光动力学疗法治疗PCV后合并眼底出血机制探讨  

Fundus hemorrhage after photodynamic therapy for polypoidal choroidal vasculopathy

作　　者：彭清[1] 董洋[1] 李婧[1] 冯华章[1] 赵培泉[1] 

机构地区：[1]上海交通大学医学院附属新华医院眼科,上海200092

出　　处：《山西医科大学学报》2012年第11期865-867,886,共4页Journal of Shanxi Medical University

基　　金：上海市教委重点学科基金资助项目(S30205);上海市科学技术委员会基础重点基金资助项目(11JC1410602)

摘　　要：目的探讨息肉样脉络膜视网膜病变(PCV)患者经光动力学(PDT)治疗后合并眼底出血的机制。方法回顾性分析2009-06～2011-05在眼科确诊为PCV,经PDT治疗后出现眼底出血或玻璃体出血的患者5例(5眼),分析其临床特征。5例患者在治疗前均经光学相干断层扫描,眼底荧光造影检查后确诊为PCV;PDT治疗光斑覆盖眼底病灶区,治疗后随诊时间为1,2,3,6,9和12月。结果 3例患者在治疗后1个月内出现视网膜下出血,1例患者在治疗后2个月时出现视网膜下出血,1例患者在治疗后3个月时出现玻璃体出血。经对症治疗后,4例患者随访至1年时眼底出血大部分被吸收,视力轻度提高,荧光造影显示病灶部位未见荧光渗漏;1例玻璃体出血的患者随访过程中出血吸收缓慢,于是进行了玻璃体切割手术,术后出血消失,但视力未见提高。结论 PCV患者行PDT治疗后可合并眼底出血,其机制可能与治疗后病变区脉络膜血管脆性增大及息肉状病灶破裂导致出血有关。Objective To investigate the machenism of lots of hemorrhagic complications in eyes with polypoidal choroidal vasculopa-thy （PCV） after photodynamic therapy （PDT）. Methods The clinical features of 5 eyes in 5 cases with lots of subretinal or vitrous hemorrhage after PDT from June 2009 to May 2011were retrospectively reviewed. The PCV was diagnosed based on optical coherence tomography（OCT） ,indocyanine green angiographic （ICGA） and fundus fluorescence angiographic examination. The biggest light spot covered all polypoidal lesions. The patients were treated by PDT and then followed up at month 1,2,3,6,9 and 12. Results During the follow-up periods,postoperative subretinal hemorrhage was seen in 3 cases within 1 month and one case at month 2. Vitreous hemor-rhage was found in one case at month 3. Subretinal hemorrhage was absorbed after taking a few of hemostyptics in 4 cases, visual acuity was increased,and ICGA and fundus fluorescence angiographic examination showed no leakage. The vitreous hemorrhage was not ab-sorbed in one case, and then the case was performed vitrectomy. Finally the hemorrhage disappeared, but the visual acuity was not in-creased. Conclusion Subretinal hemorrhage or vitreous hemorrhage can be found occasionally after PDT, which may be related with the increased fragile of choroidal blood vessels and the rupture of the polypoidal choroidal vessels terminating nodule after PDT.

关 键 词：息肉样脉络膜视网膜病变 光动力学治疗 眼底出血 光学相干断层扫描 

分 类 号：R774.1[医药卫生—眼科]