PDT治疗病理性近视黄斑部CNV的多焦视网膜电图变化观察

目的:应用多焦视网膜电图(multifocal electroretinogram,mfERG)评价光动力疗法(photodynamic therapy,PDT)治疗病理性近视(pathological myopia,PM)合并黄斑下脉络膜新生血管(choroidal neovascularisation,CNV)早期视网膜功能的改变.方法:经临床确诊的继发于PM的CNV患者30例(30眼),根据CNV的位置将患眼分为中心凹下CNV组(19例19眼)和旁中心凹CNV组(11例11眼),在治疗前及治疗后1wk;1和3mo对各患眼6个环状视网膜区域的N1,P1波潜伏期和平均反应密度进行检测.结果:中心凹下CNV组治疗后1和3mo时mfERG3～5环N1、P1波振幅密度值与治疗前均显著提高(P＜0.05).旁中心凹CNV组治疗后1wk和1mo3～5环N1波振幅密度值与治疗前对比均有明显提高(P＜0.05),3mo3～4环N1波振幅密度值显著提高(P＜0.05),治疗后1wk;1和3mo3～4环P1波振幅密度值与治疗前比均有明显提高(P＜0.05).结论:mfERG显示PDT治疗能有效改善继发于PM的CNV患眼黄斑中心凹外的视功能.     

光动力疗法治疗病理性近视所致黄斑部CNV的临床疗效观察

目的:评价光动力疗法(photodynamic therapy,PDT)治疗病理性近视所致黄斑部脉络膜新生血管(choroidal neovascularization,CNV)的临床疗效。方法:回顾性分析20例21眼临床确诊为病理性近视合并CNV患者的临床资料,对比分析PDT治疗前后患者最佳矫正视力(BCVA)、固视性质,FFA/ICGA和OCT等检查结果的变化。结果:PDT治疗后随访6mo,1例患者PDT治疗后3mo因玻璃体积血行玻璃体切除手术,未继续随访。其余患者BCVA与治疗前相比明显提高,差异具有统计学意义(P<0.05)。PDT治疗前中心固视3眼,中心外固视18眼,随访期间固视性质未发生改变。FFA/ICGA检查显示,PDT治疗后3mo,CNV病灶渗漏停止或渗漏减少者18眼(86%),持续渗漏2眼(10%),1眼出现玻璃体积血。PDT治疗后6mo,CNV病灶渗漏停止或渗漏减少者19眼(90%),持续渗漏1眼(5%),OCT显示CNV缩小,组织水肿减轻。结论:PDT治疗可以部分或完全封闭病理性近视所致脉络膜CNV,减少CNV引起的视力下降危险性。     

ETDRS视力及mfERG在评估病理性近视合并黄斑CNV疗效中的应用

目的：以ETDRS视力和多焦视网膜电图(Multifocal ERG,mfERG)比较抗血管内皮生长因子(VEGF)与光动力疗法(PDT)对病理性近视(PM)并发脉络膜新生血管(CNV)的治疗效果。

方法：将临床上经FFA、ICGA及OCT确诊为PM合并黄斑CNV的43例45眼患者纳入观察。以ETDRS视力表记录最佳矫正视力(BCVA),并进行mfERG检查。患者被随机分为两组进行治疗,20例22眼行玻璃体腔注射雷珠单抗,23例23眼行PDT。治疗后每月复查一次,随访12mo,根据复诊情况,按需行重复治疗。以末次随访为疗效判定时间点,记录并分析患者治疗前后ETDRS视力和mfERG的变化。

结果：治疗前两组基线ETDRS视力及中心凹1环和2环N1波潜伏期、P1波潜伏期及P1波反应密度值无显著差异,治疗后12mo雷珠单抗组视力39.23±20.06字母,较治疗前明显提高5.88±9.03字母(P<0.05); PDT组视力37.38±16.95字母,与治疗前比,未明显改善0.33±6.94字母(P>0.05)。两组患者mfERG的N1波、P1波的潜伏期及P1波反应密度值与治疗前比较,差异均无统计学意义(P>0.05)。

结论：对PM并发CNV的治疗,抗VEGF疗法与PDT治疗具有相似的稳定黄斑功能的作用,在视力改善上,抗VEGF疗效优于PDT治疗。     

光动力疗法治疗病理性近视脉络膜新生血管的临床观察

目的 探讨光动力疗法(PDT)治疗病理性近视(PM)黄斑部脉络膜新生血管(cNV)短期的安全性和有效性.方法 回顾经临床眼底检查、FFA和/或ICGA检查及确诊的继发于PM的CNV患者19例(19只眼)行PDT治疗前后的临床资料,对比分析其最佳矫正视力、眼底像、眼底血管造影CNV渗漏、OCT及mf-ERG检查结果.光动力治疗方案参照TAP制定的标准.随访时间为3-6个月.结果 PDT治疗后全部患者视力改善或保持不变,无视力下降者.所有患眼底出血或渗出均减轻.FFA/ICGA检查显示:CNV停止渗漏11只眼,占57.89%;渗漏减少8只,占42.11%.OCT检查显示CNV明显变薄.PDT治疗后1个月mf-ERG3-5环N1、P1波波振幅密度值与治疗前均有显著提高(P＜0.05),3个月时3～4环N1、P1波振幅密度值与治疗前均有显著提高(P＜0.05).结论 病理性近视CNV经PDT治疗短期有效,安全性好,PDT治疗CNV的长期疗效有待进一步观察.     

PDT联合玻璃体腔注射Avastin治疗病理性近视CNV

目的：观察光动力疗法（photodynamic therapy, PDT）联合玻璃体腔注射Avastin治疗并发脉络膜新生血管(choroidal neovascularization, CNV)的病理性近视（pathologic myopia, PM）的安全性和临床疗效。 方法：并发黄斑中心凹下CNV的PM 患者17例17眼纳入治疗。PDT按照国际标准进行。3d后在表面麻醉下给予1.5mg Avastin玻璃体腔注射。治疗后第1,3,6,12mo各随访1 次, 随访时间为6~16mo。复查视力、眼压、眼底检查、眼底彩照、FFA、OCT。治疗前、后对比行配对样本t检验统计分析,P<0.05为差异有统计学意义。 结果：末次随访时,视力提高2行以上者4眼（23.53%）,视力提高1行者5眼（29.41%）,视力不变者8眼(47.06%),无视力下降者。术前BCVA：0.02～0.3（logMAR值:平均1.007±0.103）,术后BCVA：0.02～0.5（logMAR值:平均0.873±0.100）（P＜0.01）。术前平均眼压为15.26±0.76mmHg,术后平均眼压为14.97±0.69mmHg（P＞0.05）。FFA检查显示:10眼CNV 完全闭合,占58.82%,其余7眼CNV大部分闭合,占41.18%。CMT：术前平均为: 194.67±12.74μm,术后平均为：132.07±8.32μm,差别有统计学意义（P＜0.01）。 结论：PDT联合玻璃体腔注射Avastin治疗并发CNV的PM安全有效,使CNV渗漏停止或减轻,视网膜水肿消退或减轻,但不同年龄的患者视力预后差别大,老年患者视力预后差,可能与其本身的进行性脉络膜视网膜萎缩有关。但尚需进一步大样本的临床随机对照研究来证实。     

光动力疗法联合玻璃体内注射Bevacizumab治疗病理性近视合并脉络膜新生血管

目的 观察光动力疗法(photodynamic therapy,PDT)联合玻璃体内注射Bevacizumab治疗病理性近视(pathological myopia,PM)合并脉络膜新生血管(choroidal neovascularization,CNV)的临床疗效和安全性.方法 回顾性分析68例(68眼)PM患者的临床资料.先行PDT治疗后1周内,行玻璃体内注射Bevacizumab 1.5 mg(0.06 mL).术后1个月、3个月、末次随访时,复查最佳矫正视力、眼底彩照、FFA、ICGA、OCT.随访时,发现CNV部分闭合或仍有渗漏者给予再次玻璃体内注射Bevacizumab.比较联合治疗前后最佳矫正视力、眼底彩照、FFA、ICGA、OCT检查结果,观察其疗效及安全性.结果 术后1个月、3个月和末次随访时最佳矫正视力均较治疗前明显提高(F=33.149,P=0.000).治疗后末次随访时,视力提高2行以上43眼(63.24％),视力稳定22眼(32.35％),视力下降2行以上3眼(4.41％).眼底检查及眼底照相显示病灶缩小,出血及神经上皮水肿完全吸收或消失.54眼(79.41％)CNV完全闭合,无荧光素渗漏;14眼(20.59％) CNV大部分闭合,轻微荧光素渗漏.所有治疗眼OCT显示神经上皮水肿消失,CNV强反射区域明显缩小.所有治疗眼均接受1次PDT治疗,36眼行1次玻璃体内注射Bevaeizumab,20眼行2次,12眼行3次,Bevacizumab玻璃体内注射平均次数1.65次.结论 PDT联合玻璃体内注射Bevacizumab治疗PM合并CNV是安全有效的,可有效封闭CNV,提高视力.     

光动力疗法治疗年龄相关性黄斑变性短期内的多焦视网膜电图变化

目的 应用多焦视网膜电图评价渗出型年龄相关性黄斑变性患者光动力疗法（photodynamic therapy，PDT）治疗后视网膜功能的改变。方法 对18例（20眼）渗出型年龄相关性黄斑变性患者在PDT治疗前，及治疗后7d～3个月分别进行视力、mfERG、FFA、OCT、ICGA的检查。应用重复测量方差分析比较mfERGN1、P1波振幅密度变化。结果 在显著经典型脉络膜新生血管（choroidal neovascularlzation，CNV）组所有8例（8眼）患者术后视力均提高或稳定，PDT治疗后7d的mfERGN1波、P1波振幅密度与治疗前比较均无明显差异（P〉0．05），但治疗后45d和3个月时mfERG1～5环N1波、P1波振幅密度值比治疗前均有提高（P〈0．05），且治疗后3个月时mfERG1～4环N1、P1波振幅密度值较45d时有所降低；轻微经典型CNV组视力提高、稳定或下降，各期mfERGN1、P1波振幅密度与治疗前比较均无明显差异（P〉0．05）；2组治疗前后各期mfERGN1、P1波潜伏期时值均无明显差异（P〉0．05）。结论 PDT疗法可以稳定显著经典型CNV组患眼视力，mfERG显示它还能改善黄斑部的功能．mfERG能为脉络膜新生血管患者的视网膜功能提供有效的评价。     

光动力疗法治疗脉络膜新生血管性疾病的多焦视网膜电图改变

目的检测脉络膜新生血管性疾病光动力疗法治疗后早期的多焦视网膜电图改变.方法对16例(17眼)经荧光素眼底血管造影(fundusfluorescein angiography,FFA)及吲哚青绿脉络膜血管造影(indocyanine green angiography,ICGA)证实患有脉络膜新生血管(choroidal neovascularization,CNV)性疾病的患者进行光动力疗法(photodynamic therapy,PDT)治疗.其中湿性型老年黄斑变性(age-related macular degeneration,AMD)11例(12眼),中心性渗出性脉络膜视网膜病变3例(3眼),高度近视2例(2眼).应用美国VERIS scienceTM 4.0视诱发反应图象系统,在PDT治疗前及治疗后3d、7d及3m,对各患眼6个环状视网膜区域的N1、P1波潜伏期和平均反应密度进行检测并比较.结果PDT治疗后7d及3m,2只视力明显提高,其余各眼视力无改变,眼底均未见新的出血.与PDT治疗前比较,治疗后3d、7d及3m各环视网膜区域的N1、P1波潜伏期和振幅密度均无明显改变(P＞0.05).结论PDT治疗CNV性疾病早期可稳定黄斑区功能,未对视网膜外层组织功能产生损伤.     

病理性近视合并脉络膜新生血管患者经光动力疗法治疗后的生存质量研究

目的评价病理性近视合并脉络膜新生血管患者(CNV)经光动力疗法(PDT)治疗后的生存质量。方法对24例(24只眼)伴CNV的病理性近视患者进行PDT治疗,并随访1年。对治疗前后病理性近视患者的最佳矫正视力、生存质量进行统计分析。结果治疗1年后,87.5%的患者视力下降小于3行。治疗后,调查量表中有部分视功能有显著改变。结论PDT治疗能有效阻止伴CNV的高度近视所致的视力严重下降,提高患者的生存质量。     

雷珠单抗和PDT治疗病理性近视合并黄斑CNV的疗效比较

目的：比较抗血管内皮生长因子(VEGF)与光动力疗法(PDT)对病理性近视(PM)并发黄斑脉络膜新生血管(CNV)的治疗效果。

方法：将临床上经FFA、ICGA及OCT确诊为PM合并黄斑CNV的患者43例45眼纳入观察,其中抗VEGF组20例22眼行玻璃体腔注射雷珠单抗治疗,PDT组23例23眼行PDT治疗。治疗后每月复查一次,随访12mo,根据复诊情况,按需行重复治疗。以末次随访为疗效判定时间点,记录并分析患者治疗前后ETDRS视力和视野变化。以ETDRS视力表记录最佳矫正视力(BCVA),测定中心10°视野平均缺损(MD)并比较。

结果：治疗前两组基线ETDRS视力及中心视野MD比较,差异均无统计学意义(P>0.05)。治疗后12mo,抗VEGF组ETDRS视力39.23±20.06字母,较治疗前明显提高5.88±9.03字母(P<0.05); PDT组ETDRS视力37.38±16.95字母,较治疗前提高0.33±6.94字母(P>0.05)。治疗后12mo,抗VEGF组中心10°MD较治疗前明显下降(P<0.05),PDT组MD较治疗前无明显改变(P>0.05)。

结论：对PM并发CNV的治疗,玻璃体腔注射雷珠单抗较PDT治疗能更好地改善患者的黄斑视功能。     

光动力疗法联合玻璃体腔注射Bevacizumab治疗息肉状脉络膜血管病变前后多焦视网膜电图的改变

目的 应用光动力疗法（PDT）联合玻璃体腔注射Bevacizumab治疗息肉状脉络膜血管病变（PCV）,探讨治疗前后患者多焦视网膜电图（mfERG）的变化.方法 前瞻性研究.共纳入黄斑型PCV患者13例（13眼）,男8例,女5例,年龄（60.2±7.7）岁.所有患者接受吲哚菁绿眼底血管造影（ICGA）指导下6 mg/m2剂量光敏剂Verteporfin的PDT治疗83 s,3 d后行玻璃体腔注射Bevacizumab 1.5 mg（0.06 ml）.治疗前及治疗后1、3、6个月,记录视力、眼底荧光素血管造影（FFA）、mfERG各环的潜伏期和振幅密度变化及并发症情况.采用Friedman＇s检验观察视功能指标的变化情况,当检验发现显著性改变时,采用Wilcoxon检验以比较治疗前后视功能的改变.结果 仅一例患者因为FFA的持续渗漏而于治疗后3个月随访时接受了再次治疗.治疗后平均logMAR视力逐渐提高,治疗后3个月及6个月视力与治疗前比较,差异有统计学意义（Z=-2.823,P=0.005;Z=-2.620,P=0.009）.与治疗前相比,6个环的潜伏期无明显下降.治疗后3个月,1环P1波（Z=-2.271,P=0.023）及2环的N1、P1波（Z=-2.202,P=0.028;Z=-1.992,P=0.046）振幅密度明显升高.治疗后6个月,1环P1波（Z=-2.432,P=0.015）及2环的N1、P1波Z=-2.158,P=0.031;Z=-2.118,P=0.034）振幅密度的升高仍具有统计学意义.结论 PDT联合玻璃体腔注射Bevacizumab治疗PCV后病灶血管渗漏改善,视力提高,外层视网膜功能部分恢复.mfERG可以作为一种评价联合治疗后PCV患者视功能变化情况的良好指标.     

中心性渗出性脉络膜病变光动力治疗的多焦视网膜电图观察

目的:应用多焦视网膜电图评价在中心性渗出性脉络膜病变患者光动力疗法治疗后视网膜功能的改变。方法:对11例(11眼)中心性渗出性脉络膜病变患者PDT在治疗前及治疗后7d～3mo分别查视力、多焦视网膜电图(mfERG)、眼底荧光造影、光学相干断层扫描图(OCT)。应用重复测量方差分析比较mfERGN1、P1波振幅密度变化。结果:中心性渗出性脉络膜病变患者PDT治疗后7d时的mfERG1～6环N1波、P1波振幅密度与治疗前比较均无明显差异(P>0.05),在治疗后45d时mfERG1～5环N1、P1波振幅密度值与治疗前有显著提高(P<0.05),治疗后3mo时mfERG1～5环N1波、1～4环P1波振幅密度值与治疗前有显著提高(P<0.05)。结论:PDT治疗中心性渗出性脉络膜病变患者疗效显著。PDT疗法可以提高或稳定中心性渗出性脉络膜病变患眼视力,mfERG显示它还能改善黄斑部的功能。     

Testing central retinal function with multifocal electroretinography before and after photodynamic therapy

BACKGROUND: Photodynamic therapy (PDT) is applied for certain forms of choroidal neovascular membrane (CNV). The aim of this study was to investigate the effect of PDT on central retinal function as assessed by multifocal electroretinography (ERG). METHODS: 24 patients (25 eyes) with CNV (>50% classic 12 eyes) or occult (9 eyes) in age related macular degeneration (AMD) and CNV with pathological myopia (4 eyes) were treated by PDT using Verteporfin((R)). Before and a median of 6 weeks after therapy, central retinal function was examined using multifocal ERG (RetiScan, 61 hexagons, first-order response). RESULTS: In the area of treatment,we found a tendency of the amplitude of the first positive deflection (P1) to decrease and of the implicit time to increase, but both effects were not statistically significant. These alterations were more pronounced in eyes with occult CNV and in myopia-related CNV. Amplitude reduction and implicit time prolongation could also be found in the areas represented by the multifocal ERG but not treated. There was no significant correlation between change in visual acuity after PDT and amplitude of the multifocal ERG. CONCLUSION: The effects of PDT on retinal function seem to be moderate as assessed by multifocal ERG. An inherent problem of this investigation was the recruitment of nontreated patients as controls. Future goals are investigations of patients with repeated PDT and of long-term alterations in multifocal ERG after PDT.     

OCT-guided photodynamic therapy for angiographic occult CNV in pathologic myopia

PURPOSE: Pathologic myopia (PM) is frequently complicated by choroidal neovascularization (CNV). Diagnosis is mainly clinical and angiographic but in recent years optical coherence tomography (OCT) has been noted to add important information. The authors report on the successfully OCT-guided photodynamic therapy (PDT) of an angiographic occult CNV complicating PM. METHODS: Observational case report. Fluorescein angiography with a confocal SLO (HRA, Heidelberg Engineering, Germany) and OCT Stratus (Carl Zeiss Meditec, Inc.) imaging were used for diagnosis and monitoring of the CNV. Standard PDT was performed. RESULTS: A highly myopic 17-year-old girl complained of a drop in visual acuity (VA) in left eye (LE), dating back a few weeks. Her best-corrected (BC) VA was 20/40 in the LE, with some metamorphopsia. No hemorrhage or evident signs of CNV were visible either at fundus or at dynamic fluorescein angiography. OCT scans indicated a slight elevation of the RPE-choriocapillary complex with rarefaction of neuroretinal tissue that has been interpreted as CNV. PDT was then performed. LE BCVA had improved to 20/25, metamorphopsias disappeared, and at OCT examination no retinal morphologic modification was evident.Nine months later, BCVA and ophthalmoscopy are still stable. CONCLUSIONS: In this case, OCT was the fundamental tool for the correct diagnosis and posttherapymonitoring of CNV-complicated PM. The CNV, not clearly detectable using angiographic imaging, was treated with PDT, and results in terms of VA and anatomic resolution were good.     

Transitions of multifocal electroretinography in patients with age-related macular degeneration after combination therapy with photodynamic therapy and intravitreal bevacizumab

To evaluate by multifocal electroretinograms (mfERG) the macular function before and after combined treatment with photodynamic therapy (PDT) and intravitreal bevacizumab in eyes suffering from choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). 15 eyes of 15 patients with subfoveal CNV were studied before and after the combined treatment. The post-treatment follow-up was 6 months. MfERG recordings were performed in each patient before and 1, 3, and 6 months after the treatment. The mean N1 response amplitudes tended to increase after the treatment, and ring 2 response amplitude was significantly increased at 3 and 6 months compared to baseline (P = 0.033, 0.005, respectively). For mean P1 response amplitudes, there was a significant increase in retinal response amplitudes in ring 1–3 at 6 months (P = 0.036, 0.013, 0.008, respectively). No statistically significant difference in both mean N1 and P1 latency was observed for any ring over the course of treatment. PDT combined with intravitreal bevacizumab can increase the response amplitudes of mfERG in neovascular AMD patients.     

Retinal pigment epithelium changes after photodynamic therapy for choroidal neovascularization in pathological myopia

PURPOSE: To describe changes in the retinal pigment epithelium (RPE) induced by photodynamic therapy (PDT) in eyes with subfoveal choroidal neovascularization (CNV) associated with pathological myopia (PM). METHODS: We carried out an open-label, prospective, interventional case series including 26 patients affected by subfoveal CNV in PM who underwent PDT with a 12-month follow-up. Particular attention was paid to the detection of changes at the RPE level in the areas exposed to the laser compared with baseline conditions. RESULTS: The median age of the patients was 58.5 years and the median duration of symptoms was 2 weeks. A pigmentary zone was present before PDT in 20 eyes (77%), incompletely encircling the CNV in all but two of the 20 eyes. At the end of the follow-up, the CNV in all eyes was seen to be completely or incompletely encircled by a band of hyperpigmentation, which was surrounded by RPE alterations, including depigmentation in all cases and atrophic changes in 14 eyes. CONCLUSIONS: After PDT, alterations in the RPE develop in myopic eyes. These include accentuation of the pigmentary zone surrounding the CNV and progressive atrophic changes. Further studies are needed to correlate post-PDT RPE damage with longterm visual outcome.     

Optical coherence tomography to monitor photodynamic therapy in pathological myopia

AIM: To evaluate the role of optical coherence tomography (OCT) in determining choroidal neovascularisation (CNV) activity before and after photodynamic therapy (PDT) in patients with pathological myopia. METHODS: 33 patients (33 eyes) with pathological myopia and being treated with PDT were included. Every 3 months all patients were evaluated and presence or absence of leakage on fluorescein angiography, presence of intraretinal or subretinal fluid on OCT, and macular and choroidal neovascular complex thickness on OCT, were determined at each examination. RESULTS: The macular thickness decreased significantly after PDT at 6 months (p = 0.001) and at 12 months follow up (p = 0.01). However, no significant changes in CNV thickness were measured after PDT at 6 months of follow up (p = 0.418) and at 12 months of follow up (p = 0.521). Once the diagnosis of CNV associated with pathological myopia was established, before treatment, OCT had a sensitivity of 96.96% for detecting CNV activity. After treatment, OCT had a good sensitivity (95.23%) and a moderate specificity (69,69%) in determining CNV activity, which resulted in a diagnostic efficiency (proportion of correct results) of 79.62%. CONCLUSIONS: OCT appears to be useful for indicating CNV activity. Therefore, it may serve as a complementary technique for deciding the need for PDT and re-treatment in patients with pathological myopia.     

The changes of multifocal electroretinography in the early stage of photodynamic therapy for choroidal neovascularization

To investigate short-term changes in the multifocal electroretinography (ERG) recordings after photodynamic therapy (PDT) for choroidal neovascularization (CNV), 16 patients (17 eyes) with classic CNV confirmed by fluorescein angiography (FA) and indocyanine green angiography (ICGA), including 11 cases (12 eyes) of exudative age-related macular degeneration (AMD), two cases (two eyes) of pathological myopia and three cases (three eyes) of idiopathic causes, were treated using PDT with verteporfin. The multifocal ERGs of these patients were tested with VERIS Science^TM4.0 imaging system. The latencies and average response densities of all six ring retinal regions were measured and compared before PDT and 3 or 7 days after PDT. The latencies and amplitude densities of the N₁ and P₁ waves in all six rings remained unchanged at 3 or 7 days post-treatment (p>0.05). Therefore, there is no significant evidence to suggest an adverse effect from PDT for classic CNV on the outer retinal function in the early stage of treatment, with the aid of the multifocal ERG recordings.