特发性脉络膜新生血管的治疗

Treatment for idiopathic choroidal neovascularization

脉络膜新生血管(choroidal neovascularization,CNV)是导致年龄<50岁的眼病患者中心视力丧失的常见原因,其病因多种多样,常见病因包括病理性近视、特发性CNV(idiopathic choroidal neovascularization,ICNV)、眼拟组织包浆菌病综合征、眼底血管样条纹以及外伤等。其中,年龄<50岁的CNV患者不伴有明显的眼内炎症反应或存在其他促使新生血管发生的因素,则将此类CNV称为ICNV。ICNV的常见症状包括视物模糊、视物变形、视野固定暗点等。虽然多数患者的自然预后相对良好,但较大面积的CNV常导致中心视力丧失,会严重影响患者生活质量,有必要对其进行及时治疗。目前ICNV的治疗方法包括光动力疗法、抗血管内皮生长因子治疗、激光光凝治疗、手术治疗、经瞳孔温热疗法以及联合治疗等,其中主要治疗方法为光动力疗法和抗血管内皮生长因子治疗。光动力疗法联合皮质类固醇类药物治疗是一种极具前景的治疗方法;对旁中心凹ICNV亦可以考虑进行激光光凝治疗。本文将就ICNV的各项治疗方法做一综述,以期对临床工作有所裨益。

Choroidal neovascularization（CNV） is a common cause of vision loss in patients aged less than 50 years old.The etiology of CNV is various,including pathologic myopia,idiopathic CNV（ICNV）,ocular histoplasmosis syndrome,angioid streaks and trauma,etc.When CNV develops in patients aged less than 50 years old,without obvious ocular inflammation or other causes of neovascularization,it is defined as ICNV.The common symptoms of ICNV include blurred or distorted vision,and scotoma.Although the natural history of ICNV may be relatively favorable,large-sized CNV often leads to the loss of central vision and affects patients’ qualities of life significantly.In this condition prompt treatment is necessary.Currently,the treatment for ICNV includes photodynamic therapy,anti-vascular epithelial growth factor therapy,laser photocoagulation,surgery,transpupillary thermotherapy and combination therapy,among which photodynamic therapy and anti-vascular epithelial growth factor therapy are the most important ones.In addition,photodynamic therapy associated with corticosteroid is a very promising treatment.For patients with juxtafoveal CNV,laser photocoagulation could also be performed.In this article,the treatment for ICNV is reviewed,hoping to benefit clinical work.