ICGA引导激光治疗渗出型AMD的临床观察  

Clinical observation of photocoagulation on AMD under the guidance of ICGA

作　　者：杜立芳[1] 喻长泰[1] 巩丽青[1] 余运娴[1] 朱研[1] 

机构地区：[1]武汉大学人民医院眼科,430060

出　　处：《中国实用眼科杂志》2002年第9期686-687,共2页Chinese Journal of Practical Ophthalmology

摘　　要：目的 :评价ICGA引导激光治疗AMD的疗效。方法 :本组 2 7例 (3 0只眼 )AMD患者。根据FFA、ICGA的结果 ,对不同的AMD患者采取不同的方法 :①有脉络膜新生血管膜形成及渗漏者 ,采取拱环外直接光凝 ;②合并有视网膜水肿者用格栅状光凝 ;③可见明显滋养血管者 ,则直接封闭该血管。在光凝后 2月复查FFA、ICGA ,如仍有CNV ,渗漏者再次光凝。结果 :本组 2 7例 ,随访 3～ 10个月 :①显效 4例 ,视力提高 0 4～ 0 8,CNV消失 ;②有效 10例 ,视力提高 0 15～ 0 3 ,CNV基本消失或有明显减轻 ;③无变化有 10例 ,视力在 0 0 1～ 0 1,CNV变化不明显 ;④退步有 2例 ,视力由 0 1下降到指数 /眼前 ,CNV增加 ,伴有视网膜水肿。结论 :①ICGA能发现FFA中不能显示的滋养血管 ,直接光凝滋养血管 ,就可治疗黄斑下的新生血管膜 ,既可使疾病得到治疗 ,又能较好地保存原有视力。②在出血或渗出遮盖的情况下FFA不能发现CNV ,而ICGA检查 ,则能早期发现这种隐匿性CNV ,及时光凝就可防止CNV的漫延 ,保护中心视力。本组资料显示 ,病程短者其效果明显好于病程长者。因此 ,对AMD患者 ,应早期用ICGA检查 ,发现CNV后及早采用光凝 ,病变不致扩大而影响中心视力。Objective:To study the photocoagulation on AMD under the guidance of ICGA. Methods:30 eyes of 27 cases of AMD were treated through 3 strategies according to the fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA),(1)direct photocoagulation on choroidal neovascularization(CNV)and leakages outside macular capillary area,(2)grid photocoagulation on CNV with retina edema,(3)direct laser blocking on apparent trophic vessels.FFA and ICGA were performed again after 2 months.If CNV still existed,the second photocoagulation would be conducted on leakages and CNV.Follow up was 3～10 months. Results:4 cases(18 6%)were cured,the visual acuities were increased by 0 4～0 8,and CNV disappeared completely.10 cases(37%)were effective,the visual acuities were increased by 0 15～0 3,and most of the CNV disappeared or apparently fallen down.10 cases(37%)were in stable,the visual acuities were 0 01～0 1,and the changes in CNV were not apparent 2 cases(7 4%)became worse,the visual acuities decreased from finger counting to 0 1,CNV became severe and retina edema complicated. Conclusions:Sub-macular neovascularization could be treated with photocoagulation of trophic vasa under the guidance of ICGA.Appropriate photocoagulation would prevent the diffusion of CNV and preserve the central visual acuity.The data also indicate that ICGA should be performed on AMD at early stage in order to get better efficiency.

关 键 词：AMD 激光治疗 ICGA 年龄相关性黄斑变性 眼底荧光素血管造影 吲哚青绿脉络膜血管造影 

分 类 号：R774.5[医药卫生—眼科]