联合光动力疗法和经瞳孔温热疗法对脉络膜血管瘤的治疗效果分析

Analysis of therapeutic effect of photodynamic therapy combine with transpupillary thermotherapy on choroidal hemangioma

目的对联合光动力疗法(PDT)与经瞳孔温热疗法(TTT)和单纯TTT对脉络膜血管瘤的治疗效果进行分析和比较。方法纳入本院收治的脉络膜血管瘤患者48例,随机分为TTT组和联合组,各24例。联合组首先使用TTT对远离黄斑区域进行治疗,间隔1个月后,对于黄斑及周围区域开展二次PDT治疗。TTT组使用TTT对患者进行治疗。对2组的治疗次数、最佳矫正视力(BCVA)变化、治疗前后的瘤体厚度以及并发症发生率进行比较。结果 TTT组治疗后,瘤体发生萎缩,并合并大量色素形成,同时伴有脉络膜处和视网膜处机化瘢痕形成。联合组治疗后,在黄斑之外区域,瘤体均发生萎缩,色素大量形成,瘢痕出现;在黄斑区域,部分瘤体出现萎缩,并变为白色,色素少量形成,未发生出血,视网膜结构清晰。治疗后,TTT组的视力下降率明显高于联合组(P<0.05)。治疗后,TTT组和联合组的瘤体厚度均明显降低(P<0.05),其中联合组瘤体厚度明显低于TTT组(P<0.05)。随访中,2组均未见虹膜萎缩、晶状体混浊、视网膜前出血、视网膜血管阻塞等并发症发生。结论 PDT联合TTT用于脉络膜血管瘤的治疗中,能够有助于缩小瘤体体积,降低瘤体厚度,减少对患者视网膜的损伤,减少治疗次数,安全性高,费用较低,值得在临床中进行推广。

Objective The effects of photodynamic therapy combined withtranspupillary thermotherapy(TTT)on choroidal hemangioma were analyzed.Methods Forty-eight patients with choroidal hemangioma admitted to our hospital were randomly divided into TTT group and combined group,24 cases in each.The combined group first used TTT to treat the area away from the macular area.After a month interval,a second PDT treatment was performed for the macular area and the surrounding area.The TTT group used TTT to treat patients.The treatment effect,BCVA change,tumor thickness before and after treatment and incidence of complications were compared between the two groups.Results After treatment in the TTT group,the tumor shrank and a large amount of pigment was formed,accompanied by organizedscar formation at the choroid and retina.After treatment in the combined group,in the area outside the macular area,the tumors all shrank,a large amount of pigment was formed,and scars appeared;in the area of the macular area,some tumors atrophied and turned white,the retina structure is clear.After treatment,the rate of vision loss in the TTT group was significantly higher than that in the combined group(P<0.05).After treatment,the tumor thickness of the TTT group and the combination group were significantly reduced(P<0.05),and the tumor thickness of the combination group was significantly lower than that of the TTT group(P<0.05).During follow-up,no complications such as iris atrophy,lens opacity,preretinal hemorrhage,and retinal vascular obstruction were found in both groups.Conclusion PDT combined with TTT is used in the treatment of choroidal hemangioma,which can help to reduce the size and the thickness of the tumor,and reduce the damage to the retina of the patient.