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.     

光动力疗法治疗老年性黄斑变性的临床研究

目的
观察光动力疗法(photodynamic therapy,PDT)对渗出型老年性黄斑变性(age-related macular degeneration,AMD)脉络膜新生血管(choroidal neovascularization,CNV)进行单次和多次治疗的临床疗效。
方法
20例经双目间接立体检眼镜、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)检查确诊的AMD患者的31只患眼纳入治疗。患者年龄47～88岁，平均年龄68.1岁，最佳矫正视力在数指/10 cm～0.6之间。光敏剂苯并卟啉衍生物单酸(benzoporphyrin derivative mono acid, BPD)(中国诺华公司)6 mg／m 2静脉滴注10 min，开始静脉用药后15 min，通过裂隙灯用强度为50 J／cm2的689 nm激光(德国Zeiss公司)照射83 s。治疗后患者尽可能避光48 h。治疗后2周开始复查，每3个月随访1次，随访时间最短3个月，最长18个月，平均随访12个月。FFA和(或)ICGA显示病灶范围扩大、或渗漏增加，即进行重复PDT治疗。其中1只眼进行了4次治疗, 4只眼进行了2次治疗，其余26只眼均只进行了1次治疗。
结果
治疗后13只眼视力明显改善(视力提高≥2行)，占41.9%；17只眼视力稳定不变(视力波动在1行以内)，占54.8%；1只眼视力下降2行，占3.2%。所有患眼于PDT治疗后眼底出血和渗出均减轻；FFA或FFA+ICGA检查显示：PDT治疗后2周，CNV的渗漏明显减少或完全停止，复发或扩大的CNV经多次PDT治疗后，渗漏逐渐减少，3例5只眼渗漏完全停止。光相干断层成像术(optic coherence tomography, OCT)检查显示CNV周围视网膜脉络膜的水肿以及神经上皮脱离、色素上皮脱离明显好转。20例患者在PDT治疗过程中及治疗后未发生任何全身和局部不良反应。
结论
单次和重复PDT治疗可以部分或完全封闭AMD 的CNV，多次PDT治疗可以封闭CNV，降低AMD引起视力下降的危险性。PDT治疗不影响病灶周围的正常视网膜和脉络膜组织，对视力无损害。
(中华眼底病杂志, 2002, 18: 175-179)     

光动力疗法治疗渗出型老年性黄斑变性

光动力疗法(PDT)是目前治疗老年性黄斑变性(AMD)的脉络膜新生血管(CNV)较为安全有效的方法。本文综述了适于PDT治疗的CNV的特点和PDT的并发症。其中CNV的类型、病灶大小、位置及活动性对治疗效果影响较大,而对于AMD特殊类型如息肉状脉络膜血管病变和视网膜血管瘤样增生症的治疗方案尚需进一步探索。     

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。     

渗出型老年性黄斑变性重复光动力疗法的临床观察

目的 总结2002年7月至2005年3月光动力疗法（PDT）治疗渗出型老年黄斑变性（AMD），重复治疗病例的疗效和临床特点。 方法 回顾分析渗出型AMD患者78例94只眼采用PDT治疗，患者平均年龄68.4岁,治疗次数为132次，平均1.4次,其中22例30只眼接受重复PDT治疗,占治疗总数31.9%。30只眼共进行PDT治疗68次，其中2次22只眼，占73.3%；3次7只眼，占23.3%；6次1只眼，占3.3%。随诊时间3~32个月,平均随诊时间16.7个月。 结果 PDT治疗后末次随诊检查时，荧光素眼底血管造影(FFA)或FFA联合吲哚青绿血管造影(ICGA)检查显示CNV渗漏停止14只眼，占46.7%；渗漏减少12只眼，占40%；持续渗漏4只眼，占13.3%。与首次PDT治疗前相比，末次检查矫正视力提高≥2行7只眼，占23.3%；视力波动在上下1行以内14只眼，占43.3%；视力下降≥2行9只眼，占30%。首次PDT后最佳矫正视力13只眼视力提高≥2行，占43.3%；12只眼视力波动在上下1行之内，占40%；5只眼视力下降≥2行，占16.7%。在随诊期中，最佳矫正视力出现在首次PDT后24只眼，占80%；有5只眼出现在2次PDT后，占16.7%；1只眼出现在3次PDT后，占3.3%。 结论 在重复PDT治疗患者中，末次随诊检查大部分眼CNV能完全或部分闭合，视力提高和维持者占67.8%，最佳矫正视力多出现在首次PDT后,随着PDT治疗次数的增加，最佳矫正视力出现的概率减小。 (中华眼底病杂志, 2006, 22: 220-223)     

Indications for photodynamic therapy in age-related macular degeneration

Exudative age-related macular degeneration (ARMD) is now benefitting from new therapeutic approaches. Three international randomized clinical trials have demonstrated the efficacy of photodynamic therapy (PDT) in stabilizing visual acuity at 2 years. PDT is based on the activation of a photosensitizer with an adapted wavelength. In age-related macular degeneration, the photosensitizer used is verteporfin (Visudyne), which accumulates preferentially in choroidal new vessels. Functional results are obtained on the basis of a strict classification based on fluorescein angiography examining the type of the new vessels responsible for exudative ARMD. Thus, subfoveal lesions, either predominantly classic (>50%) or occult only, are the indication for PDT. Classic CNVs where laser photocoagulation thermal burns extend into the foveola may be an extrapolation of the indication for PDT. In addition, fluorescein angiography is essential for considering retreatment, usually necessary. Demonstrated growth and the persistence of leakage from the CNV is an absolute indication for a new session of PDT. A number of features still require assessment in order to define the responder group more accurately and to refine and possibly simplify the indications for retreatment.     

光动力疗法治疗渗出性年龄相关性黄斑变性

目的观察光动力疗法(photodynamic therapy,PDT)治疗渗出性年龄相关性黄斑变性(age-related macular degeneration,AMD)的疗效。方法回顾分析经荧光素眼底血管造影(fundus fluorescein angiography,FFA)、吲哚菁绿血管造影(indocyanine green angiography,ICGA)以及光学相干断层扫描(optical coherence tomography,OCT)检查确诊的21例(31眼)渗出性AMD患者PDT治疗前及治疗后的临床资料,主要以视力、FFA及(或)ICGA、OCT的改变为观察指标,评价PDT对渗出性AMD的治疗效果。结果治疗后13眼视力明显改善(视力提高≥2行),占41.9%;14眼视力稳定不变(视力波动在1行以内),占45.2%;4眼视力下降2行,占12.9%。大部分患眼于PDT治疗后眼底出血和渗出减轻;ICGA检查显示:PDT治疗后1周,16眼CNV的渗漏明显减少或完全停止,8眼渗漏完全停止。OCT检查显示:CNV周围视网膜脉络膜水肿以及神经上皮脱离好转。5例6眼患者在PDT治疗过程中及治疗后发生视网膜神经上皮脱离范围变大,1例1眼发生黄斑部再次大面积出血,所有病例均未发生任何全身不良反应。结论单次和重复PDT治疗可以部分或完全封闭渗出性AMD的CNV,PDT治疗对病灶周围的正常视网膜和脉络膜组织短期内有轻度影响,对视力无损害。     

Verteporfin therapy in age-related macular degeneration (VAM): an open-label multicenter photodynamic therapy study of 4,435 patients

PURPOSE: To provide broad clinical experience and to gather safety data on photodynamic therapy with verteporfin (Visudyne, Novartis AG, Basel, Switzerland), also termed verteporfin therapy, in patients with predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). The Verteporfin in Age-related Macular Degeneration (VAM) Study was designed to provide expanded access to verteporfin therapy after beneficial results for these cases were reported but before regulatory approval in North America. METHODS: This open-label multicenter study from September 1999 through June 2000 enrolled among 222 centers patients 50 years or older in the United States, or 40 years or older in Canada, with age-related macular degeneration and subfoveal CNV with a lesion composition that was predominantly classic CNV on fluorescein angiography. Corrected visual acuity with habitual eyewear in the office setting was 20/40 to 20/200, inclusive. All patients received verteporfin therapy and returned for follow-up every 3 months. At those follow-up examinations, additional courses of treatment were recommended if any fluorescein leakage from CNV was identified. Safety information was collected from patient self-reporting, questioning (in person and by telephone), and physician evaluation. Safety was assessed by evaluating the effect of treatment on corrected distance visual acuity and by evaluating adverse events. RESULTS: A total of 4,435 patients were enrolled of whom 4,051 (91%) completed the study after receiving 6,701 treatments. Most patients received only one treatment in VAM before regulatory approval of verteporfin in the United States and Canada. Three hundred patients (6.8%) experienced an adverse event considered by the treating ophthalmologist to be associated with treatment, including 115 (2.6%) with abnormal or decreased vision, of whom 25 (0.6%) experienced acute severe visual acuity decrease, and 14 (0.3%) with transient infusion-related back pain. Patients were advised to avoid exposure to direct sunlight for 24 hours; however, after verteporfin administration only 2 (0.05%) reported a photosensitivity reaction. An additional course of verteporfin therapy was administered to 1,739 of 2,314 patients (75.2%) who had a month 3 examination that was not their close-out visit and 177 of 266 (66.5%) who had a month 6 examination that was not their close-out visit. CONCLUSIONS: Verteporfin therapy exhibited no additional or new safety concerns. The therapy associated with a low incidence of adverse events when expanded access was provided in a large, open-label, multicenter study, including a low incidence (0.05%) of reported photosensitivity reactions despite a short photosensitivity protection period (24 hours) following verteporfin administration.     

Japanese age-related macular degeneration trial: 1-year results of photodynamic therapy with verteporfin in Japanese patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration

Purpose

To determine the effect and safety of verteporfin therapy (Visudyne) in Japanese age-related macular degeneration (AMD) patients.

Design

Open-label, multicenter, prospective, noncontrolled study.

Methods

The setting was five university hospitals in Japan. The study population was patients at least 50 years old, with best-corrected visual acuity of 20/40 to 20/200 inclusive and fluorescein angiography documenting subfoveal, classic-containing choroidal neovascularization (CNV) secondary to AMD and a lesion of greatest linear dimension ≤ 5,400 μm. For the intervention, patients received verteporfin intravenously followed by light administration 15 minutes after the infusion start. Additional treatment was given every 3 months through month 9 if leakage from CNV was observed on angiogram. The main outcome measure was percentage of lesions with progression of classic CNV beyond the area of the baseline lesion.

Results

Sixty-four patients were enrolled at five centers, and 61 patients completed the study. The me-dian number of treatments given during the trial was three. At the 12-month examination, 12 patients (19%; 95% confidence interval: 11%-31%) had progression of classic CNV whereas 32 (50%) and 49 (77%) patients had no leakage from classic or occult CNV, respectively. The median visual acuity score (approximate Snellen equivalent) from baseline to month 12 increased from 50.0 (20/100)-56.5 (20/80⁺²) letters. Fourteen patients (22%) had visual disturbances, including two patients (3%) with acute vision decrease considered as serious adverse events and one patient (2%) with infusion-related back pain. No photosensitivity reactions were reported.

Conclusions

Verteporfin therapy for subfoveal CNV in these Japanese patients appeared to have a similar or better angiographic and vision effect as that observed in Caucasian patients, with the same safety profile, supporting its use in Japanese 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）     

Selective photodynamic therapy for neovascular age-related macular degeneration with polypoidal choroidal neovascularization

PURPOSE: To evaluate the efficacy of selective treatment with indocyanine green (ICG) angiography-guided photodynamic therapy (PDT) with verteporfin for polypoidal choroidal vasculopathy (PCV). METHODS: In this retrospective consecutive series, 30 eyes of 30 patients with PCV were included. Complete ocular examination, digital fluorescein angiography (FA), ICG angiography, and optical coherence tomography were performed at baseline and at standard intervals thereafter. ICG angiography-guided PDT was performed on all eyes. Only the area of the active PCV or "hot spot" evident on the ICG angiogram was treated. A spot size was chosen to cover the active neovascular lesion with a 200-mum border. Retreatment was performed when angiography revealed a recurrent lesion. RESULTS: Thirty eyes with PCV were treated and followed for 1 year. Mean age of the patients was 75 years (range, 55-90 years). These patients were all classified as having occult choroidal neovascularization (CNV) with FA and polypoidal CNV with ICG angiography. Improvement of vision (>or=3 lines) was achieved in 15 eyes (50%). Nine eyes had stable vision (30%), and 6 eyes (20%) had a decrease in vision (>or=3 lines). Repeated treatment was required in 15 eyes (50%) for an average of 2.2 treatments in 1 year. CONCLUSION: This study indicates that stabilization or improvement of vision is achieved in most eyes (80%) with neovascular AMD from PCV after selected ICG angiography-guided PDT. These outcomes compare very favorably with those in previous reports on the treatment of occult CNV. Reduced collateral damage to the choriocapillaris and reduced upregulation of vascular endothelial growth factor are presumed to be the explanation for this apparently better outcome. Further studies with longer follow-up are warranted to investigate the long-term efficacy in these conditions.     

Single-session photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration

PURPOSE: To evaluate the efficacy of combined single-session photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) for treatment of neovascular age-related macular degeneration (AMD). METHODS: In a prospective interventional case series, patients with subfoveal choroidal neovascularization (CNV) underwent PDT followed by 1.25 mg IVB injection. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) measurements were repeated at 6-week intervals and fluorescein angiography was performed after 12 weeks and when considered necessary thereafter. Repeat injections of IVB were performed based on fluorescein angiographic evidence of CNV leakage. RESULTS: Fourteen eyes were included in this study. Mean follow-up was 52.4+/-15.2 weeks (range: 26-74 weeks). Initially, mean BCVA was 0.80+/-0.42 logMAR and mean central macular thickness (CMT) was 308+/88 microm. At week 12, BCVA improved to 0.62+/-0.47 logMAR (p=0.006) and CMT reduced to 186+/-53 microm (p=0.003). Corresponding results were 0.53+/-0.52 logMAR (p=0.02) and 193+/-78 microm (p=0.002) after 24 weeks. A second IVB injection was performed in 13 eyes with a mean interval of 16.3+/-5.9 weeks. CONCLUSIONS: Combination therapy with single-session PDT and IVB can improve vision and reduce CMT in neovascular AMD. Repeat IVB injections may maintain the visual gain from the initial combination therapy.     

Full macular translocation following photodynamic therapy in neovascular age-related macular degeneration

PURPOSE: To report the long-term functional and anatomical outcome of full macular translocation (FMT) in eyes with neovascular age-related macular degeneration (AMD) following photodynamic therapy (PDT). METHODS: Twelve eyes of 12 consecutive patients with neovascular AMD who were PDT-nonresponders and underwent FMT were analysed. Best-corrected visual acuity (BCVA) measurement, fundus photography, and fluorescein angiography at baseline and at follow-up examinations in 3 months intervals were performed. Primary end point was change of BCVA from baseline to last visit. RESULTS: Totally 12 eyes of 12 patients were analysed. Mean time interval between the last PDT and FMT was 3.7 months (range 1-10 months). Mean follow-up after FMT was 25.6 months. BCVA ranged at baseline from 20/1000 to 20/80 (mean 20/230). At the last visit, mean BCVA was by 20/185. BCVA improved in 50% (6/12) of eyes by more than 1 line. Twenty five per cent (3/12) of eyes had final BCVA within +/-1 line from baseline. In 25% (3/12) of eyes the BCVA decreased by more than 1 line. One eye had recurrent CNV. In four eyes a cystoid macular oedema developed. No retinal detachment or disturbing diplopia was noted. CONCLUSIONS: In the present study, FMT in PDT-nonresponders stabilised or improved visual acuity in the majority of the eyes in a mean follow-up period of nearly 2 years. FMT can be considered as a therapeutical option in eyes who are nonresponders to the PDT in neovascular AMD.     

抗血管内皮生长因子单克隆抗体Ranibizumab联合光动力疗法治疗渗出型年龄相关性黄斑变性的临床观察

目的 观察抗血管内皮生长冈子单克隆抗体Ranibizumab玻璃体腔注射联合光动力疗法（PDT）治疗渗出型年龄相关性黄斑变性（AMD）的临床疗效和安全性.方法 回顾性系列病例研究.确诊为渗出型AMD并首次接受Ranibizumab玻璃体腔注射联合PDT治疗的患者32例（41眼）,均进行了糖尿病早期治疗研究（ETDRS）视力表、彩色眼底照像、荧光素眼底血管造影（FFA）和（或）吲哚青绿血管造影（ICGA）、光学相干断层扫描（OCT）等检查,确诊为渗出型AMD后采用PDT（光辐射率600 mW/cm2,光能量50 J/cm2,光照时间83 s）治疗,48-72 h后玻璃体腔注射Ranibizumab 0.5 mg（0.05 ml）,随后根据每个月检查情况决定是否再次治疗,重复治疗时单独注射Ranibizumab 0.5 mg,或联合PDT,或单独PDT.采用配对t检验比较治疗前后视力（ETDRS字母数）、视网膜厚度,对脉络膜新生血管（CNV）病灶渗漏情况进行计数,求百分比.结果 随诊12-39个月.在治疗后第12个月检查时,41眼ETDRS视力表字母数较治疗前平均提高9.1个字母（t=-4.14,P＜0.01）,重复Ranibizumab注射（2.0±1.1）次/眼,重复PDT治疗（0.2±0.8）次/眼.末次检查时,41眼ETDRS视力表字母数较治疗前平均提高8.9个字母（t=-3.74,P＜0.01）,重复Ranibizumab注射（2.7±1.2）次/眼,重复PDT治疗（0.3±0.7）次/眼.9眼（22%）CNV渗漏完全停止,27眼（66%）渗漏范围减少,3眼（7%）无明显变化或范围扩大,2眼（5%）有新病灶发生.OCT检查显示视网膜厚度较治疗前平均下降119.11μm（t=4.419,P＜0.01）.并发症与单独Ranibizumab或PDT治疗相比无增加.结论 Ranibizumab玻璃体腔注射联合PDT治疗渗出型AMD可使视力提高,视网膜水肿明显减轻,CNV病灶渗漏停止或减少,具有良好的疗效和较高的安全性.     

光动力疗法治疗年龄相关性黄斑变性的研究进展

光动力疗法(photodynamic therapy,PDT)始于20世纪70年代,是利用光敏剂和光产生的光动力效应进行疾病诊断和治疗的新技术,已成为治疗渗出型年龄相关性黄斑变性的主要方法.近年来,将PDT与其他疗法联合以期提高疗效、减少不良反应、降低治疗成本的研究大量开展,对于新型光敏剂的研究也有望成为PDT研究的热点.本文即对PDT治疗年龄相关性黄斑变性的研究进展作一综述.     

光动力疗法治疗老年性黄斑变性伴脉络膜新生血管膜一年疗效观察

目的观察光动力疗法(PDT)治疗老年性黄斑变性(AM D)患者脉络膜新生血管膜(CNV)的疗效和安全性。方法回顾分析临床确诊为CNV形成并进行PDT治疗后连续观察1年的AM D患者者的临床资料,共45例患者51只患眼符合条件纳入观察。其中,经典型为主性CNV(典型CNV成分≥50.00%)28只眼,占54.90%;轻微典型性CNV(典型CNV成分<50.00%)10只眼,占19.61%;隐匿性CNV(没有典型CNV成分)13只眼,占25.49%。平均视力42.3~8.7个字母,光相干断层扫描检查显示,病变的最大线性距离(GLD)为3560.1~1256.2μm。回顾分析时比较其治疗前后视力、病灶大小、CNV渗漏变化,并观察治疗后病灶纤维化程度。结果随诊结束时,平均视力45.1~8.1个字母,与治疗前比较,差异无统计学意义(t=1.62,P=0.12)。其中,视力增加5个字母以上的视力提高者12只眼,占23.53%;视力提高5个字母以下或稳定者37只眼,占72.54%。GLD 3579.4~1390.6μm,与治疗前比较,差异无统计学意义(t=0.008,P=0.94)。CNV渗漏无进展者占88.24%,有进展者占11.76%。病变纤维化程度<25.00%的38只眼中,有30只眼纤维化程度有所增加,占病变纤维化程度<25.00%患眼的78.94%。不良事件的发生率23.4%,其中严重不良反应发生率为4.26%。结论PDT治疗AM D患者CNV能够在1年内保持视力的稳定;严重不良事件的发生率低;是AM D患者CNV治疗的安全有效方法。     

光动力疗法联合抗血管内皮生长因子单克隆抗体Bevacizumab治疗渗出型老年性黄斑变性临床观察

目的 观察光动力疗法(PDT)联合玻璃体腔注射抗血管内皮生长因子单克隆抗体Bevacizumab治疗渗出型老年性黄斑变性(AMD)脉络膜新生血管(CNV)的安全性和临床疗效 。 方法 经视力、眼压、眼底检查、眼底彩色照相、荧光素眼底血管造影（FFA ）或（和）吲哚青绿血管造影（ICGA）、光相干断层扫描（OCT）检查确诊的21例渗出型AMD 患者的21只眼纳入治疗。 患者中男性15例15只眼，女性6例6只眼。年龄56～78岁, 平均年龄686岁。矫正视力：数 指/10 cm～0.9，logMAR视力为0.89±0.21。病程10 d～2年。平均眼压（14.96±2.65 ）mm Hg(1 mm Hg=0.133 kPa)。CNV位于黄斑中心凹下或中心凹旁，FFA或(和)ICGA检查均 有明显的荧光素渗漏；平均黄斑中心凹视网膜厚度（228.45±18.54） μm。PDT治疗按照 PDT治疗AMD（TAP）研究组和维替泊芬PDT治疗（VIP）研究组的方法进行。3 d后在表面麻醉下给予1.5 mg Bevacizumab玻璃体腔注射。治疗后第1、3、6、12个月随访。 结果 末次随访时,矫正视力：数指/10 cm～1.5，logMAR视力为0.42±0.18，与治疗前平均视力比较，差异有统计学意义（P＜0.01）。其中，视力提高4行以上者6只眼，占 28.57%；提高2～4行者9只眼, 占42.86%；视力稳定或波动在1行以内者6只眼，占28.57% ；无视力下降者。治疗后平均眼压（15.20±2.41）mm Hg，与治疗前平均眼压比较 ，差异无统计学意义（P＞0.05）。FFA或(和)ICGA检查CNV完全闭合13只眼，占61.90%；大部分闭合8只眼，占38.10%。平均黄斑中心凹视网膜厚度（157.67±19.32）μm，与手术前平均黄斑中心凹厚度比较，差异有统计学意义（P＜0.01）。 结论 PDT联合玻璃体腔注射Bevacizumab治疗渗出型AMD的CNV疗效较好，能较明显提高视力 ，促使CNV渗漏停止或减轻，促使视网膜水肿消退或减轻，安全性高。 (中华眼底病杂志,2008,24:164-167)