Subfoveal hemorrhage after verteporfin photodynamic therapy in treatment of choroidal neovascularization

BACKGROUND: To identify the frequency of new subfoveal hemorrhage and its impact on visual acuity 2 weeks following verteporfin photodynamic therapy (PDT) in the treatment of predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: Retrospective, noncomparative, consecutive, interventional case series. At a tertiary retinal referral center, 104 eyes of 97 consecutive patients with predominantly classic subfoveal CNV were treated by PDT. Morphological outcomes include new subfoveal hemorrhage assessed on the photo review (pretreatment, 2 and 12 weeks after PDT). Visual acuity outcomes include moderate (3-5 ETDRS lines) and severe (6 and more ETDRS lines) loss of visual acuity at 2 weeks after PDT. RESULTS: In this study, 104 eyes of 97 patients were analyzed. CNV in all eyes was secondary to AMD. New subfoveal hemorrhage was found in 22% (23/104) of the eyes 2 weeks following PDT. 17.4% (4/23) of the eyes with new subfoveal hemorrhage had moderate or severe loss of visual acuity. In such eyes the 12-week examination revealed considerable resorption of the new subfoveal hemorrhage with some improvement of visual acuity. CONCLUSIONS: In 3.8% of the eyes that underwent PDT for predominantly classic subfoveal CNV secondary to AMD, new subfoveal hemorrhage may result in moderate or severe loss of visual acuity within 2 weeks. In all eyes with new subfoveal hemorrhage, considerable resorption of the hemorrhage and some improvement of the visual acuity were seen at 12 weeks. Candidates for PDT should be informed about the low risk of this complication.     

Photodynamic therapy in age-related macular degeneration--results of one year observation

PURPOSE: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin in reducing the vision loss and progression of choroidal neovascularization (CNV) in patients with subfoveal CNV due to age-related macular degeneration (AMD). MATERIALS AND METHODS: 46 eyes of 46 patients with subfoveal, predominantly classic CNV caused by AMD and best-corrected visual acuity of 5/50 to 5/10 were treated with photodynamic therapy with verteporfin (Visudyne, CIBA Vision). Verteporfin was administered via intravenous infusion over 10 minutes. Fifteen minutes after the start of the infusion, a diode laser light at 689 nm (Opal Photoactivator, Coherent) was delivered over 83 seconds. Visual acuity and fluorescein angiography were performed before and after the treatment at 7 days and 1, 3, 6, 9 and 12 months after the initial-treatment. Retreatment in the same manner was applied if at follow-up examination fluorescein leakage from CNV was seen. Outcomes were compared with those of control group which consisted of 38 eyes of 38 patients of the same condition of the disease, not treated with any method. RESULTS: The lost of visual acuity was significantly reduced in the verteporfin--treated eyes compared--with controls. At the 12 month 73.91% eyes of PDT group versus 36.84% of control group (p < 0.001) lost fewer than 3 Snellen lines. The vision loss appeared to be more rapid in first 6 months of the study. During the study growth of CNV was diminished in PDT group compared with control group. CONCLUSIONS: Results show, that photodynamic therapy may be an effective method of treatment for predominantly classic subfoveal choroidal neovascularization caused by AMD. Further studies are needed to find the best modes of PDT procedure.     

Combined photodynamic therapy and intravitreal triamcinolone injection for the treatment of subfoveal choroidal neovascularisation in age related macular degeneration: a comparative study

AIM: To evaluate the outcomes of combined intravitreal triamcinolone (IVTA) and photodynamic therapy (PDT) with verteporfin in the treatment of subfoveal choroidal neovascularisation (CNV) caused by age related macular degeneration (AMD). METHODS: 48 eyes from 48 patients with subfoveal CNV caused by AMD were prospective recruited, with 24 eyes treated with combined PDT with IVTA and compared with a control group of 24 eyes which received PDT monotherapy. In the combined treatment group, IVTA was performed immediately after PDT as an outpatient procedure. The mean number of treatments, mean logMAR best corrected visual acuity (BCVA), mean line of visual acuity changes, and proportion of patients without moderate visual loss at 1 year were compared between the combined and monotherapy groups. RESULTS: At 1 year the logMAR BCVA for the PDT with IVTA group changed from 0.88 to 0.95 (p = 0.32 compared with baseline), whereas the logMAR BCVA for the monotherapy group reduced from 0.74 to 1.09 (p<0.001 compared with baseline). A significantly higher proportion of patients who had PDT with IVTA did not develop moderate visual loss at 1 year compared with the monotherapy group (70.8% and 33.3% respectively, p = 0.009). Eyes which had combined treatment had significantly fewer lines lost compared with monotherapy alone (0.7 and 3.5 lines respectively, p = 0.015). Subgroup analysis showed that PDT with IVTA is effective in preventing visual loss in both predominately classic and occult CNV groups. The mean number of treatments for the combined and monotherapy groups was 1.5 and 1.96 respectively (p = 0.076). CONCLUSIONS: Combined PDT with IVTA appeared more effective statistically at 12 months for stabilisation of vision (<3 logMAR lines change) compared with PDT monotherapy. Further randomised control trials might be justified to conclude the efficacy of PDT with IVTA.     

Case series outcomes at 1 week following verteporfin photodynamic therapy.

PURPOSE: To examine the choroidal neovascularization (CNV) fluorescein angiographic perfusion and visual acuity 1 week after photodynamic therapy (PDT) with verteporfin (Visudyne, Novartis AG, Switzerland) on predominantly classic, subfoveal lesions in age-related macular degeneration (AMD). METHOD: A retrospective case series study was conducted on the 1-week outcome of PDT treatment of 76 of 79 consecutive patients with the subfoveal, predominantly classic CNV form of AMD. Leakage from CNV was assessed by fluorescein angiography and best-corrected visual acuity determined on projected Snellen charts using a standardized protocol. RESULTS: One week after PDT treatment, absence of fluorescein leakage from CNV was observed in 100% of the 76 patients. Visual acuity improved (at least a three-line gain) in 11 patients (15%), remained unchanged (less than a three-line gain or loss) in 64 patients (84%), and deteriorated (at least a three-line loss) in only one patient (1%). CONCLUSION: The absence of fluorescein leakage from classic CNV at 1 week in all cases was consistent with the published outcome of the clinical Phase I and II PDT trials. Further, vision loss 1 week after PDT for predominantly classic CNV was very uncommon. Therefore 1-week post-PDT angiography is unnecessary for predominantly classic CNV in patients with AMD.     

光动力疗法治疗老年性黄斑变性合并脉络膜新生血管的临床观察

目的 观察单次光动力疗法(photodynamic therapy, PDT)治疗渗出型老年性黄斑变性(age-related macular degeneration, AMD)合并脉络膜新生血管(choroidal neovascularization, CNV)的短期治疗效果。 方法 回顾分析经荧光素眼底血管造影(fundus fluorescein angiography, FFA)、吲哚青绿血管造影(indocyanine green angiography,ICGA)和光相干断层成像术(optic coherence tomography, OCT)等检查确诊的30例渗出型AMD患者的35只患眼行PDT治疗前和治疗后1周,1、3个月的临床资料，以视力、FFA、ICGA和OCT检查结果为观察指标，评价PDT对渗出型AMD的短期治疗效果。 结果 治疗后3 个月内有34只眼视力不变或提高，1只眼因出血而视力下降；FFA检查显示有19只眼荧光素渗漏减轻或完全消退；OCT检查显示视网膜水肿和浆液性脱离明显好转。全部患者治疗过程中未发生任何不良反应；治疗后3例患者主诉有一过性视物变暗，2例主诉轻微背痛。 结论 PDT治疗渗出型AMD时，可短期封闭CNV，使渗漏减轻或消退，对视力无损害。 (中华眼底病杂志, 2002, 18: 171-174)     

Photodynamic therapy with delayed light application for the treatment of bilateral subfoveal choroidal neovascularization in age-related macular degeneration

PURPOSE: To determine if photodynamic therapy (PDT) with delayed light application at 17 minutes after the start of infusion was effective in the second eyes of patients with bilateral subfoveal classic choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: The records of 20 patients with bilateral subfoveal classic CNV secondary to AMD who were treated with bilateral PDT in the same session were reviewed. Treatment for the second eye of patients was begun 120 seconds after termination of treatment for the first eye. This time interval was necessary for applying the contact lens and entering the new laser parameters, and it was kept constant in all cases. Best-corrected visual acuity (BCVA), ophthalmologic examinations, fluorescein and indocyanine angiograms were used to evaluate the results of PDT. Follow-up time ranged from 6 to 12 months with a mean of 8.7 (+/-2.1) months. RESULTS: Mean (+/-SD) treatment sessions were 1.7 (+/-0.6) in first eyes and 1.7 (+/-0.5) in second eyes. Among first eyes, BCVA improved in 7 of the 20 eyes (35%); stabilized in 7 eyes (35%); and worsened in 6 eyes (30%). Among second eyes, BCVA improved in 5 of the 20 eyes (25%); stabilized in 8 eyes (40%); and worsened in 7 eyes (35%). CONCLUSIONS: In most cases, bilateral PDT in the same session achieved cessation of fluorescein leakage from CNV without loss of vision or growth of CNV in the second eyes of patients with bilateral subfoveal classic CNV secondary to AMD. Further studies with a larger number of patients and longer follow-up are necessary to confirm whether bilateral PDT in the same session is beneficial for bilateral subfoveal classic CNV related to AMD.     

中国维替泊芬光动力疗法治疗年龄相关性黄斑变性中心凹下脉络膜新生血管的多中心临床研究

目的探讨以维替泊芬为光敏剂的光动力疗法（PDT）治疗年龄相关性黄斑变性（AMD）合并黄斑中心凹下典型脉络膜新生血管（CNV）的疗效和安全性。方法采用多中心、开放、非对照Ⅲ期临床试验。受试对象为黄斑中心凹下以典型CNV为主的AMD患者。观察期限为24周。于第1次治疗后12和24周末进行复查。在首次治疗后12周,如发现CNV复发,则重复进行光动力治疗。比较治疗前后眼底病灶及视力的改变。记录治疗及随诊中所有的不良反应。结果共有32例患者入选,符合选择标准的患者为31例（31只眼）。在24周的观察中,38．7％的治疗眼视力增加5个字母以上,视力提高或减少小于15个字母者占83．9％。首次治疗后12周,CNV完全无渗漏的为12．9％;有渗漏,但局限于原病灶区的为61．3％;渗漏有进展者为25．8％。首次治疗后24周,病灶和病灶周围萎缩区大小、整个病变区域的最大直线距离均比治疗前稍有扩大,但差异均无统计学意义（P=0．65,0．31,0．12）。由此表明,在治疗的24周中,患眼的病灶基本稳定,未见明显扩大。PDT治疗后未发现病灶瘢痕明显扩大。整个临床试验中,11例（34．4％）发生了不良事件,其中7例（21．9％）为轻度不良事件,3例（9．4％）为中度不良事件,1例（3．1％）为重度不良事件。PDT治疗后24周,血尿常规和心电图检查均未见明显异常。结论用维替泊芬为光敏剂的PDT治疗AMD患者黄斑中心凹下CNV有较好的疗效,可以减轻CNV的渗漏,延缓视力下降,而且与药物相关的不良事件发生率低。因此,以维替泊芬为光敏剂的PDT治疗AMD继发的典型CNV其疗效肯定且安全。     

Review of first year result of photodynamic therapy on age-related macular degeneration in Chinese population

PURPOSE: To evaluate the effect of verteporfin therapy (Visudyne) on age-related macular degeneration (AMD) in Chinese patients. The baseline characteristic and the visual outcome will be compared with the treatment of AMD with photodynamic therapy study (TAP) and verteporfin in photodynamic therapy study (VIP). DESIGN: Retrospective comparative case series. METHOD: We recruited patients >50 years old, with best-corrected visual acuity >20/200 and fluorescein angiography documenting subfoveal either predominantly classic with greatest linear dimension <5400 mum or pure occult choroidal neovascularization (CNV) secondary to AMD. We applied non-thermal laser to the lesion 15 min after visudyne infusion as described in TAP study. Patients were followed up with fluorescein angiography every 3 months. Additional treatment would be offered if there was evidence of recurrence of CNV. OUTCOME MEASURE: Baseline characteristic and visual outcome. RESULT: In all, 46 eyes of 42 patients were enrolled at our centre from July 2002 to June 2003. They comprised 11 eyes with predominantly classic lesions and 35 eyes with pure occult lesion. The mean number of treatment sessions given was 2.9 in the first year. At the 12-month examination, there were 63 and 29% of patients showing visual improvement in predominantly classic and occult groups, respectively, while there were only 16% of patients in the TAP study and 12% of patients in the VIP study showing visual improvement in the same period. CONCLUSION: Verteporfin therapy for subfoveal CNV is beneficial to Chinese patients with AMD at first year. The visual result seems to be better than that observed in Caucasian patients.     

Photodynamic therapy with verteporfin following transpupillary thermotherapy for CNV evolving from an initially occult to a predominantly classic form, in patients with AMD

The purpose of this paper is to evaluate photodynamic therapy (PDT) in the management of choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) that converted from occult CNV to classic CNV after treatment with transpupillary thermotherapy (TTT). One hundred and fifty-four eyes of 130 patients with symptomatic occult CNV were treated between June 2000 and August 2001. We have analyzed data from patients treated with PDT because of a conversion from occult to classic CNV after TTT. The results were that twenty-four of 154 eyes developed a predominantly classic CNV; 20 eyes of 19 consecutive patients were treated with PDT with verteporfin. The mean follow-up period was 10 months. The mean delay for retreatment with TTT was 3 months; 3 eyes initially presented a pure occult CNV, 15 a minimally classic CNV, 1 an occult CNV with pigment epithelial detachment, and 1 a large macular subretinal hemorrhage with a subfoveal focal hot spot. The average classic component within a lesion before TTT was 20%. Recurrence of classic CNV was noted in the first 3 months for 14 eyes. Visual acuity improved in 5 eyes by >/=2 lines, and in 2 eyes by 1 line; 4 of 20 eyes had stabilized visual acuity; 7 eyes had a visual acuity decline of >/=2 lines; 2 eyes lost 1 line. All patients had reduction of metamorphopsia and reduction of exudation; 14 eyes had a little subretinal fibrosis and some partially atrophic areas; 6 eyes had slightly increased leakage in the late phase of the angiogram. In conclusion, association of TTT and PDT appears to be safe and may help practitioners to manage some difficult cases. This study seems to confirm the great efficacy of PDT in CNV with recent activity.     

Long-term efficacy of transpupillary thermotherapy for subfoveal choroidal neovascularization in age-related macular degeneration

AIM: To determine the long-term efficacy of transpupillary thermotherapy (TTT) in the treatment of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD). METHODS: Fourteen eyes of 14 patients with subfoveal CNV secondary to AMD were treated with diode laser (810nm) TTT. The mean age was 67.1 years. Complete ophthalmic examination was done, color fundus photographs and macular optical coherence tomography scans were taken, fluorescein and indocyanine green angiography were performed during initial and at subsequent follow-up examinations. Treatment was given in one minute using 2-3mm spot sizes, and laser power settings were between 650-800mW. The follow-up period was between 5 and 64 months and the mean was 28.6 months. RESULTS: There was subfoveal classic CNV in 10, predominantly classic CNV in 2, minimally classic CNV in 1, and type 1 occult CNV in one of the fourteen eyes. Four patients were noted to have post-treatment hemorrhage which was absorbed in a short time. Macular non-perfusion occurred in one patient immediately after treatment. Most of the eyes demonstrated a decrease in exudation during the follow-up. With a mean follow-up of 28.6 months, visual acuity improved in 5, remained the same in 8 and decreased in 1 of the 14 eyes. CONCLUSION: Transpupillary thermotherapy is shown to close subfoveal CNV with rapid resolution of subretinal fluid while maintaining visual function in patients with AMD. It may be performed as an alternative laser treatment in classic and predominantly classic subfoveal choroidal neovascularization due to AMD.     

Photodynamic therapy with verteporfin following transpupillary thermotherapy for CNV evolving from an initially occult to a predominantly classic form,in patients with AMD

The purpose of this paper is to evaluate photodynamic therapy (PDT) in the management of choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) that converted from occult CNV to classic CNV after treatment with transpupillary thermotherapy (TTT). One hundred and fifty-four eyes of 130 patients with symptomatic occult CNV were treated between June 2000 and August 2001. We have analyzed data from patients treated with PDT because of a conversion from occult to classic CNV after TTT. The results were that twenty-four of 154 eyes developed a predominantly classic CNV; 20 eyes of 19 consecutive patients were treated with PDT with verteporfin. The mean follow-up period was 10 months. The mean delay for retreatment with TTT was 3 months; 3 eyes initially presented a pure occult CNV, 15 a minimally classic CNV, 1 an occult CNV with pigment epithelial detachment, and 1 a large macular subretinal hemorrhage with a subfoveal focal hot spot. The average classic component within a lesion before TTT was 20%. Recurrence of classic CNV was noted in the first 3 months for 14 eyes. Visual acuity improved in 5 eyes by ≥2 lines, and in 2 eyes by 1 line; 4 of 20 eyes had stabilized visual acuity; 7 eyes had a visual acuity decline of ≥2 lines; 2 eyes lost 1 line. All patients had reduction of metamorphopsia and reduction of exudation; 14 eyes had a little subretinal fibrosis and some partially atrophic areas; 6 eyes had slightly increased leakage in the late phase of the angiogram. In conclusion, association of TTT and PDT appears to be safe and may help practitioners to manage some difficult cases. This study seems to confirm the great efficacy of PDT in CNV with recent activity.     

经瞳孔温热疗法和光动力疗法治疗渗出型老年性黄斑变性短期疗效比较

目的 比较经瞳孔温热疗法(TTT) 和光动力疗法(PDT)治疗渗出型 老年性黄斑变性(AMD)脉络膜新生血管(CNV)的疗效。 方法 对比分析渗出性AMD患者行PDT 治疗的35例42只眼、TTT治疗的35例40只眼治疗前和治疗后3个月的临床资料。所有患者治疗前后均进行视力 、荧光素眼底血管造影（FFA）、吲哚青绿血管造影（ICGA）和光相干断层扫描（OCT）检查 。CNV类型均为黄斑中心凹下型或旁中心凹型。其中，隐匿性或隐匿性为主型的CNV44只眼 ，典型性及典型性为主型的CNV38只眼。PDT治疗的42只眼中，隐匿性或隐匿性为主型CNV19只眼，典型性或典型性为主型CNV23眼；TTT治疗的40只眼中，隐匿性或隐匿性为主型CNV25只眼，典型性及典型性为主型CNV15只眼。 结果 典型性或典型性为主型CNV治疗后1、3个月时，PDT组分别有47.8%、43.5%的患眼视力提高2行以上；TTT组分别有6.7%、6.7%的患眼视力提高2行以上。两组之间治疗后1、3个月时视力提高的比例比较，差异均有显著性的意义（χ2=7.118,P=0.0076；χ2=5.500,P=0.0190）。PDT组分别有100%、69.6%的患眼CNV荧光素渗漏停止或改善；TTT组分别有53.2%、80.0%的患眼CNV荧光素渗漏停止或改善。两组之间治疗后1个月时CNV荧光素渗漏停止或改善的比例比较，差异有显著性的意义（χ2=13.16,P=0.0003）；3个月时CNV荧光素渗漏停止或改善的比例比较，差异无显著性的意义（χ2=0.5098,P=0.4752）。隐匿性或隐匿性为主型CNV治疗后1、3个月时，PDT组分别有15.8% 、10.5%的患眼视力提高2行以上；TTT组分别有4.0%、8.0%的患眼视力提高2行以上。两组之间治疗后1、3个月时视力提高的比例比较，差异均无显著性的意义（χ2=1.816,P=0.17 78；χ2=0.0838,P=0.7728）。PDT组分别有78。9%、42.1% 的患眼CNV荧光素渗漏停止或改善；TTT组分别有52.0%、84.0%的患眼CNV荧光素渗漏停止或改善。两组之间治疗后1个月时CNV荧光素渗漏停止或改善的比例比较，差异无显著性的意义（2=3.388,P=0.0657）；3个月时CNV荧光素渗漏停止或改善的比例比较，差异具有显著性的意义（χ2=8.433,P=0.0037）。 结论 典型性及典型性为主型CNV治疗后3个月视力结果PDT优于TTT；治疗后1个月时FFA检查渗漏改善PDT明显优于TTT，但随诊至3个月时，二者疗效差异无显著性的意义。隐匿性或隐匿性为主型CNV治疗后3个月视力结果PDT与TTT差异无显著性的意义；治疗后1个月FFA检查渗漏改善改善PDT与TTT差异无显著性的意义，但随诊至3个月时，CNV渗漏消失和减少方面TTT疗效明显好于PDT。尚需要更多的病例及更长的随诊时间来评价两种治疗方法的疗效.（中华眼底病杂志，2004，20：285-288）     

经瞳孔温热疗法治疗老年黄斑变性所致黄斑中心凹下脉络膜新生血管的长期观察(英文)

目的:评价经瞳孔温热疗法(TTT)治疗年龄相关性黄斑变性(AMD)所致黄斑中心凹下脉络膜新生血管(CNV)的长期疗效。方法:AMD所致黄斑中心凹下脉络膜新生血管14例14眼。平均年龄67.1岁。记录详尽的眼科检查结果,拍摄彩色眼底相,并行黄斑部光学相干断层成像(OCT)检查。在初诊及随后的复诊中行眼底荧光素血管造影和吲哚青绿血管造影。TTT的治疗参数为:时间1min,光斑大小2 ~3mm,激光能量650 ~800mW。随诊时间5 ~64mo,平均28.6mo。结果:在14眼中,典型性CNV有10眼,典型为主性有2眼,1眼为少量典型性,1型隐匿性CNV有1眼。共4例患者出现治疗后出血,均在短期内吸收。有1眼在治疗后立刻出现了黄斑无灌注区。多数患眼在随诊中可见渗出逐渐减少。在平均28.6mo的随诊中,14只患眼,有5眼视力提高,8眼保持稳定,1眼视力下降。结论:经瞳孔温热疗法在AMD患者中能封闭黄斑中心凹下的CNV,促进网膜下积液的迅速吸收,从而稳定患者的视力。它可以作为一种治疗典型和典型为主性黄斑中心凹下脉络膜新生血管的激光治疗手段。     

Verteporfin photodynamic therapy for extrafoveal choroidal neovascularisation secondary to age-related macular degeneration

PURPOSE: To report the results of verteporfin photodynamic therapy (PDT) of extrafoveal predominantly classic choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD). METHODS: In this retrospective study 20 consecutive patients (20 eyes) undergoing verteporfin PDT for extrafoveal predominantly classic CNV in AMD were examined. Colour photography of the fundus, fluorescein angiography and complete ophthalmic examination, including visual acuity assessment with ETDRS charts, were performed before treatment and at 3-month intervals thereafter. The primary outcome criterion was the change in visual acuity. The secondary outcome criterion was the extension of the CNV beneath the centre of the fovea during the follow-up period. RESULTS: Mean follow-up time of the patients was 24.2 months (range 12 to 58 months). Visual acuity at baseline varied from 20/200 to 20/20 (mean 20/50+/-2.3 lines). Final visual acuity ranged from 20/1000 to 20/20 (mean 20/200+/-5.1 lines) (P<0.001). In 85% (17/20) of the eyes visual acuity worsened. Visual acuity improved in 15% (3/20) of the eyes. During the course of the follow-up period, subfoveal extension of the CNV was detected in 80% (16/20) of the eyes. CONCLUSION: In 85% of the eyes with extrafoveal predominantly classic CNV secondary to AMD, visual acuity worsened after verteporfin PDT in an average follow-up time of 24 months. Subfoveal CNV was found in 80% of the eyes during follow-up. Even though verteporfin PDT can preserve visual acuity in selected cases, deterioration was seen in the majority of the patients.     

光动力疗法治疗渗出型老年性黄斑变性四年临床观察总结

目的 总结4年来光动力疗法（PDT）治疗渗出型老年性黄斑变性(AMD)的临床疗效，以评价PDT的长期治疗效果。 方法 回顾73例经双目间接检眼镜、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)检查确诊的渗出型AMD患者的95只患眼行PDT治疗前后的临床资料，对比分析其视力、眼底像、FFA、ICGA和光相干断层扫描(OCT)检查结果的变化。73例患者平均年龄67.8岁，就诊时最佳矫正视力数指/10 cm～1.0。95只眼PDT平均治疗次数为1.5次，治疗后随访时间为3个月～4年。 结果 PDT治疗后末次随访时，39只眼视力提高≥2行，占41.1％；51只眼视力波动在1行以内，占53.7％；5只眼视力下降≥2行，占5.3％ 。所有患眼眼底出血和渗出均减轻。FFA或FFA联合ICGA检查显示：58只眼脉络膜新生血管（CNV）渗漏完全停止，转为瘢痕期，占61.05％；6只眼CNV部分闭合， 占6.32％；22只眼CNV小部分闭合，占23.16％；9只眼CNV复发，占9.47％。早期AMD患者12只眼经过1次PDT治疗后，最佳矫正视力0.6～1.5，CNV完全闭合，OCT检查显示黄斑区水肿及神经上皮脱离消失。随访时间最长达4年，未见有复发，视力保持稳定。 结论 单次和重复PDT治疗渗出型AMD长期疗效较好，安全性较高。对于早期渗出型AMD患者微小典型性CNV，单次PDT治疗可以使其完全封闭，使患者视力保持在较好的水平。 （中华眼底病杂志，2004，20：275-279）     

光动力学治疗脉络膜新生血管的临床观察

目的观察光动力学治疗继发于不同病因的黄斑中心凹下或中心凹旁脉络膜新生血管的疗效和安全性。方法回顾16例16眼经荧光血管造影、吲哚青绿造影证实活动性脉络膜新生血管,继发于老年性黄斑变性4眼,病理性近视6眼和中心性渗出性脉络膜视网膜病变6眼。比较PDT治疗前后最佳矫正视力,散瞳前置镜眼底检查以及荧光血管造影和脉络膜血管造影的资料。典型性为主型CNV14眼,轻微典型性CNV1眼,隐匿性CNV1眼。CNV位于黄斑中心凹下12眼,黄斑中心凹旁4眼。光动力学治疗方案参照TAP制定的标准。结果随访时间:1~14个月,平均(5±4.28)个月。1次治疗14眼,重复治疗2次1眼,3次1眼。最终患眼视力提高8眼,保持不变8眼。FFA检查示CNV渗漏停止1眼,渗漏减少10眼,渗漏无明显减少5眼,渗漏面积较治疗前明显缩小(P<0.05)。CNV复发3眼。仅1例在输液时发生光敏剂渗漏,但未发生光敏反应。治疗后视网膜一过性出血增加3眼。结论光动力学治疗为继发于不同病因的黄斑中心凹下或中心凹旁CNV患者提供一种安全有效的治疗选择。部分患者治疗后短时间内复发,PDT治疗CNV的长期疗效有待进一步观察。     

Photodynamic therapy

Photodynamic therapy with Verteporfine (Visudyne Novartis Ophthalmics) achieves a photo occlusion of subfoveal choroidal neovascularization (CNV) resulting from age-related macular degeneration (AMD) in phase 1 and 2 studies. Thereafter, two international randomized clinical trials evaluated the product's efficacy in term of visual acuity. Eyes with neovascular lesions due to AMD of less than 5,400 micro, in size involving the fovea and presenting well-defined CNV on fluorescein angiography could be included when visual acuity was between 5 and 1/10. Six hundred and nine patients were subsequently randomized either to Verteporfine or to placebo (proportion 2:1). A follow-up of 3 months made it possible to consider retreatment when a fluorescein leakage was observed. Functional and angiographic results demonstrated the efficacy of PDT with Verteporfine in comparison with placebo at each examination during follow-up. A visual acuity decrease of less than 15 letters on ETDRS (or 3 lines or approximately 1.5/10) occured less frequently in the treated group with PDT (61% out of 402 treated eyes compared with 46% of 207 placebo eyes). Subgroup analysis of predominantly well-defined CNV (involving 50% or more of the total of the exsudative lesion) showed even more favourable effects (67% of treated eyes versus 39% of placebo eyes). Conversely, when well-defined CNV extended to a smaller area, the results were not significant. The most frequent side effect was Verteporfine extravasation at the injection site. As dynamic phototherapy with Verteporfine limits the decrease in visual acuity always occurring in the natural history of CNV caused by AMD, it is desirable that patients presenting subfoveal predominantly well-defined lesions benefit from this new treatment approach.     

Retinal pigment epithelial tear following photodynamic therapy for choroidal neovascularization secondary to AMD

PURPOSE: To describe retinal pigment epithelial tear following photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). DESIGN: Retrospective interventional case series. METHODS: A retrospective study in an institutional practice. We describe seven cases of retinal pigment epithelial (RPE) tear, which developed in seven eyes of seven patients following PDT. All eyes had subfoveal CNV secondary to AMD. RESULTS: Six eyes had occult subfoveal CNV, and one eye had recurrent classic subfoveal CNV. In five patients, the eye that developed the tear was the second eye, whereas the first eye had a disciform scar. In four eyes, the RPE tear developed after one PDT, in one eye the RPE tear developed after the second PDT, and in two eyes the RPE tear developed after the third PDT. In five of seven cases, there was a significant visual deterioration following the RPE tear. CONCLUSIONS: RPE tear is a complication that may occur following PDT in particular when the PDT is applied to an occult subfoveal CNV.     

光动力疗法治疗老年黄斑变性临床初步观察

目的　观察应用光动力疗法 (photodynam ic therapy,PDT )单次治疗渗出型年龄相关性黄斑变性 (age- related m acu-lar degeneration,A MD )并发脉络膜新生血管 (choroidal neovascularization,CN V )的近期治疗效果。方法　以眼底检查、视力、眼底荧光血管造影 (FFA)、吲哚青绿脉络膜血管造影 (ICG)和光学相干断层成像技术 (O CT)等影像学检查为观察指标 ,总结PDT治疗 15例 16眼 A MD合并的典型 CNV后 1周和 1个月随访的短期治疗效果 ,从而评价 PDT治疗 CNV的安全性和短期治疗效果。结果　治疗后 1周和 1个月分别有 6眼和 10眼视力不同程度提高 ,1眼因新出血视力略有下降 ,无证据表明与治疗有关。 15例 16眼治疗后荧光渗漏均有不同程度的减弱或消退 ,其中 7例 8眼渗漏完全消退 ,1月后复查无复发 ;其余 8例8眼荧光渗漏明显减轻。全部 15例治疗过程中未发生任何不良反应 ;仅 3例治疗后主述有一过性轻度视力紊乱。结论　光动力疗法单次治疗渗出型年龄相关性黄斑部变性并发的脉络膜新生血管膜短期疗效满意、安全 ,对视力无损害。     

Chorioretinal anastomosis as unfavourable prognostic factor during photodynamic therapy

BACKGROUND: The aim of this study was the documentation of chorioretinal anastomosis in neovascular age-related macular degeneration (AMD) and correlation with functional and angiographic results following photodynamic therapy (PDT). METHOD: A total of 100 patients presenting with neovascular AMD and indication for PDT based on the presence of predominantly classic choroidal neovascularization (CNV), underwent ophthalmoscopic and angiographic screening for chorioretinal anastomosis. Conventional PDT using verteporfin was performed according to the recommended standard procedure.The pre- and post-treatment status at 3 and 6 months post-PDT in all patients and at 1 week in selected patients was documented with respect to the central visual acuity test (ETDRS), ophthalmoscopy as well as fluorescein (FA) and indocyanine green angiography (ICGA). RESULTS: A primary chorioretinal anastomosis was found in 6% ( n=12) of all eyes with CNV and classic PDT indication. Mean visual loss within the first 6 months after therapy was 3 lines indicating lack of visual stabilization according to the PDT study criteria.Furthermore, an increase in visual acuity could not be documented in any case.Angiography demonstrated continuous progression of CNV size although PDT had been uneventful. The characteristic initial occlusion of the CNV with homogeneous hypofluorescence was absent angiographically at 1 week post-PDT.The anastomosis was detected by ICGA in all eyes and by ophthalmoscopy or optical coherence tomography (OCT) in most eyes. DISCUSSION: Chorioretinal anastomosis is not a rare finding associated with predominantly classic CNV.The presence of anastomosis appears to be an unfavourable prognostic factor during PDT. If a chorioretinal shunt is suspected evaluation by ICGA and/or OCT should be performed and the indication for PDT should be rediscussed.