光动力疗法治疗脉络膜血管瘤的临床分析  

Clinical analysis of photodynamic therapy for choroidal hemangioma

作　　者：史雪辉[1] 魏文斌[1] 杨丽红[1] 王光璐[1] 王诏华[1] 

机构地区：[1]首都医科大学附属北京同仁医院,北京同仁眼科中心,北京市眼科学与视觉科学重点实验室,北京市100730

出　　处：《眼科新进展》2010年第10期945-948,951,共5页Recent Advances in Ophthalmology

基　　金：北京市自然科学基金资助(编号:7092021);首都医学发展基金资助(编号:2002-2008);首都特色临床医学技术发展研究基金资助(编号:Z08050703080802)~~

摘　　要：目的观察光动力疗法（photodynamic therapy,PDT）治疗脉络膜血管瘤（choroidal hemangioma,CH）的疗效。方法回顾性分析接受PDT治疗的13例（13眼）CH患者的临床资料。其中,孤立性脉络膜血管瘤（circumscribed choroidal hemangioma,CCH）10例（10眼）,Sturge-Weber综合征弥漫性脉络膜血管瘤（diffused choroidal hemangioma,DCH）3例（3眼）。PDT治疗采用维替泊芬6mg.m-2体表面积剂量10min内匀速静脉注射,5min后激光照射,功率密度600mW.cm-2,曝光时间83~166s,能量强度50~100J.cm-2。照射1~3个光斑以完全覆盖整个CCH瘤体;治疗前后进行彩色眼底照相、荧光素眼底血管造影及眼部超声检查。结果 PDT治疗后3~6个月,10眼CCH中,3眼视力提高,达到0.4~0.8,瘤体均位于颞上或颞下血管弓旁;5眼患者视力无变化,其中2眼瘤体位于颞上或颞下血管弓旁,1眼位于视盘鼻下,2眼位于黄斑中部;2眼视力下降,瘤体位于黄斑中部。眼底检查部分患眼CCH橘红色病灶缩小,表面有少许色素。荧光素眼底血管造影检查荧光素渗漏减轻,部分消退。超声检查治疗前CCH瘤体平均厚度为（3.40±2.00）mm,治疗后平均厚度为（2.22±1.37）mm,差异有统计学意义（t=2.51,P〈0.05）。治疗前,CCH瘤体平均最大直径为（8.97±3.12）mm,治疗后平均最大直径为（7.27±3.40）mm,差异无统计学意义（t=2.20,P=0.07）。PDT治疗后,DCH3眼中,2眼视力无变化,1眼下降。PDT治疗前后眼底检查、荧光素眼底血管造影及超声检查瘤体厚度无明显变化。结论 PDT治疗CCH安全有效,可作为CCH的首选治疗方法,治疗后视功能恢复与CH瘤体的位置及厚度有关;单次PDT治疗DCH的疗效不确定,需要进一步探讨。Objective To investigate the efficacy of photodynamic therapy（PDT）for choroidal hemangioma（CH）.Methods The clinical data of 13 CH patients（13 eyes）taking PDT treatment were retrospectively analyzed.There were 10 cases（10 eyes）with circumscribed choroidal hemangioma（CCH）and 3 cases（3 eyes）with Sturge-Weber diffused choroidal hemangioma（DCH）.Intravenous injection of verteporfin with 6 mg·m-2 body surface was taken for 10 minutes in PDT treatment.Laser exposure was taken 5 minutes later,power density was 600 mW·cm-2,exposure time was 83 seconds to 166 seconds,and energy intensity was 50 J·cm-2 to 100 J·cm-2.About 1 to 3 fusion facula completely covered the CCH tumor body.Fundus photography,fundus fluorescein angiography and ocular ultrasonography were taken before and after treatment.Results At 3 months to 6 months after PDT treatment,in 10 eyes with CCH,there were 3 eyes with visual acuity improved to 0.4 to 0.8,and tumor bodies were at arcus of blood vessels above and under temple;Visual acuity of 5 eyes were unchanged,about tumor bodies of 2 eyes were at arcus of blood vessels before and under temple,1 eye at optic disc under nose and 2 eyes at the center of macula lutea;Visual acuity of 2 eyes decreased and tumor bodies were at center of macula lutea.Fundus photography showed that jacinth focus decreased in some eyes with CCH and with a little pigment.Fundus fluorescein angiography examination showed that fluorescein leakage was lessened and some were extinct.The average thickness of CCH tumor body was（3.40±2.00）mm before treatment and（2.22±1.37）mm after treatment with ultrasound examination,there was statistical difference（t=2.51,P0.05）.Before PDT treatment,the average biggest diameter of CCH tumor body were（8.97±3.12）mm,and（7.27±3.40）mm after treatment,there was no statistical difference（t=2.20,P=0.07）.After PDT treatment,visual acuities of 2 eyes were unchanged,and 1 eye decreased in total 3 eyes with DCH.There was no change in examination of fundus,

关 键 词：脉络膜血管瘤 光动力疗法 维替泊芬 孤立性脉络膜血管瘤 弥漫性脉络膜血管瘤 

分 类 号：R773.4[医药卫生—眼科]