脉络膜新生血管单次光动力治疗后黄斑区视功能与形态变化  

Changes of macular visual function and morphology after single photodynamic therapy for choroidal neovascularization

作　　者：宫媛媛[1] 宋毅[1] 解正高[1] 吴颖[1] 吴星伟[1] 

机构地区：[1]上海交通大学第一人民医院眼科,上海200080

出　　处：《上海交通大学学报（医学版）》2008年第6期677-680,共4页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市科委基金(05dz22322);上海市视觉复明临床医学中心基金(FM040102-18)~~

摘　　要：目的观察单次光动力治疗(PDT)脉络膜新生血管(CNV)后黄斑区视功能与形态变化及其相关性。方法选择17例(23眼)经典为主型CNV患者进行单次光动力治疗,于治疗前及治疗后3个月和8个月分别行视力、多焦视网膜电图(mfERG)、荧光素眼底血管造影(FFA)、相干光视网膜断层扫描(OCT)检查,观察黄斑中心的厚度以及功能改变;选择相匹配的正常30眼作为对照组。结果与对照相比,CNV患眼治疗前黄斑中心厚度增加,且mfERG的N1和P1波反应密度明显下降。PDT治疗后,视力有改善趋势,但差异无统计学意义。OCT显示治疗后黄斑区中心厚度显著减小,但治疗后8个月与治疗后3个月差异无统计学意义。mfERG显示治疗后1区P1波和2区N1波反应密度显著增加;治疗后8个月1区N1波反应密度显著增加;1区和2区的P1和N1潜伏期治疗前后差异无统计学意义。治疗后3个月视力变化与黄斑中心厚度变化有相关性(r=0.43,P=0.04),与mfERG各波的变化无相关性,1区的N1和P1波反应密度与黄斑中心厚度变化呈负相关(r=-0.43,P=0.04;r=-0.51,P=0.01)。结论对较小范围的CNV患眼单次PDT治疗可在3个月内减少黄斑区中心厚度并改善视功能,并在相对远期保持稳定。黄斑中心区和旁中心区的恢复有所不同;视功能变化与形态变化有一定相关性。Objective To evaluate the changes of macular visual function and morphology after single photodynamic therapy （PDT） for choroidal neovascularization（CNV） and explore their associations. Methods Twenty-three eyes of 17 patients with predominantly classic CNV were subjected to single PDT. Three and 8 months after PDT, examinations of visual acuity, muhifocal electroretinogram （mfERG）, fluoriscein fundus angiography （FFA） and optical coherence tomography（OCT） were conducted for the evaluation of central macular thickness and function. Thirty normal eyes were served as controls. Results Before PDT, central macular thickness increased and N1 and P1 wave amplitudes of mfERG reduced in CNV eyes compared to the normal controls. After PDT, there was an insignificant tendency for the improvement of visual acuity. It was revealed by OCT that central macular thickness decreased significantly after PDT, while there was no significant difference between those at 3 months and 8 months after treatment. It was indicated by mfERG that P1 wave amplitudes increased significantly in area 1 and N1 wave amplitudes increased significantly in area 2 after PDT, and N1 wave amplitudes increased significantly in area 1 eight months after treatment. There was no significant difference in P1 and N1 implicit time of area 1 and area 2 before and after treatment. Visual acuity changes correlated with central macular thickness（r= 0. 43,P = 0.04）, hut were not related to mfERG changes. Changes of central macular thickness were negatively related to changes of P1 and N1 wave amplitudes（r = -0.43,P =0.04;r = -0.51 ,P =0.01 ）. Conclusion Central macular thickness can he decreased and visual function he improved within 3 months after single PDT for CNV, and the therapeutic effects can he maintained for a relatively long term. There are differences in the recovery in central macular and paracentral macular areas. The changes of visual function are correlated with morphologic changes of macular to some extent.

关 键 词：脉络膜新生血管 多焦视网膜电图 光动力疗法 体层摄影术 光学相干 

分 类 号：R774.5[医药卫生—眼科]