强化光动力疗法治疗脉络膜新生血管临床效果对比观察  

A comparative observation of strengthen photodynamic therapy in the treatment of choroidal neovascularization

作　　者：冯琳[1] 陈松[2] 毕雪 韩梅[4] 

机构地区：[1]天津医科大学眼科临床学院,天津300020 [2]天津市眼科医院 [3]天津市眼科学与视觉科学重点实验室 [4]天津市眼科研究所

出　　处：《中国实用眼科杂志》2012年第7期792-796,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的对比观察强化光动力疗法（photodynamictherapy，PDT）治疗脉络膜新生血管（choroidalneovascular，CNV）的临床疗效。方法临床病例对照研究。对2009年7月至2011年4月在天津市眼科医院就诊的病人，回顾性分析CNV并行PDT治疗的患者27例28只眼的临床资料。以北美和欧洲的PDT（treatmentofAMDwithPhotodynamictherapy，TAP）研究组的照射光斑在病灶最大线性距离的周围增加0．5mm，照射时间83S参数标准治疗的13例14只眼为对照组，以TAP研究组PDT治疗CNV基础上对病灶实际大小的光斑强化照射10S治疗的14例14只眼为观察组，术后随访3-23个月，平均随访6．8个月。观察两组患者在治疗前后最佳矫正视力（bestcorrectedvisualacuity，BC-VA）、CNV病灶大小情况，以及治疗前后眼底荧光素血管造影（fundusfluoresceinangiography，FFA）、吲哚青绿血管造影（indocyaninegreenangiography，ICGA）的CNV渗漏情况，比较两种PDT治疗方法的临床效果。结果治疗前两组患者的年龄、BCVA、病灶最大线性距离（greatestlineardi．mension，GLD）、CNV的最高隆起值差异均无统计学意义（P=0．94，0．57，0．37，0．21，）；BCVA在治疗后3周、2月、3月时差异有统计学意义（P=0．001，0．004，0．008），两组视力变化在治疗后2个月时差异显著，CNV的最高隆起值在治疗后3周差异无统计学意义（P=0．19），治疗后2月、3月时差异有统计学意义（P=0．04，0．009）。治疗后3月，观察组和对照组FFA显示CNV渗漏结果比较，差异无统计学意义（P=O．23）。结论强化PDT法治疗CNV安全有效，可迅速提高CNV患者的视力，减小CNV病灶大小，可进一步用于临床。Objective To compare the clinical efficacy of strengthen photodynamic therapy （PDT） for choroidal neovascularization （CNV）. Methods Using retrospective analysis to continuous observed 28 eyes of 27 consecutive patients with PDT therapy caused by CNV. In the control group including 14 eyes of 13 cases, PDT was performed after the procedures described in the North American and European multi-center standard PDT treatment of AMD （TAP） protocols, that was spot size was set at 0.5mm greater than the GLD for 83 seconds; In the observation group, including 14 eyes of 14 cases, PDT was performed plus a strengthen spot light with 15 seconds in addition to the TAP protocols. Follow-up duration varied from 3 to 23 months （mean： 6.8 months）. Best correct- ed visual acuity （BCVA）, leakage of CNV in fundus fluorescein angiography （FFA） and indocyanine green angiography （ICGA）, and the thickness of CNV before and aider the ti＇eatments were observed and analyzed. The clinical efficacy between the two groups was compared. Results Age, BCVA, GLD, the thickness of CNV and the disease related to CNV at baseline did not differ significantlybetween groups （P =0.94, 0.57, 0.37, 0.21）. BCVA was improved at 3 weeks, 2 months, and 3 months after treatment and there was difference between the two groups （P =0.001, 0.004, 0.008）. However, thickness of CNV did not differ significantly between groups at 3 weeks after treatment （P =0.19）, but was different at 2 months and 3 months （P =0.04, 0.009）. The result of FFA showed that the leakage of CNV was no significantly different. Conclusions Strengthen PDT is a safe and effective approach. It provides a significantly better BCVA and reduced CNV lesion size, is a replica- ble method of PDT for CNV.

关 键 词：脉络膜新生血管化 光化学疗法 治疗结果 

分 类 号：R774.5[医药卫生—眼科]