局限性脉络膜血管瘤两种激光治疗效果对比  

Comparision of therapeutic effects between transpupillary thermotherapy and photodynamic therapy for circumscribed choroidal hemangioma

作　　者：王明扬[1,2] 李筱荣[1] 王光璐[2] 

机构地区：[1]天津医科大学眼科医院眼科研究所,300384 [2]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

出　　处：《中华眼外伤职业眼病杂志》2014年第4期255-258,共4页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的比较光动力疗法（PDT）和经瞳孔温热疗法（Trr）对局限性脉络膜血管瘤的治疗效果。方法任选进入经瞳孔温热疗法组114例（114只眼）和光动力疗法组20例（20只眼）。采用荧光素眼底血管造影及眼B型超声波检查。经瞳孔温热疗法治疗时光斑覆盖整个瘤体呈灰白色反应。如瘤体较大则多个光斑组合。每次所作光斑点数1～6个。治疗次数1～5次。治疗间隔时间1～3个月。光动力疗法治疗采用维替泊芬（verteporfin）静脉注射15min后，用689nm激光照射。肿物厚度≤3mm者采用83s，〉3mm采用166s。光斑点数1～4个。治疗间隔时间≥3个月。结果从5个方面对两种疗法进行对比。（1）瘤体部位。经瞳孔温热疗法治疗黄斑区肿物有效率达91．0％（61／67），视盘旁肿物有效率为94．3％（33／35），二者差异无统计学意义（P=0．563）。（2）视网膜脱离。该因素对PDT治疗的影响比TTT大。（3）瘤体厚度≥4mm者，TTT所用激光穿透力强，比PDT优越。（4）激光对瘤体和组织的反应。PDT治疗后有轻微色素变动，也可引起迟发性脉络膜视网膜的萎缩。邢治疗所形成色素瘢痕增生比PDT明显（5）有效率及视力。两组进行有效率及视力对比，P=0．40，0．28，均无统计学意义。结论两种疗法均有治疗效果。位于黄斑中心区的渗液较少且不厚的肿物，可优先考虑作PDT治疗。如需再作，应慎重考虑PDT对组织的损伤。国人PDT治疗参数及对组织的损伤仍有观察探讨的必要。瘤体较厚渗液较多者可优先考虑，TTT治疗。Objective To compare the therapeutic effects between transpupillary thermotherapy （TIT） and photodynamic therapy （PDT） for circumscribed choroidal hemangioma（CCH）. Methods One hundred and fourteen eyes of 114 cases treated by TTT and twenty eyes of 20 cases treated by PDT were en- rolled in the study. Fundus fluorescein angiography（FFA） and uhrasonography（B-scan） were used for ex- amination. In TTT, the entire tumor surface was covered by the laser spots resulting in a gray-white reaction and overlapping laser spots were placed for larger tumors. There were 1 - 6 laser spots in each treatment. The session for management was 1 -5 times with 1 - 3 months interval. The standard photodynamic therapy with the photosensitizer verteporfin was carried out. The intravenous verteporfin was administered 15 minutes be- fore laser irradiation at 689 nm. Tumors less than 3 mm thick were irradiated for 83 seconds ; tumors thicker than 3 mm were irradiated for 166 seconds. The interval time was ≥3 months. Results The five factors were compared. （ 1 ） The location of tumor. The rate of efficiency of TTT in foveal and para-foveal cases was 91% （61/67） and 94.3% （33/35） in around disk. There was no significant difference in effective rate be- tween the two locations （P = 0. 563 ）. （2） Retinal detachment. The incidence of retinal detachment over the tumor surface was higher in PDT group than TIT group. （3）Tumor thickness. For tumor with thickness ≥4 mm, the effect of TIT was better than PDT penetrate tissue . （4） The response of body tissues and tumor tolaser power. There were higher degrees of scarring, pigment, proliferation in ~ cases than PDT cases which only had slight pigment changes and sometimes with delayed chorioretinal atrophy. （5）The efficiency and visual acuity（VA）. There was no significant difference in the rate of efficiency and VA improvement be- tween TTT and PDT groups （P =0.40,0.28）. Conclusion The two laser are effective for CCH. The CCH in foveal an

关 键 词：血管瘤 脉络膜 疗法 光动力 温热 经瞳孔 效果 

分 类 号：R739.7[医药卫生—肿瘤]