光动力疗法治疗老年性黄斑变性伴脉络膜新生血管膜一年疗效观察  

Therapeutic effects of photodynamic therapy on age-related macular degeneration with choroidal neovascularization 1 year after the treatment

作　　者：陈有信[1] 董方田[1] 张承芬[1] 谭柯[1] 叶俊杰[1] 郑霖[1] 韩宝玲[1] 杜虹[1] 

机构地区：[1]中国医学科学院北京协和医院眼科,100730

出　　处：《中华眼底病杂志》2007年第1期9-12,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察光动力疗法（PDT）治疗老年性黄斑变性（AMD）患者脉络膜新生血管膜（CNV）的疗效和安全性。方法回顾分析临床确诊为CNV形成并进行PDT治疗后连续观察1年的AMD患者者的临床资料，共45例患者51只患眼符合条件纳入观察。其中，经典型为主性CNV（典型CNV成分≥50．00％）28只眼，占54．90％；轻微典型性CNV（典型CNV成分〈50．00％）10只眼，占19．61％；隐匿性CNV（没有典型CNV成分）13只眼，占25．49％。平均视力42．3～8．7个字母，光相干断层扫描检查显示，病变的最大线性距离（GLD）为3560．1～1256．2μm。回顾分析时比较其治疗前后视力、病灶大小、CNV渗漏变化，并观察治疗后病灶纤维化程度。结果随诊结束时，平均视力45．1～8．1个字母，与治疗前比较，差异无统计学意义（t=1．62，P=0．12）。其中，视力增加5个字母以上的视力提高者12只眼，占23．53％；视力提高5个字母以下或稳定者37只眼，占72．54％。GLD3579．4～1390．6μm，与治疗前比较，差异无统计学意义（t=0．008，P=0．94）。CNV渗漏无进展者占88．24％，有进展者占11．76％。病变纤维化程度〈25．00％的38只眼中，有30只眼纤维化程度有所增加，占病变纤维化程度〈25．00％患眼的78．94％。不良事件的发生率23．4％，其中严重不良反应发生率为4．26％。结论PDT治疗AMD患者CNV能够在1年内保持视力的稳定；严重不良事件的发生率低；是AMD患者CNV治疗的安全有效方法。Objective To investigate the efficacy and safety of photodynamic therapy （PDT） on choroidal neovascularization in age-related macular degeneration （AMD）. Methods The clinical data of 45 patients （51 eyes） with AMD who had been followed up for 1 year after PDT for CNV were retrospectively analyzed. The typical type as the main type of CNV （typical CNV ≥50.00% ） was found in 28 eyes （54.90%）, mild typical type CNV （typical CNV 〈50.00%） was in 10 （19, 61%）, and latent CNV （without typical CNV） was in 13 （25.49%）. The average visual acuity was （42.3-8.7） letters, and the result of optic coherent tomography （OCT） showed that the greatest linear dimension （GLD） of the lesion was （3560.1-1256.2） μm. The visual acuity, size of the lesion, and CNV leakage changes before and after PDT, and the fibrosis extent of the lesion after the treatment were observed. Results At the end of the follow-up period, the average visual acuity was （45. 1-8. 1） letters, which didn＇t differ much from which before the treatment （t test, P=0. 17）. The visual acuity which increased 5 or more letters was found in 12 eyes （23.53%）, and improved or kept still in 72.54% out of the 51 patients. The GLD was （3579. 4-1390. 6） μm, which didn＇t differ much from which before the treatment （t test, P=0. 93）. Most of the patients （88.24%） had no development of CNV leakage, while the other 11.76% had. In 38 eyes whose fibrosis extent of the lesion 〈25. 00%, fibrosis extent increased in 30 （78. 94%）. The incidence of the adverse response was 23.40%, and the serious adverse response was 4.26%. Conclusion PDT may keep the visual acuity of the patient with AMD and CNV stable within 1 year and the incidence of the adverse response is low, which suggest that PDT is an effective and safe treatment for CNV in patients with AMD.

关 键 词：黄斑变性/治疗 脉络膜新生血管化/药物疗法 光化学疗法/方法 激光疗法 小剂量 治疗结果 

分 类 号：R686[医药卫生—骨科学]