光动力学治疗实验性猴眼脉络膜新生血管的组织病理学研究

目的通过眼底荧光血管造影(fundus fluorescein angiography,FFA)检查、光镜及电镜观察,在影像学、组织病理学及超微结构上探讨光动力学治疗(photodynamic thera-py,PDT)猴眼脉络膜新生血管(choroidal neovascularization,CNV)模型的机制。方法采用过量激光凝固破坏猴眼视网膜及Bruch膜,建立猴眼CNV模型,采用FFA证明CNV的产生;对PDT治疗后1个月、2个月、3个月、6个月CNV模型进行FFA、光镜、电镜检查;将正常猴眼和未作PDT治疗的CNV模型眼分别作为对照1、2组。结果治疗组中,经FFA证实PDT治疗后1个月的CNV渗漏几乎停止,PDT治疗2～6个月CNV再次出现渗漏,程度较对照2组均有减轻。光镜、电镜下PDT治疗后1个月时CNV内有红细胞形成的血栓,并见CNV的内皮细胞增生。PDT治疗的非CNV区的视网膜解剖结构与对照1、2组相比在光镜、电镜下未见明显损伤。结论PDT治疗猴眼CNV模型是有效的,从病理组织学上证实了PDT治疗CNV主要是引起血管内血栓形成,PDT治疗对病变浅层及其周围的视网膜组织是安全的。     

光动力治疗脉络膜新生血管性疾病观察

目的 观察光动力疗法治疗脉络膜新生血管性疾病的临床疗效及安全性.方法 回顾性分析2010年9月至2012年6月在贵阳医学院附属医院眼科门诊采用维替泊芬光动力疗法(PDT)治疗脉络膜新生血管性疾病50例65只眼的临床效果,比较PDT治疗前后的视力、CNV范围、光学相干断层成像(OCT)、荧光素血管造影(FFA)、吲哚青绿血管造影(ICGA)等图像资料.年龄相关性黄斑变性(AMD) 35例50只眼;中心性渗出性脉络膜视网膜病变(CEC)5例5只眼;息肉状脉络膜血管病变(PCV)4例4只眼;病理性近视(PM)5例5只眼;外伤性脉络膜裂伤CNV1例1只眼.结果 全组50例65只眼PDT治疗后随访观察6个月,视力稳定和提高的AMD30只眼(60.00％)、CEC 4只眼(80.00％)、PCV 2只眼(50.00％)、PM 4只眼(80.00％)、脉络膜裂伤CNV 1只眼(100％);视力下降、CNV渗漏有进展的AMD 20只眼(40.00％)、CEC 1只眼(20.00％)、PCV 2只眼(50.00％)、PM 1只眼(20.00％).经ICGA、FFA检查发现CNV复发的30例30只眼,重复治疗2次的10例10只眼, 3次的3例3只眼.重复治疗时间:1个月者1例1只眼,3个月者8例8只眼,6个月者1例1只眼.所有病例均未见严重的不良反应.结论 PDT对治疗继发于不同病因的黄斑CNV安全、有效,可以减轻CNV的渗漏,延缓视力下降,但治疗后仍有复发需反复治疗.     

强化光动力疗法治疗脉络膜新生血管临床效果对比观察

目的 对比观察强化光动力疗法(photodynamic therapy,PDT)治疗脉络膜新生血管( choroidal neovascular,CNV)的临床疗效.方法 临床病例对照研究.对2009年7月至2011年4月在天津市眼科医院就诊的病人,回顾性分析CNV并行PDT治疗的患者27例28只眼的临床资料.以北美和欧洲的PDT(treatment of AMD with Photodynamic therapy,TAP)研究组的照射光斑在病灶最大线性距离的周围增加0.5 mm,照射时间83 s参数标准治疗的13例14只眼为对照组,以TAP研究组PDT治疗CNV基础上对病灶实际大小的光斑强化照射10 s治疗的14例14只眼为观察组,术后随访3～23个月,平均随访6.8个月.观察两组患者在治疗前后最佳矫正视力(best corrected visual acuity,BCVA)、CNV病灶大小情况,以及治疗前后眼底荧光素血管造影(fundus fluorescein angiography,FFA)、吲哚青绿血管造影(indocyanine green angiography,ICGA)的CNV渗漏情况,比较两种PDT治疗方法的临床效果.结果 治疗前两组患者的年龄、BCVA、病灶最大线性距离(greatest linear dimension,GLD)、CNV的最高隆起值差异均无统计学意义(P=0.94,0.57,0.37,0.21,);BCVA在治疗后3周、2月、3月时差异有统计学意义(P =0.001,0.004,0.008),两组视力变化在治疗后2个月时差异显著,CNV的最高隆起值在治疗后3周差异无统计学意义(P=0.19),治疗后2月、3月时差异有统计学意义(P =0.04,0.009).治疗后3月,观察组和对照组FFA显示CNV渗漏结果比较,差异无统计学意义(P =0.23).结论 强化PDT法治疗CNV安全有效,可迅速提高CNV患者的视力,减小CNV病灶大小,可进一步用于临床.     

光动力疗法在脉络膜新生血管治疗中的应用

光动力疗法(photodynamic therapy，PDT)是一种利用光化学反应特异性地阻塞新生血管而达到治疗目的的新技术。近年来对PDT治疗脉络膜新生血管进行了大量研究。本文就光动力疗法的原理、光敏剂种类以及它在脉络膜新生血管治疗上的一些进展作一综述。     

脉络膜新生血管光动力治疗药物光敏剂的研究进展

脉络膜新生血管(choroidal neovascularization,CNV)主要继发于年龄相关性黄斑变性(age-related macular degeneration,AMD),严重影响中心视力,甚至致盲.目前,以光敏剂维替泊芬介导的光动力疗法(photodynamic therapy,PDT)治疗CNV取得了令人瞩目的效果.但由于维替泊芬价格昂贵等问题,临床应用受到一定限制.因此各国的学者均致力于新型光敏剂的研发,以期获得替代维替泊芬的效用,我们就应用于CNV治疗的光敏剂的研究进展作一综述.     

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。     

光动力疗法重复治疗中应注意的问题

光动力疗法的重复治疗贯穿于黄斑下脉络膜新生血管（CNV）的整个治疗过程中。因此有必要对重复治疗的必要性、重复和终止治疗的指征、重复治疗的时间间隔及安全性等问题进行阐述,针对尚不明确且有争议之处提出个人看法,旨在为科学开展重复治疗研究提供参考。     

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)     

脉络膜新生血管的治疗研究进展

脉络膜新生血管(choroid neovascularization,CNV)多见于年龄相关性黄斑变性、病理性近视黄斑变性和中心性渗出性脉络膜视网膜病变等眼底疾病,是导致其视力下降甚至丧失的主要原因。治疗上,激光光凝,经瞳孔温热疗法及光动力学疗法等已在我国广泛开展; 而抗新生血管形成和病变炎性反应过程的药物应用于临床也显著增多; 用基因疗法、靶向治疗CNV等新领域亦取得了成绩,现就近年来国内外关于CNV的治疗研究现状做一综述。     

光动力疗法治疗高度近视眼的脉络膜新生血管

目的 :探讨光动力疗法 (Photodynamictherapy ,PDT)治疗高度近视眼脉络膜新生血管 (Choroidalneo vascularization ,CNV)的初步疗效及安全性。方法 :2例 3眼高度近视脉络膜新生血管患者 ,注射光敏剂Visu dyneTM(Verteporfin ,BPD)后予 5 0J/cm2 的红光 (6 90nm)照射CNV病变区 83秒 ,观察其不良反应及短期疗效。结果 :初步检查显示治疗后视力稳定或提高 ,未发现任何不良反应。结论 :PDT治疗高度近视所致的CNV是有效的、安全的     

Stabilization of visual acuity with photodynamic therapy in eyes with chorioretinal anastomoses

Purpose (1) To evaluate, in a non-randomized, institutional, prospective study, the efficacy of photodynamic therapy with Visudyne (PDT) in neovascular age-related macular degeneration (AMD) eyes with chorioretinal anastomoses (CRA). (2) To review, in a retrospective study and for comparison, the natural evolution of neovascular AMD eyes with CRA.Methods Prospective clinical and angiographic study of 17 consecutive eyes with CRA, treated with PDT. Retrospective clinical and angiographic study of the natural course of 17 consecutive patients with CRA. Masked best-corrected visual acuity (VA) and angiographic features at baseline and during the period of one year were evaluated.Results The two groups presented similar characteristics at baseline regarding age, sex, initial VA, duration of follow-up and angiographic features. PDT-treated eyes showed, at 1-year follow-up, VA stabilization or improvement in 73.3% of the eyes, no cases with very severe VA loss, and no fluorescein leakage in 46.6% of the eyes. In contrast, at 1-year follow-up the natural evolution of CRA was characterized by severe or very severe VA loss in 69% of the eyes and statistically significant mean VA loss (P=0.001) with persistence of fluorescein leakage in all cases.Conclusion The natural history of AMD eyes with CRA leads to progressive and dramatic VA loss, which is associated with blindness in most of the cases. PDT with verteporfin can offer some benefit to these patients, allowing VA stabilization or improvement in more than two thirds of the cases, at one year.     

Verteporfin photodynamic therapy of six eyes with retinal capillary haemangioma

Acta Ophthalmol. 2010: 88: e334–e340

Abstract.

Purpose: Single‐centre consecutive interventional case series by retrospective chart review to evaluate the efficacy of verteporfin (Visudyne?) photodynamic therapy (PDT) of retinal capillary haemangioma (RCH). Methods: Following an initial period of observation, six eyes of five patients with RCH (juxtapapillary 3 and extrapapillary (EP) 3) received 1–3 sessions of standard verteporfin PDT upon the development of progressive vision‐threatening complications. Four of the five patients had von Hippel‐Lindau (VHL) disease. Follow‐up included documentation of best‐corrected Snellen visual acuity (BCVA), tumour regression, and presence or absence of subretinal fluid (SRF) and/or lipid exudation as assessed by dilated fundus examination (DFE), fundus photos, and optical coherence tomography (OCT). These parameters were documented at 1 week, 1 month, and 3 months following each PDT session and up to 32 months following the first PDT. Results: All eyes showed favourable response to PDT as defined by tumour regression or stabilization as well as improvement of SRF and lipid exudation. BCVA improved or stabilized in three eyes. Three eyes required PDT retreatment for recurrent SRF. Epiretinal membrane (ERM) worsened in three eyes, requiring vitreoretinal surgery at a median of 6 months following PDT. Conclusions: PDT is a moderately effective treatment for juxtapapillary and EP RCH. In this series, PDT resulted in tumour regression or stabilization as well as in the improvement of SRF and lipid exudation in all cases. However, stabilization or improvement of visual acuity was observed in only 50 per cent of the cases. The treatment benefits may be limited by pre‐existing macular changes and worsening of ERM. A larger prospective study is necessary to validate these findings.     

Choroidal vein and artery occlusion following photodynamic therapy in eyes with pathologic myopia

Purpose To describe highly myopic patients in which either the large choroidal veins or arteries were occluded following PDT treatment.Methods Demographic features of two highly myopic patients in which large choroidal vessels were occluded at 1 week following PDT, among a total of 23 patients who received PDT due to choroidal neovascularization (CNV) caused by high myopia, were demonstrated.Results In case 1, ICG angiography demonstrated the complete occlusion of several large choroidal veins within the laser-applied area at 1 week after PDT. In case 2, ICG angiography demonstrated an occlusion of choroidal artery emanating from beneath the CNV. One month after PDT, re-perfusion of the occluded choroidal vessels was noted in both patients.Conclusion Occlusion of choroidal veins has never been reported in eyes with CNV treated by verteporfin therapy. Although further studies are necessary, occlusion of large choroidal vessels might happen in highly myopic eyes more commonly than expected. ICG angiography at 1 week after PDT was useful to evaluate the impact of PDT on large choroidal vessels.This study was in part supported by 17591823 and 16390495 from Japan Society for Promotion of Science.     

Classic choroidal neovascularization developing after photodynamic therapy in eyes with polypoidal choroidal vasculopathy

Purpose  

To investigate the characteristics of eyes with polypoidal choroidal vasculopathy (PCV) which develop secondary classic choroidal neovascularization (CNV) after photodynamic therapy (PDT).     

The effect of photodynamic therapy with rose bengal on posterior capsule opacification in rabbit eyes

We investigated the in vivo effect of photodynamic therapy (PDT) using rose bengal on the development of posterior capsule opacification (PCO). Endocapsular phacoemulsification was performed on white rabbits, which were divided into 4 groups: control group; group 1, treated with visible light only; group 2, treated with rose bengal only, and group 3, treated with PDT. In the case of the PDT group, rose bengal dissolved in sodium hyaluronate was injected into the empty capsular bag and treated with visible light. Three months after surgery, the rabbits were sacrificed and the eyeballs enucleated. The obstruction rate of visible light caused by PCO was measured with an optical powermeter. The mean obstruction rate was 30.6% in the control group, 28.3% in group 1, 19.3% in group 2, and 14.3% in group 3. Group 3 showed a statistically significant decrease in PCO compared with the control group and group 1 (p = 0.0014). Our results suggest that PDT using rose bengal effectively decreased PCO in rabbit eyes.     

The effect of photodynamic therapy on macular sensitivity in eyes with acute central serous chorioretinopathy

Background

To evaluate the effect of half-fluence rate indocyanine green angiography (ICGA)-guided verteporfin photodynamic therapy (PDT) on macular sensitivity (MS) in eyes with acute symptomatic central serous chorioretinopathy (CSC).

Methods

Single-center consecutive case series by retrospective chart review. Sixteen eyes of 16 patients with acute CSC of 3 months duration or less, treated with half-fluence (25 mJ/cm²) ICGA-guided verteporfin PDT were reviewed. At baseline and after 1, 3, and 6 months, all patients underwent MS testing of the central 20 °, MS testing of the retinal area covered by the PDT laser spot (MSLS), and evaluation of fixation stability (FS) for the central two degrees with the MP-1 microperimeter (Nidek, Vigonza, Italy).

Results

Macular sensitivity improved from 16.4?±?3.0 dB at baseline (n?=?16) to 18.2?±?2.4 dB (p?<?0.001) at 1 month (n?=?16). At the 3-month (n?=?13) and 6-month (n?=?12) follow-up, MS stabilized at 19.5?±?0.9 dB (p?=?0.21) and 19.0?±?1.3 dB (p?=?0.74), without changes when compared to respective precedent follow-up. Mean MSLS improved from 12.9?±?5.4 dB at baseline to 16.4?±?4.9 dB (p?<?0.001) after 1 month. At the 3- and 6-month follow-up, MSLS was 19.1?±?1.2 dB (p?=?0.1) and 18.9?±?1.9 dB (p?=?0.8) respectively. Mean FS at the central 2 ° was 78.8?±?30.4 % before treatment and 81.8?±?29.5 % (p?=?0.7), 81.9?±?27.5 % (p?=?0.7) and 83.6?±?17.1 % (p?=?0.5) respectively 1, 3 and 6 months after treatment.

Conclusion

Half-fluence (25 mJ/cm²) PDT significantly increased mean MS of central 20 ° and mean MSLS, in eyes with acute symptomatic CSC. Fixation stability was stable at baseline and throughout 6 months of follow-up.