Transient reduction in retinal function revealed by multifocal electroretinogram after photodynamic therapy

PURPOSE: To evaluate the early changes in retinal function after photodynamic therapy (PDT) by multifocal electroretinogram (mfERG). DESIGN: Prospective interventional case series. METHODS: Seventeen eyes from 17 patients scheduled for standard PDT with verteporfin were prospectively recruited. Patients' diagnoses included choroidal neovascularization (CNV) secondary to age-related macular degeneration, idiopathic CNV, myopic CNV, polypoidal choroidal vasculopathy, and central serous chorioretinopathy. Serial mfERG recordings were performed before PDT, and at 4 days, 2 weeks, and 1 month after PDT. The first-order kernel N1 and P1 mfERG response from the central 0 to 7 degrees and peripheral 7 to 25 degrees were grouped and analyzed. The mean response amplitudes and peak latencies of the mfERG recordings were compared longitudinally. RESULTS: There were statistically significant reductions in the mean N1 response amplitude for the central group at 4 days (P =.007) and 2 weeks after PDT (P =.024), in the mean P1 response amplitude for both the central (P =.006) and peripheral (P =.013) groups at 4 days, and for the central group at 2 weeks after PDT (P =.017). There were also statistically significant increases in the mean P1 response latencies at 4 days (P =.004) and at 2 weeks (P =.018) after PDT for the central group and at 4 days after PDT (P =.026) for the peripheral group. At 1 month after PDT, no significant differences in the N1 and P1 mean response amplitudes and peak latencies were observed compared with pre-PDT mfERG. CONCLUSIONS: Transient impairments in retinal function for as long as 2 weeks after PDT were noticed by reduction in response amplitudes and a delay in peak latencies of mfERG. These findings may explain the common adverse event of subjective visual disturbance early after PDT with normal findings in visual acuity and ophthalmoscopy.     

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.     

Multifocal electroretinography in patients with exudative amd and intravitreal treatment with pegaptanib sodium

BACKGROUND: To objectively investigate central retinal function in patients with choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) before and after treatment with pegaptanib sodium (PS). METHODS: Patients with CNV due to exudative AMD received intravitreal injections of 0.3 mg PS every sixth week if angiographic activity was evident. Longitudinal observation included recordings with multifocal electroretinography (mfERG) before the first treatment and before each injection at follow-up intervals. RESULTS: During the observation period of 30.5 +/- 8 weeks (mean +/- SD) a mean number of 5.3 +/- 1.3 injections were applied. Final mean log(MAR) visual acuity decreased, statistically nonsignificant, from 0.67 +/- 0.3 at baseline to 0.74 +/- 0.16. mfERG recordings in 12 patients after 25 +/- 9 weeks evinced a decrease in response density which was statistically significant in the central 5 degrees . Mean P1-amplitudes of ring 1, 2, and 3 were reduced by 66%, 39% and 30%, respectively. During follow-up, implicit times of the P1 components remained stable within 4% of baseline. In three of four patients with vision loss of 2 lines or more, P1-response amplitudes decreased substantially at least 6 weeks prior vision loss. CONCLUSION: Treatment with PS resulted in a decrease of central retinal function more obvious in mfERG than in VA longitudinal testing. Good correlations were seen between changes in mean vision and changes in mfERG response density components. As a decline in P1-response amplitudes anteceded vision loss in this study, our results indicate a possible role of mfERG to predict vision loss during intravitreal pharmacotherapy.     

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.     

Recurrence of choroidal neovascularisation after photodynamic therapy in patients with age-related macular degeneration

AIM: To determine the incidence of recurrence of choroidal neovascularisation (CNV) 18 months after cessation of photodynamic therapy (PDT) with verteporfin monotherapy in patients with age-related macular degeneration (AMD). METHODS: This was a prospective interventional cohort study. The sample consisted of 108 individuals with CNV secondary to AMD which was treated with PDT. Data on demographics, pre-PDT and post-PDT Early Treatment of Diabetic Retinopathy Study (ETDRS) acuity, pre-PDT lesion size and composition were collected for each participant. All participants returned for fundus photographs and ETDRS acuity measurements 18 months after their final PDT, which were compared with the same measurements from the final treatment session to determine recurrence status. Recurrences were classified primarily on the basis of haemorrhage and increased lesion size. RESULTS: Recurrences were observed in 36 of 108 (33%) eyes. 23 of 36 (64%) recurrences were clinically meaningful. Of the explanatory variables considered, only final PDT acuity was significantly different between those that recurred (45.5 ETDRS letters) and those that did not (38.4 letters; p = 0.03). CONCLUSION: CNV recurrences are common after PDT for AMD, occurring in 33% of eyes in this study. Visual acuity measured at the final PDT treatment visit may be a predictor of subsequent recurrence.     

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.     

Clinical effects of photodynamic therapy with Verteporfin for age-related macular degeneration 1: three-month results

PURPOSE: To evaluate the 3-month effects after one-time photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD). SUBJECTS AND METHODS: The subjects were 122 patients with subfoveal CNV due to AMD detected by fluorescein angiography (FA). FA, indocyanine-green angiography (IA), and the examination of visual acuity were done before and 3 months after PDT. The diameter of CNV in FA was compared, and ophthalmological examination before the treatment determined whether there were any factors associated with a reduction or suppression of CNV. RESULTS: 3 months after PDT, 89 eyes had a significant (p < 0.001) reduction of CNV (41 eyes had blockage of CNV). In case of polypoidal choroidal vasculopathy (PCV) detected by IA, CNV was significantly reduced compared with the effects of other types of therapy (p = 0.032). Moreover, CNV was blocked significantly when fibrin tissue was present on a part of CNV before treatment (p = 0.026). Visual acuity was maintained or improved in 96 eyes. CONCLUSION: One-time PDT was effective in reducing or suppressing CNV as confirmed by FA.     

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。     

Deficits in the electroretinogram in neovascular age-related macular degeneration and changes during photodynamic therapy

Purpose To describe the deficits in four electroretinography (ERG) modalities in patients with neovascular age-related macular degeneration (AMD). To describe the changes in these parameters during a course of verteporfin photodynamic therapy (PDT). Methods Pattern (PERG), multifocal (mfERG) (19 segment simplified test protocol), flash ERG and flicker ERG were performed in patients with active neovascular AMD before PDT and compared to fellow eye controls using paired t-tests. Changes in ERG parameters during the 12 month treatment course were visualised using 95% confidence intervals of the median difference. The statistical significance of any changes was quantified using Wilcoxon signed ranks tests. Results Fifty patients were recruited and followed. At presentation all ERG amplitudes were reduced with greater reductions in focal as opposed to global test protocols (P < 0.05). Over the 12 month course of PDT, PERG P50 amplitude showed a general downward trend and latency remained unchanged. mfERG p1 amplitude density showed an upward trend at six months before returning to baseline by 12 months. mfERG ring 2 amplitude density was significantly increased at 12 months compared to baseline (P = 0.010). Flicker ERG latency was significantly increased at six months compared to baseline (P = 0.015). Discussion The simplified mfERG protocol was tolerated by this patient group, however, they found the full test protocol demanding. Large deficits in the retinal ERG function occur in neovascular AMD and involve retinal locations adjacent to as well as overlying choroidal neovascularisation (CNV). After PDT there is an improvement in electro-retinal function in retinal locations overlying the CNV.     

A comparison of pattern and multifocal electroretinography in the evaluation of age-related macular degeneration and its treatment with photodynamic therapy

This study compares pattern electroretinography (PERG) and multifocal electroretinography (mfERG) measures in 13 patients with predominantly classic choroidal neovascularisation (CNV) associated with age-related macular degeneration (ARMD, 9/13 unilateral, 4/13 bilateral), assesses the usefulness of each test in monitoring disease progression, and identifies electrophysiological predictors of outcome following treatment with photodynamic therapy (PDT). PERG and mfERGs were recorded at presentation, 2 weeks post-treatment, and at 3 monthly intervals for 2 years. The PERG was detectable in 8/13 patients with unilateral disease; the mfERG was detectable in 12/13 patients. P50 and N95 amplitudes increased in 6/8 patients and mfERG p1 increased in 7/13 patients at 2 years. PERG amplitudes correlated strongly with mfERG amplitudes in patients with unilateral disease. PERG P50 and mfERG p1 amplitude correlated with visual acuity at 2 years (R = 0.68, R = 0.82, respectively). The largest PERG P50 and mfERG p1 amplitude difference between treated and fellow eyes of all the groups on initial visit was associated with a poor visual outcome (P50 64% difference; p1 29% difference) whereas those with the smallest P50 and p1 amplitude difference was associated with improved vision at 2 years (P50 30% difference; p1 21% difference). The PERG and mfERG provide an objective measure of central retinal function in the progression of ARMD. A detectable PERG on presentation was the single best indicator of improved function and visual acuity at 2 years. The mfERG demonstrated disease progression from central retina into the paramacular regions over 2 years. Patients with poor visual outcomes had the largest inter-ocular amplitude difference on presentation, suggesting that such patients may have a worse prognosis following treatment.In part presented at ARVO 2004 (Fort Lauderdale, USA) and ISCEV 2004 (Peurto Rico, USA).     

光动力疗法治疗渗出型老年性黄斑变性的初步报告

目的 观察单次光动力治疗(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)的近期治疗效果。 方法 回顾分析经荧光素眼底血管造影(fundus fluorescein angiography, FFA)、吲哚青绿脉络膜血管造影(indocyanine green angiography, ICGA)以及光学相干断层扫描(optic coherence tomography,OCT)检查确诊的5例渗出型AMD患者的7只患眼行PDT治疗前及治疗后随访观察1周和1个月时的临床资料,主要以视力、FFA及(或)ICGA、OCT的改变为观察指标,评价PDT对渗出型AMD的治疗效果。 结果 7只患眼在治疗后1个月视力均无下降。治疗后1周时除1只眼在ICGA后期仍可观察到CNV有轻微渗漏外,其余6只眼FFA及(或)ICGA均显示CNV渗漏停止;OCT检查显示CNV有不同程度缩小,CNV周围视网膜脉络膜水肿及神经上皮脱离明显好转。但在治疗后1个月时观察到有2只眼在原渗漏病灶处又有渗漏灶出现。 结论PDT 治疗可以在短期内封闭AMD的CNV,使其停止渗漏,且不影响视力。(中华眼底病杂志,2000,16:213-216)     

The Changes of Pattern Electroretinography at the Early Stage of Photodynamic Therapy

Purpose To evaluate the short-term changes in pattern electroretinography (PERG) after photodynamic therapy (PDT). Methods Thirty eyes of 30 patients (17 males, 13 females) with choroidal neovascularization secondary to age related macular degeneration were included in this study. Standard PDT with verteporfin was performed on each patient. Serial PERG recordings were performed before, 1 week, and 1 month after PDT. Results Mean age of the patients was 69.6 ± 8.4 years (range 56 and 90 years). One month after PDT, the visual acuity improved in 16 eyes, remained unchanged in 12 eyes and deteriorated in two eyes. New hemorrhages were seen in two eyes in the first week after PDT and visual acuity was decreased in those patients. No other patient complained of ocular and systemic adverse events. There was a statistically significant reduction in the amplitudes of P₅₀ and N₉₅ waves at the first week recordings after PDT. At 1 month after PDT, no significant differences in the P₅₀ and N₉₅ amplitudes were observed compared with pre-PDT PERG recordings. There were no significant changes in the latencies of P₅₀ and N₉₅ at the first week and first month recordings when compared with pre-treatment PERG values. Conclusions Reduction in P₅₀ and N₉₅ amplitudes suggests that transient impairments in macular function occur at the first week after PDT.     

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)     

Effects of different degrees of cataract on the multifocal electroretinogram

AIM: To study the effect of different degrees of nuclear cataract on the multifocal electroretinogram (mfERG). METHODS: mfERGs were recorded from 30 elderly subjects with very mild, mild, or moderate nuclear cataracts using a VERIS System (version 4.1). The subjects were divided into three groups (10 in each group) according to their degree of nuclear cataracts as classified according to the Lens Opacities Classification System III (LOCS III). No subjects had any significant eye disease or degenerative changes except for cataracts. The mfERG responses were grouped into six concentric rings for analysis. Both the N1 and P1 amplitudes and the latencies of N1 and P1 of first-order responses were used for analysis. RESULTS: Amplitudes of N1 and P1 from the central retina (14 degrees) were significantly reduced in patients with mild or moderate cataract when compared with subjects with very mild cataract. However, there was no significant reduction of N1 and P1 amplitudes in the para-central retina (14-40 degrees). There was no difference in the latencies of N1 and P1 in these three groups of subjects. CONCLUSIONS: The mfERG responses from the central retina (central 14 degrees) were affected by the severity of cataract, but responses from the paracentral retina (14-40 degrees) were not affected. This suggests that in interpreting the mfERG in subjects with mild or moderate cataract subjects some care should be taken as reduced amplitudes (N1 and P1) will be expected from the central retina.     

Acute effects of cigarette smoking on multifocal electroretinogram

BACKGROUND: Cigarette smoking was shown to have stimulant effects on pattern visual-evoked potentials. The aim of this study was to investigate the acute effects of cigarette smoking on multifocal electroretinogram (mfERG). METHODS: This prospective case-control study was held in a tertiary referral centre in Turkish Armed Forces. mfERGs were investigated in a group of habitual smokers (30 right eyes of 30 subjects) in separate real smoking and sham smoking sessions. mfERG responses of the subjects were recorded after overnight abstinence. The responses were averaged over five retinal regions, the central hexagon (CH; central 6 degrees) and four concentric rings (ring 1 [R1; 7-12 degrees], ring 2 [R2; 13-18 degrees], ring 3 [R3; 19-24 degrees], ring 4 [R4; 25-30 degrees]). On each session mfERGs were recorded before (BS) and after smoking (AS) conditions. RESULTS: Regarding P1 amplitudes (first positive deflection of the mfERG) in the real smoking sessions, the differences were significant in the CH (BS: 66.2 +/- 16.3 microV, AS: 73.3 +/- 19.6 microV, P < 0.001), in R1 (BS: 44.3 +/- 13.0, AS: 48.3 +/- 16.0, P = 0.004) and in R2 (BS: 30.1 +/- 8.3, AS: 33.7 +/- 9.7, P = 0.002). Similar results were found for N1 amplitudes and P1 and N1 (first negative deflection of the mfERG) latencies in the CH, R1 and R2. The differences in outer retinal areas (R3, R4) in the real smoking sessions and in all rings in the sham smoking sessions were not significant. CONCLUSION: Cigarette smoking may stimulate the central retinal areas in the acute phase. This effect may be related with the stimulant effect of nicotine on neurotransmission, deleterious effects on retinal and/or choroidal circulation, carbon monoxide toxicity and nicotine withdrawal.     

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患者光动力疗法治疗前后视功能变化

目的 观察渗出型老年性黄斑变性（AMD）患者光动力疗法（PDT） 治疗前后的视功能变化。 方法 对经临床眼底检查、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）检查确诊的AMD患者25例34只眼采取PDT治疗，治疗后随访4个月～2年，平均随访观察时间9.2个月。对比分析治疗前以及治疗后定期随诊观察的最佳视力［采用最小分辨角度的对数视力(logMRA)统计平均视力］、视物变形及中心暗点、对比敏感度、双眼单视功能和立体视功能、以及色觉辨认等的变化情况。 结果 PDT治疗前患眼平均视力为logMAR 0.73±0. 37，治疗后不同时期的平均视力较治疗前提高，尤其在3个月时较明显，其平均视力logMAR 0.59±0.45。治疗前后比较，差异无显著性的意义（P＞0.05）；其中视力提高者13只眼 ，占38.24%；无变化15只眼，占44.12%；下降6只眼，占17.65%。Amsler方格表检查视物变形和中心暗点均较治疗前范围缩小，但差异无显著性的意义（P＞0.05）。治疗后各频区的对比敏感度值均较治疗前呈现不同程度提高，低频区（1.5 c/d）差异有显著性的意义（P＜0.05） 。患者的双眼同时视功能、融合功能、立体视功能以及色觉辨认功能均较治疗前有轻度改善 （P＞0.05）。 结论 渗出型AMD患者的视功能变化是多方面的，PDT 治疗可改善患者的部分视功能. （中华眼底病杂志，2004，20：289-291）     

Dynamics of Retinal Function after Multiple Photodynamic Therapies in Age-Related Macular Degeneration: A Report of Cases

Purpose: To monitor retinal function after multiple laser treatments by photodynamic therapy (PDT) with the multifocal electroretinogram (mfERG) in age-related macular degeneration (AMD). Methods: Five eyes of five subjects with AMD were investigated before the first and 1 month after each of three PDT treatments. Function was assessed using the cone- and rod-mediated mfERG, high-contrast distance visual acuity, central visual fields and contrast sensitivity. For each subject the local first-order mfERG results before treatment were used as a template and fitted against the local post-treatment results (Matlab, Mathworks). Results: We found transient reduction of the cone- and rod-mediated amplitudes between the first and second treatments but stable or improved mfERG function in four of five eyes for the cone-mediated mfERG and in all eyes for the rod-mediated mfERG after three treatments. Visual acuities and contrast sensitivities remained stable between treatments in four and two eyes respectively, whereas visual fields showed substantially higher mean defects in two subjects after all treatments. Conclusion: As found in previous studies of the cone-mediated mfERG after one PDT treatment, objective function was stabilized after multiple treatments in this case report. Similarly, although poor at baseline, rod-mediated function was not further compromised. Transiently reduced amplitudes after 1 month possibly reflected choroidal hypoperfusion. A larger sample size is needed to confirm if additional evaluation using electrophysiological criteria might be helpful in re-treatment decisions during PDT. This study was presented in part at the 2004 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) Fort Lauderdale, Florida.The authors have no propriety interest.     

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.     

Photodynamic therapy with verteporfin for polypoidal choroidal vasculopathy of the macula

PURPOSE: Indications for photodynamic therapy (PDT) have increased from age-related macular degeneration with choroidal neovascularization (CNV), containing more than 50% of the classic component, to occult CNV, myopic CNV and CNV due to ocular histoplasmosis syndrome. In the present study, the effect of PDT with verteporfin was examined in polypoidal choroidal vasculopathy (PCV) of the macula. METHODS: PDT was performed in 9 eyes with PCV of the macula. Fundus examination, fluorescein angiography, and indocyanine green angiography were performed before PDT and 3 months after PDT in all eyes. Optical coherence tomography was performed in 6 eyes. RESULTS: After the initial PDT, visual acuity was stabilized or improved in 8 eyes (89%), polypoid elements were obliterated in 7 eyes (78%), and vascular nets were reduced in 8 eyes (89%). Of 6 eyes that received optical coherence tomography, pigment epithelium detachment was reduced or disappeared in all eyes except 1, which developed a disciform scar. An additional PDT was performed in 4 eyes to decrease vascular leakage. During the follow-up period of 3-18 months, no reactivation of PCV was observed. CONCLUSION: PDT offers an effective way of treating PCV of the macula, by obliterating polypoid elements of the PCV. However, long-term follow-up is needed.