PDT治疗前后脉络膜新生血管的光学相干断层扫描观察

目的利用光学相干断层扫描(OCT)观察光动力学治疗(PDT)黄斑脉络膜新生血管(CNV)前后CNV的组织形态变化,以评价PDT的疗效。方法回顾性分析从2004年5月至2005年6月在我院接受PDT治疗的各类CNV患者34例38眼,对治疗前后CNV的OCT形态特征进行评估和分类。结果PDT治疗后的OCT形态特征可分为5型。I型:急性炎症反应,有4眼,平均出现于PDT后26h;II型:黄斑中心凹结构基本恢复正常,视网膜下积液吸收,有38眼,平均出现于PDT后2.8w;III型:视网膜下积液重新出现伴纤维化,根据积液与纤维化程度又可分为IIIa/IIIb。IIIa:视网膜下积液为主,有8眼,平均出现时间为PDT后1.7m;IIIb:视网膜下纤维化30眼,平均出现时间PDT后1.9m;IV型:黄斑囊样水肿伴视网膜下纤维化有3眼,于PDT后平均4.9m出现。V型视网膜下纤维化伴萎缩有8眼,于PDT后平均8.1m出现。结论OCT可用于动态观察PDT后CNV的形态变化,根据分型可协助制订治疗方案,IIIa型代表CNV复发,可能需再次PDT治疗,而IIIb和IV型则可随访观察。     

光动力学疗法治疗AMD后OCT检查的特征性改变

目的：通过前瞻性观察PDT治疗湿性年龄相关性黄斑变性（aged-related macular degeneration,AMD）前后不同随访时间点光学相干断层成像（optical coherence tomography, OCT）的特征性改变,旨在更好地反馈PDT治疗后黄斑区结构的变化过程。方法：将在本院接受PDT治疗的26例30眼湿性AMD患者纳入本研究。维速达尔用量根据厂家推荐方法计算。治疗前后均行FFA,ICG,OCT及最佳矫正视力等相关临床检查,术后随访日期为术后2wk; 1,2,3mo。傅立叶OCT扫描以标准五线结合六线扫描,覆盖病变的关键部位并保持前后扫描位置的一致性。重点观察黄斑中心凹层间厚度、外层高反射带高度、囊肿（包括视网膜下积液和视网膜内积液）的总面积。分析这些变化与随访时间的依赖关系。统计分析使用SPSS 13.0软件。结果：至治疗后3mo,PDT治疗后22眼（73%）视力提高两行以上,3眼视力无明显改变,3眼视力下降,2例患者因故失访。视力提高的22眼治疗前平均黄斑厚度为 722.5±55.6μm,治疗后2wk,平均黄斑层间厚度为708.3±45.3μm,1mo 为584.4±49.3μm,2mo为430.7±50.2μm,3mo为 180.6±36.3μm。治疗前和治疗后外层高反射带厚度分别为302.3±50.2,277.5±42.3,202.7±40.1,180.6±35.7,100.8±22.9μm,囊肿的总面积为0.34±0.12,0.25±0.07,0.10±0.05,0.08±0.04,0.05±0.01mm2。结论：AMD患者在PDT治疗后1mo黄斑区视网膜下液有显著吸收,视网膜水肿显著吸收,黄斑中心凹层间厚度、外层高反射厚度也有明显变薄倾向。     

OCT对光动力疗法治疗CNV的疗效评估

目的：观察光学相干断层扫描(optical coherence tomography,OCT)评估光动力疗法(photodynamic therapy,PDT)治疗老年黄斑变性(age-related macular degeneration,AMD)、病理性近视(pathological myopia, PM)和中心性渗出性脉络膜视网膜病变(central exudative chorioretinopathy,CEC)引起的脉络膜新生血管(choroidal neovascularization,CNV)视网膜的疗效和安全性。

方法：回顾分析2010-01/2012-12经视力、眼压、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OCT检查,临床确诊为有CNV形成的临床患者资料,共53例53眼符合条件纳入观察。患者经PDT治疗后,每3mo进行随访复查,复发的患者再次进行PDT治疗。对比分析治疗前与治疗后1a患者最佳矫正视力(BCVA)及黄斑中心视网膜厚度(central macular thickness,CMT)的改变。

结果：截止随访结束时,患者经PDT治疗后,最佳矫正视力均比治疗前提高35例,视力稳定无明显变化15例,视力下降3例; 所有患者眼底渗漏均减轻,经FFA检查42例患者CNV闭合且渗漏完全停止,11例患者CNV大部分闭合。治疗前后患者视力及CMT改变均有统计学意义。整个治疗及随访中所有患者均未见与接受PDT治疗相关的眼部和全身不良反应。

结论：PDT治疗AMD患者CNV能够在1a内保持视力的稳定,且严重不良事件的发生率低,是AMD 患者CNV治疗的安全有效方法。     

Factors influencing poor visual outcome in patients treated with photodynamic therapy for choroidal neovascularization secondary to age-related macular degeneration

BACKGROUND: This study evaluated patients with choroidal neovascular membranes secondary to age-related macular degeneration for factors that may predict the visual outcome after photodynamic therapy. METHODS: A retrospective review of 172 eyes of 172 consecutive patients who received photodynamic therapy for predominantly classic with and without occult, minimally classic and occult choroidal neovascular membranes secondary to macular degeneration in private practice from June 2000 to September 2004 was undertaken. All eyes had a baseline vision of 6/12 to 6/60. Classification of lesion composition, retreatment and follow up adhered to published photodynamic therapy guidelines. The primary outcomes measured were effects of patient age, baseline visual acuity, lesion composition and lesion size on final visual acuity and loss of less than 15 letters of logMAR at 12 months. RESULTS: All eyes were followed up for 12 months. Baseline mean logMAR visual acuity was logMAR 0.64. Using multivariate logistic regression, loss of logMAR vision at 12 months was independently associated with increasing age (P=0.004), better baseline vision (P=0.009) and increasing lesion size (P=0.035). However, there was no association with lesion composition (P=0.16). At 12 months the loss of 15 letters or less was found in 101 (59.7%; 95% confidence interval: 51.0-66.2%) of all patients. CONCLUSIONS: This study found no statistically significant association between lesion composition defined on fluorescein angiography and loss of visual acuity compared with previous studies. Factors associated with an increased rate of loss of 15 letters were increasing age of the patient, increasing lesion size and better baseline logMAR vision.     

光动力疗法治疗脉络膜新生血管性疾病的初步临床观察

目的:观察使用维替泊芬光动力疗法(photodynamic thera-py,PDT)治疗年龄相关性黄斑变性(age-related maculardegeneration,AMD)、病理性近视和特发性脉络膜新生血管(choroidal neovascularization,CNV)等3种主要的CNV相关疾病的临床效果。方法:对96例(109眼)经临床确诊的上述CNV患者进行PDT治疗,随访1～24(平均9.4)mo。采用最佳矫正视力、荧光素血管造影、吲哚青绿血管造影、光学相干断层成像等指标,观察治疗前后患者的视功能、CNV病灶大小及渗漏情况、以及视网膜水肿变化等,评价PDT治疗CNV的疗效。结果:本组病例包括AMD42例(54眼),病理性近视17例(18眼),特发性CNV患者37例(37眼)。AMD、病理性近视和特发性CNV的平均治疗次数分别为1.2,1.5和1.2次;视力稳定和提高者各组分别为83.3%,83.3%和86.5%;CNV渗漏停止或减少者各组分别为90.7%,83.3%和89.2%:视网膜水肿减轻者各组分别为77.8%,88.9%和86.5%。除3例AMD患者出现眼部严重不良反应外,未发现其他严重不良反应。结论:PDT可有效地改善或稳定AMD、病理性近视和特发性CNV患者的视功能,控制病变进展,近期随访结果安全有效。     

光动力疗法治疗国人常见脉络膜新生血管疾病的二年随访观察

目的研究光动力疗法（PDT）治疗年龄相关性黄斑变性（AMD）、病理性近视（PM）和特发性脉络膜新生血管形成（CNV）三种国内常见CNV相关疾病的长期效果和安全性。设计回顾性病例系列。研究对象2005年6月至2007年12月西京医院眼科确诊的CNV患者91例（101眼）。方法患者经常规PDT治疗,治疗后每3个月进行复查,复发的患者再次行PDT治疗。观察治疗前与治疗后12、24个月时患者的最佳矫正视力（BCVA,ETDRS视力表）、荧光素眼底血管造影（FFA）图像上CNV病灶情况、治疗次数及不良事件等。患者治疗后均完成24个月随访。主要指标BCVA,CNV病灶大小和活动性。结果AMD、PM和特发性CNV的平均治疗次数分别为1．50、1．38和1．19次。AMD组治疗后BCVA和CNV病灶大小均无明显变化,保持稳定;PM组和特发性CNV组视力提高（分别为7．0和7．7个字母,7．6和11．6个字母）,并且CNV病灶缩小。三组病例视力稳定和提高者12个月时分别为77．1％、76．2％和87．5％;24个月时为79．2％、81．0％和87．5％。CNV进展者12个月时各组分别为18．8％、19．0％和12．5％;24个月时为14．6％、14．3％和6．2％。除3例（2．2％）AMD患者因玻璃体积血和视网膜色素上皮撕裂导致眼部严重不良反应外,未发现其他严重不良反应。结论在2年的随访期间,PDT可安全有效地改善或稳定我国临床常见CNV患者的视功能,控制病变进展。     

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.     

ARMD的光学相干断层成像分析

本文给出了一种老年性黄斑变性(age-related macular degeneration,ARMD)的早期诊断方法,在ARMD的发展过程中出现的各种病理改变如玻璃膜疣、脉络膜视网膜地图状萎缩、视网膜色素上皮萎缩、脉络膜新生血管、视网膜色素上皮/神经上皮脱离等,用光学相干断层成像技术(optical coherence tomography,OCT)对其进行图像分析。     

OCTA在湿性年龄相关性黄斑变性诊疗中的研究进展

光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)是一种快捷的、无创的新兴成像技术,可以定性、定量分析视网膜血流灌注,在临床的应用越来越广泛。脉络膜新生血管(choroidal neovascularization,CNV)是湿性年龄相关性黄斑变性(neovascular age-related macular degeneration,nARMD)导致老年人视力丧失的主要原因,因此在nARMD中对CNV的检测十分重要。本文通过OCTA对CNV的诊断、形态、面积及血流灌注的分析,综述了其在nARMD诊疗中的研究进展。     

老年黄斑变性43例光学相干断层扫描分析

目的:研究老年黄斑变性的光学相干断层扫描(optical coherence tomography,OCT)特征.方法:对经眼底荧光造影(fundus fluorescein angiography,FFA)确诊的老年黄斑变性患者43例45眼,其中湿性型28例30眼、干性型15例15眼,按年龄匹配的正常人30例43眼利用OCT分别进行检测.观察黄斑部神经纤维层(nerve fiber layer of macular,MNFL)、色素上皮/脉络膜毛细血管复合层(retinal pigment epithelium/choriocapillaris,RPE/CC)及视网膜神经上皮层(retinal neurepithelium layer,RNE)的厚度变化.应用秩和检验比较其差异性.结果:MNFL厚度:湿性型老年黄斑变性组为76.5±51.7 μm、干性型老年黄斑变性组为32.5±7.6 μm、正常对照组为27.7±6.4 μm,湿性型组与其他组比较差异有显著性(P＜0.05).RNE厚度:湿性型老年黄斑变性组为307.1±130.8 μm、正常对照组为239.9±13.4 μm、干性型老年黄斑变性组为223.4±22.6 μm,湿性型组与其他组比较差异有显著性(P＜0.05).RPE/CC厚度:湿性型老年黄斑变性组为115.3±30.6 μm、干性型老年黄斑变性组为81.7±20.4 μm、正常对照组为76.4±11.5 μm,湿性型组与其他组比较差异有显著性(P＜0.05).结论:黄斑部神经纤维层厚度、视网膜神经上皮层厚度及色素上皮/脉络膜毛细血管复合层厚度随着老年黄斑变性病程的发展,其厚度增加.OCT可以作为湿性型老年黄斑变性发生与发展的监测工具之一.     

PDT联合血栓通治疗AMD并发脉络膜新生血管化

目的: 观察光动力疗法(PDT)联合中药血栓通注射液治疗年龄相关性黄斑变性(AMD)并发脉络膜新生血管化(CNV)的临床疗效。方法: 选择年龄相关性黄斑变性并发脉络膜新生血管化(AMD-CNV)患者17例17眼,男7例,女10例,年龄53～72岁。患者经过视力、眼压、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)和光学相干断层成像(OCT)等检查确诊。患者用PDT治疗5d后,再用500mg中药血栓通注射液静脉滴注10d,1次/d,疗程为15d,观察治疗后1,3和6mo疗效。结果: 治疗6mo,17例中视力提高8例(47%),视力稳定无明显变化6例(35%),视力下降3例(18%);12例(71%)CNV闭合且渗漏完全停止,5例(29%)CNV大部分闭合。1例出现一过性视物模糊。结论: PDT联合中药血栓通注射液治疗AMD-CNV方法简单,疗效可靠,可在临床推广应用。     

Polypoidal choroidal vasculopathy examined with en face optical coherence tomography

BACKGROUND: To study the morphologic features of polypoidal choroidal vasculopathy (PCV) with the use of en face optical coherence tomography (OCT). METHODS: We reviewed retrospectively 57 eyes of 57 patients with PCV. The macular region was examined with OCT en face planes scanned at different sequential depths, following which detailed scanning was performed of arbitrarily selected longitudinal planes. RESULTS: In 48 of the cases (84.2%), en face OCT allowed us to detect round protrusions of the retinal pigment epithelium (RPE) that corresponded to the polypoidal lesions seen on indocyanine green angiography (ICGA); the branching vascular networks seen on ICGA often induced slight elevation of the overlying RPE, which typically assumed a geographical shape. In 30 cases (52.6%), branching vascular networks were detected as elevations of the RPE. With en face OCT, serous pigment epithelial detachments, most of which were seen as round protrusions of the RPE, were often accompanied by adjacent smaller round protrusions of the RPE, consistent with polypoidal lesions. These protrusions of the RPE were often fused and typically appeared as a 'snowman'. Subsequent longitudinal examination revealed the polypoidal lesions to be sharp protrusions of the RPE with moderate inner reflectivity. Consistent with the location of the branching vascular network, a highly reflective line was seen often just beneath the slightly elevated reflective line of RPE. CONCLUSIONS: En face examination using OCT has an advantage in screening lesions of PCV and in examination of the detailed relationship of each component of these lesions.     

Optical coherence tomography analysis of a randomized study combining photodynamic therapy with intravitreal triamcinolone

BACKGROUND: The objective of the study was to analyze optical coherence tomography (OCT) scan differences between patients with predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with only photodynamic therapy (PDT) and patients treated with PDT combined with intravitreal triamcinolone acetonide (IVTA). METHODS: In this prospective study, 61 patients were randomized to receive PDT (n = 30) or PDT combined with IVTA (n = 31). They were evaluated every 3 months with a refraction protocol for best-corrected visual acuity (VA) measured with Early Treatment Diabetic Retinopathy Study (ETDRS) charts, fluorescein angiography (FA), and OCT. When measuring foveal thickness on OCT scans, neuroretinal foveal thickness (NFT) was differentiated from outer high reflectivity band thickness (OHRBT). The main outcome measures were mean change in OCT measurements and correlation of VA and angiographic area of the lesion with OCT measurements. RESULTS: At the 12-month follow-up, the mean change in NFT was not significantly reduced (P = 0.9), but the mean change in OHRBT was significantly lower (P = 0.004) in the group of patients who received combined therapy. There was no correlation between final VA and NFT in either patient group (P = 0.2). The final VA was significantly worse in eyes with a thicker OHRBT (P = 0.04) in the group of patients treated with only PDT. There was no correlation between angiographic area and NFT and OHRBT in either patient group (P > 0.3). There was a statistically significant difference between the pre-treatment angiographic area of the lesion and VA at the 12-month follow-up in the combined therapy group (P = 0.01), and more eyes treated with only PDT presented with intraretinal fluid at the last follow-up (P = 0.01). CONCLUSION: Combined PDT+IVTA therapy was more effective than PDT alone at reducing OHRBT. This OCT measurement seems to be have a greater effect on VA than NFT.     

频域OCT在光动力疗法治疗病理性近视脉络膜新生血管中的应用

目的 评价频域光学相干断层扫描(optical coherence tomography,OCT)检查在光动力疗法(photodynamic therapy,PDT)治疗病理性近视所致的黄斑区脉络膜新生血管(choriodal neovascularization,CNV)中的临床应用价值.方法 对比分析21例26眼病理性近视患者PDT治疗前后频域OCT图像中黄斑中心凹层间厚度及外层高反射厚度,观察不同时期OCT的形态变化.结果 26眼CNV生长方式均属于Ⅱ型.PDT治疗后6个月18眼视网膜层间厚度恢复,视网膜下液吸收,CNV反光团逐渐缩小或纤维化,中心凹形态恢复.黄斑中心凹层间厚度治疗后1周(339.96±74.40)μm增加,治疗后1个月(267.78±33.39)μm开始下降,且差异均有统计学意义(均为P＜0.05).外层高反射厚度与术前(247.33±49.31)μm相比,从治疗后1个月(226.73±83.15)μm开始明显减少,但仅治疗后6个月(165.15±22.90)μm时差异有统计学意义(P=0.042).结论 频域OCT对病理性近视CNV行PDT治疗前后视网膜形态结构的连续观察具有重要意义,为临床治疗提供一种安全、无损伤的检测方法.     

PDT治疗65例脉络膜新生血管临床分析

目的:研究光动力疗法(photodynamic therapy,PDT)治疗脉络膜新生血管的效果和相关护理的价值。方法:回顾性分析我科用PDT治疗65例68眼脉络膜新生血管的效果、并发症及处理效果。结果:31眼(46%)视力提高2行及以上,33眼(49%)视力变化在2行以内,4眼(6%)视力下降2行以上;41眼荧光素渗漏停止(60%),22眼荧光素渗漏减少(32%),而5眼荧光素渗漏增加(8%);2例输液相关性背痛,未发生药液渗漏和皮肤光敏反应。全部治疗病例对治疗结果无不满意。结论:PDT治疗脉络膜新生血管疗效可靠,详细解释和精心护理是避免医疗纠纷的关键。     

Factors affecting visual outcome of myopic choroidal neovascularization treated with verteporfin photodynamic therapy

AIM: To evaluate the visual outcomes of choroidal neovascularization (CNV) secondary to pathological myopia and the impact of novel risk factors affecting the final visual outcome.METHODS:Interventional case series of 18 consecutive patients with pathological myopia treated with photodynamic therapy (PDT). Inclusion criteria were spherical equivalent -6D or worse or features of pathological myopia on retinal examination. The main outcome measure was final best-corrected visual acuity (BCVA).RESULTS:Of 18 eyes, 13 (72.2%) avoided moderate visual loss (≥3 lines of LogMAR BCVA) and 5 eyes (27.8%) improved by at least 1 line after 1 year. Patients with LogMAR BCVA ≤0.3 (Snellen equivalent 20/40) at one year were younger than those with BCVA >0.3 (mean age 39.0 vs 61.6 years, P=0.001). A higher proportion of eyes with greatest linear dimension (GLD) of ≤1000µm avoided moderate visual loss (100% vs 50%, P=0.026). Among patients who were treated within 2 weeks of visual symptoms, 88.9% avoided the loss of 3 or more lines compared to 55.6% for those who presented later. The mean improvement in LogMAR BCVA of those with GLD ≤1000µm was +0.12 compared to a loss of 0.55 LogMAR units for those with GLD >1000µm (P=0.02). Visual outcomes were not associated with gender or refractive error.CONCLUSION: Good visual outcome in myopic CNV is associated with younger age, smaller lesion size and earlier initiation of treatment. These factors are relevant for ophthalmologists considering treatment options for myopic CNV.     

OCTA对湿性年龄相关性黄斑变性脉络膜新生血管诊断价值的Meta分析

目的：采用Meta分析方法评价相干光断层扫描血管成像(OCTA)对湿性年龄相关性黄斑变性(wARMD)患者脉络膜新生血管(CNV)的诊断价值。

方法：计算机检索PubMed、Embase、Web of science、Cochrane library、CNKI、Wanfang、CBM和VIP数据库建库至2020-10-27关于OCTA诊断wARMD患者CNV的相关研究。由两位研究员独立筛选文献、提取资料并采用QUADAS-2工具评价纳入研究的偏倚风险,使用Meta-Disc 1.4及Stata 16.0软件进行Meta分析。

结果：纳入文献11篇,患者995眼。OCTA诊断wARMD患者CNV的Meta分析结果显示,合并灵敏度、特异度、阳性似然比、阴性似然比、诊断比值比、sROC曲线下面积和阳性验后概率依次为0.88\〖95%CI(0.83,0.92)\〗、0.95\〖95%CI(0.85,0.99)\〗、18.45\〖95%CI(5.36,63.52)\〗、0.12\〖95%CI(0.08,0.18)\〗、152.73\〖95%CI(36.39,641.05)\〗、0.95\〖95%CI(0.92,0.96)\〗和0.96。

结论：相干光断层扫描血管成像用于诊断wARMD患者CNV具有较高价值,尤其适用于wARMD的早期诊断。     

病理性近视脉络膜新生血管形态学分析及单次光动力治疗临床效果观察

目的分析病理性近视脉络膜新生血管(choroidal neovascularization,CNV)图像特征,并观察单次光动力治疗(photo-dynamic therapy,PDT)治疗CNV的临床效果。方法确诊病理性近视CNV患者12例13眼,进行单次PDT治疗,随访1～24个月,平均7.7个月,观察PDT前后症状、视力以及CNV的光学相干断层扫描(optical coherence tomography,OCT)、荧光素眼底血管造影(fundus fluorescein angiography,FFA)、吲哚菁绿脉络膜血管造影(indocyanine green angiography,ICGA)、眼底照像的变化,探讨CNV的形态学特征及PDT治疗效果。结果 60.0%眼视物变形症状减轻或消失。末次随访时84.6%眼保持PDT前裸眼视力或不同程度提高。OCT将CNV分为类圆形、纺锤形、不规则形及色素上皮下型;结果示8眼类圆形CNV经过PDT治疗后6眼(占总数的46.2%)CNV瘢痕形成、2眼(占总数的15.4%)无改善,其他型CNV5眼(占总数的38.5%,包括纺锤形、不规则形及色素上皮下型)经过PDT后CNV消退。眼底血管造影示92.3%眼荧光素渗漏减弱或消退,7.7%眼荧光素渗漏未见减弱。眼底照像可见69.2%眼有Fuch斑;30.8%眼有灰色、扁平、较小病灶,相应处CNV形成;30.8%可见黄斑新鲜出血。结论 OCT对病理性近视CNV形态分型、观察具有重要意义;单次PDT具有抑制或消退CNV的作用和稳定视力的临床效果。     

Photodynamic therapy with verteporfin for choroidal neovascularization due to age-related macular degeneration and other causes: a New Zealand outcomes study

PURPOSE: To assess the efficacy and safety of photodynamic therapy (PDT) for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and other conditions by analysing visual acuity changes. METHODS: A retrospective review of patients treated with PDT was conducted. CNV was confirmed on fluorescein angiography. Visual acuity outcomes were recorded at 3-monthly intervals to a maximum of 48 months. The primary outcome measure was the proportion of patients avoiding moderate visual loss (losing less than three lines of visual acuity relative to baseline) at 12 months. RESULTS: A total of 343 patients receiving PDT were followed up for a mean of 14.9 months. Two hundred and eighty-five (83%) patients presented with CNV due to AMD and 58 patients (17%) due to other causes. Seventy per cent of patients with CNV secondary to AMD avoided moderate visual loss at both 12 and 24 months. Secondary outcomes (including mean change in visual acuity, proportion of patients with stable or improved vision and proportion of patients with severe vision loss) also compared favourably with the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Investigation. Of patients with CNV secondary to causes other than AMD, 76% avoided moderate visual loss at both 12 and 24 months. The safety profile identified one severe adverse reaction, with development of a serous pigment epithelial detachment and subsequent rip. CONCLUSION: The results of this present retrospective, open-label, clinical practice study in New Zealand are consistent with the findings of multicentre randomized, placebo-controlled trials and confirm the treatment benefit of PDT in a clinical setting.     

抗血管内皮生长因子治疗前后脉络膜新生血管的光学相干断层扫描血管成像分析

目的　应用光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)观察抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗后不同类型脉络膜新生血管（choroidal neovascularization,CNV）的应答反应，分析应答差异及CNV的特征。方法　收集我院经荧光素眼底血管造影联合吲哚菁绿血管造影确诊为CNV的患者52例（55眼），所有患眼在治疗前及随访中均行最佳矫正视力(best corrected visual acuity，BCVA)、眼底及OCTA检查。一方面按照CNV病因分组，观察不同病因CNV治疗后BCVA及黄斑中心凹视网膜厚度的差异；另一方面按照CNV形态及视网膜层间有无积液分组，观察各组治疗前后BCVA及黄斑中心凹视网膜厚度的差异。结果　年龄相关性黄斑变性并发CNV、特发性CNV治疗前后BCVA及黄斑中心凹视网膜厚度均较治疗前明显改善，差异均有统计学意义（均为P<0.05）；病理性近视合并CNV及脉络膜炎合并CNV治疗前后黄斑中心凹视网膜厚度差异均无统计学意义（均为P>0.05）。CNV血管粗大且视网膜层间有积液组及CNV血管细小且视网膜层间有积液组治疗前后BCVA、黄斑中心凹视网膜厚度均有明显改善，差异均有统计学意义（均为P<0.05）；CNV血管粗大且视网膜层间无积液组治疗前后BCVA差异无统计学意义（P>0.05）。结论　不同类型的CNV对抗VEGF治疗的应答存在差异，CNV的形态学特征一定程度上能够反映新生血管的活动性及成熟性，有助于预测抗VEGF治疗的应答反应。