光动力学疗法治疗AMD后OCT检查的特征性改变

Optical coherence tomography changes on age-related macular degeneration patients after photodynamic therapy

目的:通过前瞻性观察PDT治疗湿性年龄相关性黄斑变性(aged-related macular degeneration,AMD)前后不同随访时间点光学相干断层成像(optical coherence tomography,OCT)的特征性改变,旨在更好地反馈PDT治疗后黄斑区结构的变化过程。方法:将在本院接受PDT治疗的26例30眼湿性AMD患者纳入本研究。维速达尔用量根据厂家推荐方法计算。治疗前后均行FFA,ICG,OCT及最佳矫正视力等相关临床检查,术后随访日期为术后2wk;1,2,3mo。傅立叶OCT扫描以标准五线结合六线扫描,覆盖病变的关键部位并保持前后扫描位置的一致性。重点观察黄斑中心凹层间厚度、外层高反射带高度、囊肿(包括视网膜下积液和视网膜内积液)的总面积。分析这些变化与随访时间的依赖关系。统计分析使用SPSS 13.0软件。结果:至治疗后3mo,PDT治疗后22眼(73%)视力提高两行以上,3眼视力无明显改变,3眼视力下降,2例患者因故失访。视力提高的22眼治疗前平均黄斑厚度为722.5±55.6μm,治疗后2wk,平均黄斑层间厚度为708.3±45.3μm,1mo为584.4±49.3μm,2mo为430.7±50.2μm,3mo为180.6±36.3μm。治疗前和治疗后外层高反射带厚度分别为302.3±50.2,277.5±42.3,202.7±40.1,180.6±35.7,100.8±22.9μm,囊肿的总面积为0.34±0.12,0.25±0.07,0.10±0.05,0.08±0.04,0.05±0.01mm2。结论:AMD患者在PDT治疗后1mo黄斑区视网膜下液有显著吸收,视网膜水肿显著吸收,黄斑中心凹层间厚度、外层高反射厚度也有明显变薄倾向。

AIM： To better reveal the changing process of macula area after photodynamic therapy（PDT）, the changes of tomographic imaging on macular fovea optical coherence tomography（OCT）scan at different follow-up time points after treating age-related macular degeneration（AMD）by PDT were investigated.METHODS： This cohort study included 30 eyes of 26 patients diagnosed as AMD. The dosage of verteporfin was calculated according to manufacturer＇s instruction. All participants got FFA, ICG, OCT scan and best corrected visual acuity before and followed up for 2wk, 1, 2, 3mo after PDT. The standard five lines combined with 6 lines OCT scan covered key parts of lesion and the scan locations before and after were kept the same. The bilaminar foveal thickness（BFT）, outer high reflectivity band thickness（OHRBT）, and the total area of intraretinal fluid（IRF）and subretinal fluid（SRF）were measured at different time points. The relationship between the changes and follow up time was analyzed. Statistical analysis of the data was performed using SPSS for windows version 13.0.RESULTS：There months after treatment, an improvement of 2 lines or better on the Snellen chart was achieved on 22 eyes, visual acuity of 3 eyes without significant change, 3 eyes got decreased, 2 cases lost follow up. The average macular thickness of improved 22 eyes before treatment was 722.5±55.6μm, 2wk after treatment, 708.3±45.3μm, 1mo, 584.4±49.3μm, 2mo, 430.7±50.2μm and 180.6 ±36.3μm at 3mo.The OHRBT before and after treatment respectively were 302.3±50.2μm, 277.5±42.3μm, 202.7±40.1μm, 180.6±35.7μm, 100.8±22.9μm. The total area of both IRF and SRF was estimated as 0.34±0.12mm2, 0.25±0.07mm2, 0.10±0.05mm2, 0.08±0.04mm2, 0.05±0.01mm2. CONCLUSION： SRF and retinal edema of patients with AMD were absorbed 1mo after PDT, and the BFT, OHRBT were significantly tend to be thin.