光动力学治疗脉络膜新生血管的临床观察  

Verteporfin for choroidal neovascularization

作　　者：沈洁[1] 王竞[1] 

机构地区：[1]浙江大学医学院附属第一医院浙益眼科中心,杭州310003

出　　处：《中国实用眼科杂志》2005年第9期925-928,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的观察光动力学治疗继发于不同病因的黄斑中心凹下或中心凹旁脉络膜新生血管的疗效和安全性.方法回顾16例16眼经荧光血管造影、吲哚青绿造影证实活动性脉络膜新生血管,继发于老年性黄斑变性4眼,病理性近视6眼和中心性渗出性脉络膜视网膜病变6眼.比较PDT治疗前后最佳矫正视力,散瞳前置镜眼底检查以及荧光血管造影和脉络膜血管造影的资料.典型性为主型CNV14眼,轻微典型性CNV1眼,隐匿性CNV1眼.CNV位于黄斑中心凹下12眼,黄斑中心凹旁4眼.光动力学治疗方案参照TAP制定的标准.结果随访时间:1～14个月,平均(5±4.28)个月.1次治疗14眼,重复治疗2次1眼,3次1眼.最终患眼视力提高8眼,保持不变8眼.FFA检查示CNV渗漏停止1眼,渗漏减少10眼,渗漏无明显减少5眼,渗漏面积较治疗前明显缩小(P＜0.05).CNV复发3眼.仅1例在输液时发生光敏剂渗漏,但未发生光敏反应.治疗后视网膜一过性出血增加3眼.结论光动力学治疗为继发于不同病因的黄斑中心凹下或中心凹旁CNV患者提供一种安全有效的治疗选择.部分患者治疗后短时间内复发,PDT治疗CNV的长期疗效有待进一步观察.Objective To observe the efficacy and safety of photodynamic therapy with verteporfin for choroidal neovascularization. Methods Clinical data of 16cases （ 16 eyes） diagnosed as active choroidal neovascularization （CNV） by fluorescein angiography （FFA） and/or indocyanine green angiography （IC- GA）, secondary to age- related degeneration （AMD） 4 eyes, pathologic myopia （PM） 6 eyes, central exudative chorioretinopathy （CEC） 6 eyes. To compare the changes of best - corrected visual acuity, fundus manifestations, FFA and ICGA before and after PDT. There were predominantly classic CNV in 14 eyes, minimally classic CNV in leye and occult CNV in 1 eye. The CNV in 12 eyes were subfoveal, the others were parafoveal. The therapy methods refered to TAP protocol. Results Follow up time varied from 1 month to 14 months, mean 5 （SD= 4.28） months. 14 eyes were treated once, one eye received retreat- ments twice, one eye received three times retreatments. The final visual acuity improved in 8 eyes, stabilized in 8 eyes. FFA showed absence of leakage in one eye, minimal leakage in 10 eyes, moderate leakage in 5 eyes. The areas of leakage decreased significantly than those pre- PDT （P〈 0.05）. Leakage recurrence was noted in 3 eyes secondary to PM. Verteporfin solution exudated into exovascular during intravenous infusion in one case. Fortunately no photosensitive reaction took place. Retinal hemorrhage increased in 3 eyes after PDT. Conclusions PDT is an efficacy and safty therapy alternative for CNV which were secondary to different etiologies in subfoveal or parafoveal area. But CNV in .some people recurrent in a very short period. The long-term efficacy of PDT for CNV is about to observing further.

关 键 词：光动力学 脉络膜新生血管 光动力学治疗 脉络膜新生血管 中心性渗出性脉络膜视网膜病变 临床观察 黄斑中心凹下 荧光血管造影 老年性黄斑变性 脉络膜血管造影 吲哚青绿造影 

分 类 号：R454.2[医药卫生—治疗学] R774.5[医药卫生—临床医学]