经瞳孔温热疗法封闭脉络膜新生血管疗效的初步观察

Transpupillary Thermotherapy:A Prospective Study on Its Clinical Therapeutic Efficacy for Choroidal Neovascularisation in 29 Patients

目的评价经瞳孔温热疗法封闭脉络膜新生血管(CNV)的临床疗效。方法使用IRIS810nm半导体激光对继发于年龄相关性黄斑变性(ARMD)14例15只眼、中心性渗出性脉络膜视网膜病变13例14只眼、外伤、高度近视2例3只眼典型CNV病人进行治疗,根据病灶确定光斑直径(0.5、0.8、1.2、2.0和3.0mm),照射时间为60s,输出功率100～350mW,以照射区无可见的颜色变化至颜色轻度发灰为准。结果ARMD组:术后2只眼(占13.3%)视力提高,11只眼(占73.3%)视力不变;7只眼(占46.7%)眼底荧光血管造影渗出减少。中心性渗出性脉络膜视网膜病变组:术后5只眼(占35.7%)视力提高,8只眼(占57.2%)视力不变;所有眼术后眼底荧光血管造影(FFA)均见渗出减少。其他原因引起的CNV组:治疗后2只眼视力提高,1只眼视力不变;3只眼FFA示眼底渗出均减少。结论经瞳孔温热疗法是治疗各种原因引起的CNV的新方法,它的近期治疗效率高,并发症少,其优越性需进一步证实。

Objective To assess the effectiveness of transpupillary thermotherapy(TTT) for treatment of classic choroidal neovascularisation (CNV) secondary to all kinds of reasons. Methods In a prospective case selected trial 32 eyes of 29 patients with angiographically defined classic CNV secondary to central exudative chorioretinopathy (14 eyes of 13 patients),age-related macular degeneration(ARMD)(15 eyes of 14 patients),accidental trauma and others (3 eyes of 2 patients) were studied.Thirty two eyes were treated with diode laser (810 nm) TTT.Laser beam sizes ranged from 0.5 to 3.0mm and power settings between 100-350 mW.Treatment was given in one area for 60 seconds and the end point being no visible change,or slight greying of retina.Outcome was assessed with Snellen visual acuity and clinical examinations. Results All the treated eyes were followed up at least 6 months.ARMD group:2 eyes(13.3%)improved visual acuity by 2 or more lines,11 eyes(73.3%)had no change,and 7 eyes(46.7%)demonstrated decreased exudation by fundus fluorescein angiography(FFA).Central exudative chorioretinitis group:5(35.7%)of 14 eyes improved visual acuity,8 eyes(57.2%)had no change,and all the treated eyes demonstrated decreased exudation on FFA.Trauma and high myopia group:2 eyes improved visual acuity by 2 lines,one eye had no change,and all the eyes demonstrated decreased exudation by FFA. Conclusions TTT is a potential treatment for CNV,it is effective for reduction or CNV and its complication is little,though the long therapeutic effect is needed for further research.