经瞳孔温热疗法治疗渗出性老年性黄斑变性的疗效观察

目的观察经瞳孔温热疗法（TTT）治疗渗出性老年性黄斑变性（AMD）时对脉络膜新生血管（CNV）的封闭效果及对视力的影响。方法采用随机、自身对照、回顾性分析的方法，对41例临床诊断为老年性黄斑变性中的脉络膜新生血管患者进行治疗。治疗效果用国际标准视力表和荧光眼底血管造影（FFA）进行评估。结果随访6—15个月，视力提高或不变为45眼，占98％（45／46）；视力下降为1眼，占2％（1／46）。CNV膜完全或部分封闭率为84％（31／37），保持不变为15％（6／37）。结论TTT是治疗渗出性AMD的一种有效方法，它能够封闭大部分CNV，雏持或提高患者的视功能。

经瞳孔温热疗法治疗眼底病

经瞳孔温热疗法治疗眼底病作为一种新的治疗方法 ,正日益受到临床医生的重视。本文就其发展史、原理、适应证、方法、并发症和亟待解决的问题进行较全面的综述。

阈值下TTT激光治疗CCSC所致的浆液性视网膜脱离

目的:报告阈值下经瞳孔温热疗法(transpupillary thermotherapy,TTT)在治疗慢性中心性浆液性脉络膜视网膜病变(chronic central serous chorioretinopathy,CCSC)继发的视网膜神经上皮浆液性脱离的效果。方法:选取视网膜神经上皮浆液性脱离持续时间达≥6mo的CCSC患者10例13眼。采用810nm半导体激光给予阈值下TTT激光治疗。通过眼科检查、血管造影及光学相干断层扫描(optic coherence tomography,OCT)比较治疗前后病损变化情况,采用自身对照法进行最佳矫正视力(best-corrected visual acuity,BVCA)的对比研究。结果:TTT治疗平均(1.23±0.44)次。所有患者随访6mo。治疗前视力0.05～0.4(平均0.16±0.10),治疗后视力0.05～0.8(平均0.35±0.21),视力改善结果差异有统计学意义(P<0.05)。治疗后眼底荧光素血管造影(fundus fluorescein angiography,FFA)均未显示荧光染料渗漏,吲哚青绿血管造影(indocyanine green angiography,ICGA)未见明显脉络膜通透性增加,治疗区域没有出现与治疗相关的副作用。结论:阈值下TTT对存在持续神经上皮层脱离的CCSC具有明显治疗效果,同时未出现显著并发症。

中心性浆液性脉络膜视网膜病变的治疗新进展

中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)是继年龄相关性黄斑病变、糖尿病视网膜病变、视网膜分支静脉阻塞后的第四大常见的非手术性视网膜疾病。视网膜下液的持续存在可能引起视网膜神经上皮层与视网膜色素上皮层(retinal pigment epithelium,RPE)结构永久性紊乱。但目前尚无统一的治疗方案。本文就其治疗方法的研究进展进行综述。

EFFECT OF FUNDUS PIGMENT ON RESPONSE OF RABBIT RETINA TO TRANSPUPILLARY THERMOTHERAPY

Objective To study the effect of fundus pigment on the response of the retina to transpupillary thermotherapy (TTT). Methods The retina were irradiated with 810 nm diode laser in 16 eyes of 8 pigmented rabbits and 12 eyes of 6 albino rabbits. The spot size was 1.2 mm; the duration was 60 s; and powers were 50, 80, 150 and 300 mW for pigmented rabbits and 800, 1 200 and 1 500mW for albino rabbits. All of the eyes were followed up with ophthalmolscope. The fundus was photographed and examined histologically with optic microscope immediately and 1 month after TTT respectively. Results The changes of the fundus and the histological examination were not significant immediately and 1 month after TTT in 50 mW group of pigmented rabbit and 800 mW of albino rabbit. Grey spot on the retina was observed on the fundus in 80 mW group of pigmented rabbit and 1 200 mW of albino rabbit immediately after TTT. The structure of the retina remained intact and subretinal fluid was observed histologically. Grey spot was still visible on the fundus, though the fluid was absorbed after 1 month. As the power of diode laser was increased to 150 mW for pigmented rabbits and 1500 mW for albino rabbit, fundus white spots were observed and the outer retina was destroyed while photoreceptors existed immediately after TTT. Pigmentation was found in white lesions and the fibrous proliferation was found in choroid 1 month after TTT. Prominent white spot was seen on the fundus immediately after laser irradiation of 300 mW in pigmented rabbits and the structure of the retina was obscured. One month after TTT, dense pigmentation appeared at laser lesions. The retina was thinner. There was prominent fibrous proliferation in the choroid. Conclusion The fundus pigment seems to play an important role in the response of the retina to TTT. The reaction of the retina is in proportion to the intensity of laser.

葡萄膜黑色素瘤的发病趋势、治疗及预后[英]

葡萄膜黑色素瘤是成年人常见的眼内原发性恶性肿瘤。常见的治疗手段为眼球摘除术、放射治疗或其他方法。其5年生存率不等，在25％～66％之间。随着新治疗手段（如经瞳孔温热治疗）的出现，以及大量较小的黑色素瘤由新技术所诊断，保留患眼的治疗方法重新受到重视，传统的患眼摘除术逐渐减少。