TTT联合PDT治疗后极部孤立性脉络膜血管瘤的临床疗效观察  

Therapeutic efficacy of transpupillary thermotherapy combined with photodynamic therapy in the treatment of posterior circumscribed choroidal hemangioma

作　　者：张黎 袁容娣 杨惟惠 Zhang Li;Yuan Rongdi;Yang Weihui(Department of Ophthalmology,Xinqiao Hospital,Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院眼科,重庆400037

出　　处：《临床眼科杂志》2018年第3期201-203,共3页Journal of Clinical Ophthalmology

摘　　要：目的观察经瞳孔温热疗法(TTT)联合光动力疗法(PDT)治疗瘤体位于后极部且波及黄斑中心凹的孤立性脉络膜血管瘤(CCH)的临床疗效。方法选取经临床确诊的瘤体位于后极部且波及黄斑中心凹的CCH患者7例(7只眼),治疗前眼部B超及相干光断层扫描(OCT)检查均提示黄斑区视网膜神经上皮层下积液。所有患者予TTT治疗黄斑以外区域,1个月后再针对黄斑中心凹病灶行1次PDT治疗。随访6~18个月,黄斑以外区域可反复多次TTT治疗,观察治疗前后最佳矫正视力(BCVA)、眼底照相、眼部B超、荧光素眼底血管造影(FFA)、OCT检查结果。结果 5例患者BCVA提高,2例稳定,瘤体部分萎缩,黄斑周围灰白色瘢痕形成,可见较多色素增生,黄斑区呈灰白色,可见色素紊乱,眼部B超显示所有患者瘤体厚度较治疗前明显降低,且神经上皮层下积液吸收,FFA提示瘤体渗漏明显减轻或消失,OCT检查显示黄斑部神经上皮层下积液吸收,视网膜平伏。结论TTT与PDT均为临床治疗CCH的有效方法,但对于波及黄斑中心凹且肿瘤较为巨大的患者,可采用TTT联合PDT的治疗方法,TTT反复治疗黄斑中心凹以外区域,PDT针对黄斑中心凹治疗,这样既可避免TTT对黄斑区视网膜的损伤,又可使瘤体有效萎缩、视网膜下液消失,同时还能减轻患者多次PDT治疗所带来的经济压力。Objective To observe the therapeutic efficacy of transpupillary thermotherapy(TTT)combined with photodynamic therapy(PDT)in the treatment of circumcised posterior choroidal hemangioma(CCH)that involved macular fovea.Methods Seven patients(7 eyes)were selected.CCH was located at the posterior pole and involved macular fovea.Pre-treatment ocular B-ultrasound and OCT examination showed subretinal fluid in macular region.All patients were treated with TTT outside the macular area,and then treated with PDT for macular foveal lesion one month later.In 6-18 months,TTT can be repeated on the area outside the macula.Best corrected visual acuity,fundus photography,ocular B-ultrasound,retinal angiography(FFA)and OCT before and after treatment were observed.Results The best corrected visual acuity(BCVA)improved in 5 patients and was stable in 2 patients.The tumor was partially atrophied.Grayish white scar was formed around the macula where pigmentation was present.The macular was gray-white and disordered pigmentation was observed.Ocular B-ultrasound showed significantly decreased retinal thickness in all patients,and FFA suggested that the leakage of the tumor was significantly reduced or disappeared.OCT examination showed that subretinal fluid was absorbed in macular region.Conclusions Both TTT and PDT are effective in the treatment of CCH,but TTT combined with PDT can be used in the treatment of patients with macular fovea involvement and large CCH.TTT has been used repeatedly to treat the area outside the fovea,which not only avoids the damage to the fovea but also effectively causes the tumor to atrophy and the subretinal fluid disappear.At the same time,it can relieve the stress caused by multiple PDT therapy.

关 键 词：孤立性脉络膜血管瘤 黄斑区 经瞳孔温热疗法 光动力疗法 

分 类 号：R739.7[医药卫生—肿瘤]