光动力疗法治疗渗出型老年性黄斑变性四年临床观察总结  

Four-year clinical summarization of photodynamic therapy for age-related macular degeneration

作　　者：张美霞[1] 陆方[1] 严密[1] 张军军[1] 孟丹[1] 杜彩凤[1] 沈齐[1] 王顺清[1] 廖晋英[1] 

机构地区：[1]四川大学华西医院眼科,成都610041

出　　处：《中华眼底病杂志》2004年第5期275-279,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的　总结 4年来光动力疗法 (PDT)治疗渗出型老年性黄斑变性 (AMD)的临床疗效 ,以评价 PDT的长期治疗效果。　方法　回顾 73例经双目间接检眼镜、荧光素眼底血管造影 (FFA)、吲哚青绿血管造影 (ICGA)检查确诊的渗出型 AMD患者的 95只患眼行 PDT治疗前后的临床资料 ,对比分析其视力、眼底像、FFA、ICGA和光相干断层扫描 (OCT)检查结果的变化。 73例患者平均年龄 6 7.8岁 ,就诊时最佳矫正视力数指 / 10 cm～ 1.0。 95只眼 PDT平均治疗次数为 1.5次 ,治疗后随访时间为 3个月～ 4年。　结果　 PDT治疗后末次随访时 ,39只眼视力提高≥ 2行 ,占 4 1.1% ;5 1只眼视力波动在 1行以内 ,占5 3.7% ;5只眼视力下降≥ 2行 ,占 5 .3%。所有患眼眼底出血和渗出均减轻。FFA或 FFA联合 ICGA检查显示 :5 8只眼脉络膜新生血管 (CNV)渗漏完全停止 ,转为瘢痕期 ,占 6 1.0 5 % ;6只眼 CNV部分闭合 ,占6 .32 % ;2 2只眼 CNV小部分闭合 ,占 2 3.16 % ;9只眼 CNV复发 ,占 9.4 7%。早期 AMD患者 12只眼经过1次 PDT治疗后 ,最佳矫正视力 0 .6～ 1.5 ,CNV完全闭合 ,OCT检查显示黄斑区水肿及神经上皮脱离消失。随访时间最长达 4年 ,未见有复发 ,视力保持稳定。　结论　单次和重复 PDT治疗渗出型 AMD长期疗效较好 ,安全性较高。Objective To summarize the clinical results and safety of photodynamic therapy (PDT) through 4 years after single and multi-treatments of patients with subfoveal choroidal neovascularization (CNV) caused by age-related macular degeneration (AMD). Methods Clinical data of 73 AMD cases (95 eyes) diagnosed through fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography (OCT), treated with PDT were reviewed and analyzed in this hospital from June 2000 to June 2004. The changes of best corrected visual acuity (BCVA), fundus pictures, FFA, ICGA and OCT were compared before and after PDT. Follow-up time varied from 3 months to 4 years (mean, 2 years). Results The mean age of 73 patients was 67.8 years old. The BCVA was from (CF/10 cm) to 1.0. At the final follow up, the BCVA was improved (increase≥2 lines) in 39 eyes (41.1%), stabilized (±1 line) in 51 eyes (53.7%) and decreased 2 lines in 5 eyes (5.3%). Fundus hemorrhage and exudation reduced after PDT. FFA and ICGA showed CNV complete closure in 58 eyes (61.05%), partial closure in 6 eyes (6.32%), CNV incomplete closure in 22 eyes (23.16%) and recurrence in 9 eyes (9.47%). After once PDT of 12 eyes with early-stage AMD, the BCVA improved (from 0.6 to 1.5), CNV completely closed, and the OCT showed disappearance of macular edema and neursensory retinal detachment. No CNV recurred in our four years follow-up observation and the BCVA of the patients remained stable. The mean number of PDT treatment was 1.8 per eye in 95 cases. No serious local or systemic complications were encountered. Conclusions Single or multiple sessions of PDT can acheive long-term safety and efficacy. For early-stage AMD patients with minimally classic CNV, PDT can completely make CNV closed and reduce the risk of visual loss.

关 键 词：治疗后 PDT CNV 渗出 患者 ICGA 眼视力 典型性 

分 类 号：R774.505[医药卫生—眼科]