2,exposure time was 83 seconds to 166 seconds,and energy intensity was 50 J·cm-2 to 100 J·cm-2.About 1 to 3 fusion facula completely covered the CCH tumor body.Fundus photography,fundus fluorescein angiography and ocular ultrasonography were taken before and after treatment.Results At 3 months to 6 months after PDT treatment,in 10 eyes with CCH,there were 3 eyes with visual acuity improved to 0.4 to 0.8,and tumor bodies were at arcus of blood vessels above and under temple;Visual acuity of 5 eyes were unchanged,about tumor bodies of 2 eyes were at arcus of blood vessels before and under temple,1 eye at optic disc under nose and 2 eyes at the center of macula lutea;Visual acuity of 2 eyes decreased and tumor bodies were at center of macula lutea.Fundus photography showed that jacinth focus decreased in some eyes with CCH and with a little pigment.Fundus fluorescein angiography examination showed that fluorescein leakage was lessened and some were extinct.The average thickness of CCH tumor body was（3.40±2.00）mm before treatment and（2.22±1.37）mm after treatment with ultrasound examination,there was statistical difference（t=2.51,P0.05）.Before PDT treatment,the average biggest diameter of CCH tumor body were（8.97±3.12）mm,and（7.27±3.40）mm after treatment,there was no statistical difference（t=2.20,P=0.07）.After PDT treatment,visual acuities of 2 eyes were unchanged,and 1 eye decreased in total 3 eyes with DCH.There was no change in examination of fundus,fundus fluorescein angiography and tumor thickness with ultrasound examination.Conclusions PDT is safe and effective for CCH,and the initial treatment for CCH.After treatment,recovery of visual function is related to CCH tumor location and thickness.Curative effect of PDT with one time is uncertain,and more studies are needed.