多灶性脉络膜炎并发中心凹下脉络膜新生血管的光动力治疗  

Photodynamic therapy for subretinal choroidal neovascularization in patients with multifocal choroiditis

作　　者：李鹏程[1] 盛双燕[1] 彭冲[1] 张缨[1] 王智[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院眼科,武汉430022

出　　处：《中华眼底病杂志》2011年第6期542-544,共3页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察光动力疗法（PDT）为主的综合疗法对多灶性脉络膜炎（MC）并发脉络膜新生血管（CNV）的疗效。方法临床确诊为MC并发中心凹下CNV并接受PDT等综合治疗的8例9只眼纳入研究。其中，男性1例1只眼，女性7例8只眼。年龄25～54岁，平均年龄（41．8±10．6）岁。所有患者均进行最佳矫正视力（BCVA）、裂隙灯显微镜、间接检眼镜、荧光素眼底血管造影、光相干断层扫描检查。BCVA为20／333到20／50，转换成最小视角对数（10gMAR）后其平均值为0．68±0．32；CNV平均面积为（0．767±0．445）mm2；黄斑中心凹视网膜平均厚度为（355．2±65．2）μm。其中行单纯PDT者4只眼，联合口服糖皮质激素2只眼，玻璃体腔注射抗血管内皮生长因子单克隆抗体bevaeizumab（商品名Avastin）者1只眼，后Tenon囊下注射曲安奈德者2只眼。治疗后随访3～22个月，平均随访（14．0±5．7）个月。对比分析治疗前后BCVA、CNV面积和中心凹视网膜厚度。结果末次复诊时，BCVA为20／250到20／25，logMAR平均值为0．58±0．37，与治疗前比较，差异无统计学意义（t=1．890，P=0．095）。其中，3只眼视力提高3行，占33．3％；1只眼视力提高1．5行，占11．1％；4只眼视力稳定，占44．4％；1只眼视力下降1．5行，占11．1％；无下降超过3行者。CNV平均面积为（0．684±0．371）mm2，与治疗前比较，差异无统计学意义（t=0．996，P=0．349）。黄斑中心凹视网膜平均厚度为（295．3±79．4）μm，与治疗前比较，差异无统计学意义（t=2．242，P=0．055）。结论PDT为主的综合治疗可有效稳定MC并发CNV患者的视力，尤其是联合抗血管内皮生长因子药物或糖皮质激素后。Objective To observe the clinical effect of photodynamic therapy （PDT）based comprehensive treatment for choroidal neovascularization （CNV） in patients with multifocal choroiditis （MC）. Methods Nine eyes of 8 MC patients （7 females and 1 male） with CNV who had undergone PDT based comprehensive treatment were enrolled in this study. The patients aged from 25 to 54 years with the mean of （41.8±10.6） years. The examinations of best-corrected visual acuity （BCVA）, slit lamp microscope, indirect ophthalmoscopy, fundus fluoreseein angiography and optical coherence tomography were performed. The BCVA ranged from 20/333 to 20/50 （mean logMAR 0. 68±0. 32）. The mean CNV area was （0. 767±0. 445） mm2. The central retinal thickness （CRT） was （355.2±65.2） μm. Among the 8 patients, 4 eyes received only PDT, 2 eyes received PDT and oral corticosteroid, 1 eye received PDT and intravitreal injection of 1. 25 mg bevacizumab, 2 eyes received PDT and subtenon injection of 40 mg triamcinolone acetonide. The follow-up period ranged from 3 to 22 months, with the mean of （14.0±5.7） months. The BCVA, mean CNV area and CRT before and after treatment were analyzed. Results By the end of last visit, the BCVA improved to 20/250 to 20/25 （mean logMAR 0. 58±0. 37） , but the difference was not statistically significant （t=1. 890, P=0. 095）. Visual acuity improved 3 lines in 3 eyes （33.3%）, improved 1.5 lines in 1 eye （11.1%）, unchanged in 4 eyes （44.4%） and decreased 1.5 lines in 1 eye （11.1%）. The mean CNV area decreased to （0. 684±0. 371） mm2 , but the difference was not statistically significant （t=0. 996, P=0. 349）. The CRT decreased to （295.3±79.4） μm, but the difference was not statistically significant （t=2. 242, P=0. 055）. Conclusion PDT can stabilize visual acuity in patients with subretinal CNV secondary to MC, especially when combined with intravitreal injection of anti-vascular endothelial growth factor drugs or steroid.

关 键 词：脉络膜新生血管化/治疗 光化学疗法 脉络膜炎/并发症 

分 类 号：R774.1[医药卫生—眼科] R773.4[医药卫生—临床医学]