光动力疗法治疗病理性近视继发脉络膜新生血管的疗效观察

Clinical observation of photodynamic therapy for choroidal neovascularization secondary to pathological myopia

目的观察光动力疗法（PDT）治疗病理性近视（PM）继发脉络膜新生血管（CNV）的临床效果。方法临床确诊为PM继发CNV并接受PDT治疗的66例患者73只眼纳入研究。所有患者均按常规方法进行PDT治疗。治疗前后均行最佳矫正视力（BCVA）、检眼镜、荧光素眼底血管造影（FFA）和（或）吲哚青绿血管造影（ICGA）及光相干断层扫描（OCT）检查。视力检查结果转换为最小分辨角对数视力（10gMAR）记录，对比分析所有患眼治疗前后logMARBCVA。治疗后52只眼保存完整的FFA检查记录，根据其CNV渗漏或出血以及CNV扩大或缩小设定为治疗效果良好、中等、较差。治疗后11只眼保存完整的OCT检查记录，根据其检查结果对比分析黄斑中心凹视网膜厚度改变情况。结果治疗后患眼平均logMARBCVA为0．74±0．51；与治疗前比较，差异无统计学意义（t=1．11，P=0．27）。其中，视力改善18只眼，占24．7％；稳定43只眼，占58．9％；下降12只眼，占16．4％。保存完整FFA检查记录的52只眼中，治疗效果良好39只眼，占75．0％；中等9只眼，占17．3％；较差4只眼，占7．7％。保存完整OCT检查记录的11只眼中，中心凹视网膜厚度变薄7只眼，占63．6％；稳定2只眼，占18．2％；增厚2只眼，占18．2％。结论PDT能有效治疗PM继发CNV，改善或稳定大部分患者视力。

Objective To observe the efficacy of photodynamic therapy （PDT） for choroida[ neovascularization （CNV） secondary to pathological myopia （PM）, Methods Sixty-six patients （73 eyes） with CNV secondary to PM who had undergone PDT were enrolled in this study. PDT was performed according to the standard treatment. The patients received the examinations of best corrected visual acuity （BCVA）, ophthalmoscopy, fundus fluorescein angiography （FFA） and/or indocyanine green angiography （ICGA）, and optical coherence tomography （OCT） before and after the treatment. Vision results were converted into logMAR records and compared before and after the treatment. The complete records of FFA were found in 52 eyes. FFA findings, treatment effects, were judged as well, moderate or poor according to the CNV leakage or bleeding, and CNV expanding or shrinking. The complete records of OCT were found in 11 eyes. CNV regional edema and foveal thickness were analyzed based on OCT examination. Results The mean logMAR BCVA after PDT treatment was 0.74±0.51 with no significant difference compared with before treatment （t=1. 11, P=0.27）. There were 18 eyes （24.7%） with improved vision, 43 eyes （58.9%） with stable vision, and 12 eyes （16.4%） with decreased vision. In 52 eyes with FFA findings, 39 eyes （75.0%） with well effect, 9 eyes （17.1%） with moderate effect, and 4 eyes （7.7%） with poor effect. OCT showed that after treatment the CNV regional edema subsided in most of eyes, and there were 7 （63.64%） with decreased foveal thickness, 2 （18.18%） with stable thickness, and 2 （18.18%） with increased thickness. Conclusions PDT is an effective treatment for CNV secondary to PM. It may improve or stabilize the visual acuity.