经瞳孔温热疗法治疗老年性黄斑变性的疗效观察

Observation on the effect of transpupillary thermotherapy in the treatment of age-related macular degeneration

目的 观察 经瞳孔温热疗法(transpupillarythermotherapy,TTT)治疗渗出型老年性黄斑变性(age-relatedmacular degeneration,AMD)隐匿型脉络膜新生血管(choroidalneovascularization,CNV)的效果。方法 对28例34眼经眼底 荧光血管造影(fundus fluorescein angiography,FFA)及吲哚青绿血管造影(indocyanine green angiography,ICGA)确诊的继发于渗出型AMD的隐匿型CNV行TTT治疗,并主要以视力、眼底检查、FFA及ICGA改变为指标,评价TTT治疗渗出型AMD的效果。结果 随访3～20个月,平均6.65个月,视力提高19眼,视力稳定13眼,视力下降2眼,视网膜水肿基本消退6眼,水肿明显减轻21眼,水肿无明显变化5眼,2眼水肿加重,出血吸收22眼,8眼出血减少,出血无明显变化者2例,另有2眼发生少量新鲜视网膜深层出血,第1次治疗后复查FFA及ICGA,10眼CNV消失,19眼CNV渗漏减轻,3眼无明显变化,2眼CNV增大。结论 TTT治疗可使大部分AMD患者视力稳定或提高,是一种极具潜力的治疗方式,但对其确切疗效的评价,尚需与自然病程及其他治疗方法对比。

Objective To assess the effect of transpupillary thermotherapy (TTT) for the treatment to occult choroidal neovascularization (CNV) secondary to age-related macular degeneration(AMD). Methods Occult CNV secondary to AMD of 34 eyes in 28 patients which were diagnosed according to fundus fluorescein angiography ( FFA) and indocyanine green angiography (ICGA) were treated by TTT. Curative effect was assessed with the change of visual acuity, fundus examination, FFA, ICGA. Results Thirty-four eyes in 28 patients were followed up for a mean of 6.65 months (range 3~20 months). Nineteen eyes showed an improvement in visual acuity. Visual acuity remained stable in 13 eyes . The remaining 2 eyes showed a decline in visual acuity. Retina edema almost extincted in 6 eyes. Twenty-one eyes decreased edema. Five eyes showed no magnificent changes. In 2 eyes edema more significent retinal hemorrhage . Nineteen eyes decreased hemorrhage while the remaining 2 eyes had no magnificent changes. Another 2 eyes showed some fresh hemorrhage outside the laser spot. CNV was resolved in 10 eyes. Nineteen eyes showed a decline of CNV activity. In 3 eyes CNV was persistent. CNV appeared larger in 2 eyes . Conclusion TTT is a potential treatment for CNV. Initial results demonstrate improvement or maintenance of acuity in majority of AMD patients. Further trials of TTT are needed to compare this intervention with the natural history and other modalities.