中国维替泊芬光动力疗法治疗年龄相关性黄斑变性中心凹下脉络膜新生血管的多中心临床研究

目的探讨以维替泊芬为光敏剂的光动力疗法（PDT）治疗年龄相关性黄斑变性（AMD）合并黄斑中心凹下典型脉络膜新生血管（CNV）的疗效和安全性。方法采用多中心、开放、非对照Ⅲ期临床试验。受试对象为黄斑中心凹下以典型CNV为主的AMD患者。观察期限为24周。于第1次治疗后12和24周末进行复查。在首次治疗后12周,如发现CNV复发,则重复进行光动力治疗。比较治疗前后眼底病灶及视力的改变。记录治疗及随诊中所有的不良反应。结果共有32例患者入选,符合选择标准的患者为31例（31只眼）。在24周的观察中,38．7％的治疗眼视力增加5个字母以上,视力提高或减少小于15个字母者占83．9％。首次治疗后12周,CNV完全无渗漏的为12．9％;有渗漏,但局限于原病灶区的为61．3％;渗漏有进展者为25．8％。首次治疗后24周,病灶和病灶周围萎缩区大小、整个病变区域的最大直线距离均比治疗前稍有扩大,但差异均无统计学意义（P=0．65,0．31,0．12）。由此表明,在治疗的24周中,患眼的病灶基本稳定,未见明显扩大。PDT治疗后未发现病灶瘢痕明显扩大。整个临床试验中,11例（34．4％）发生了不良事件,其中7例（21．9％）为轻度不良事件,3例（9．4％）为中度不良事件,1例（3．1％）为重度不良事件。PDT治疗后24周,血尿常规和心电图检查均未见明显异常。结论用维替泊芬为光敏剂的PDT治疗AMD患者黄斑中心凹下CNV有较好的疗效,可以减轻CNV的渗漏,延缓视力下降,而且与药物相关的不良事件发生率低。因此,以维替泊芬为光敏剂的PDT治疗AMD继发的典型CNV其疗效肯定且安全。     

光动力疗法治疗湿性年龄相关性黄斑变性脉络膜新生血管膜的临床效果

目的探讨光动力疗法（PDT）对湿性年龄相关性黄斑变性（AMD）患者脉络膜新生血管（CNV）膜的临床疗效。方法回顾性分析2000年8月至2006年2月经PDT治疗后随访≥6个月的93例（98只眼）湿性AMD患者的临床效果,比较其治疗前后的视力、荧光素眼底血管造影（FFA）及吲哚氰绿眼底血管造影（ICGA）图像特征。结果PDT治疗后6个月,患者视力稳定不变的有59只眼（60．2％）,视力提高的有21只眼（21．4％）,视力下降的有18只眼（18．3％）。经FFA检查发现CNV复发且重复治疗者有54只眼（55．1％）;重复治疗时间：1个月者1只眼,3个月者24只眼,6个月者15只眼,9个月者6只眼,〉12个月者8只眼。54只眼重复治疗次数：2次40只眼,3次12只眼,4次2只眼,平均治疗次数为1．7次。随访时间：6—58个月,平均14个月。所有病例均未见严重的不良反应。结论PDT是治疗CNV的安全、有效方法,但需反复治疗。     

特发性脉络膜新生血管采用光动力疗法后视网膜色素上皮损伤的研究

目的探讨特发性脉络膜新生血管（CNV）采用光动力疗法（PDT）后视网膜色素上皮（RPE）损伤的原因。方法对43例（45只眼）接受PDT治疗的特发性CNV患者资料进行回顾性分析,以25例（27只眼）CNV膜大小接近的病理性近视合并CNV患者作为对照。分析治疗后4周的荧光素眼底血管造影图像,判断病灶周围色素上皮的透见荧光情况,探讨治疗后8-12周CNV患者的复发原因。结果特发性CNV患者经初次治疗后,PDT光照区内有21只眼的RPE发生改变,二次治疗后又增加了1只眼,RPE改变的发生率约为48．9％,而病理性近视组仅2只眼经PDT治疗后RPE发生改变。随访期内4例特发性CNV患者经PDT治疗后CNV明显扩大。两组CNV患者男女比例基本相同,其男女RPE改变的发生率差异也无统计学意义（P〉0．05）。与病理性近视的CNV患者相比,特发性CNV患者的发病年龄较轻,而病理性近视的CNV患者经治疗后出现RPE改变的2例患者中,1例为37岁,1例为15岁。结论特发性CNV患者经PDT治疗后病灶周围出现RPE损伤,提示年轻患者易出现治疗后的过度反应。     

特发性脉络膜新生血管光动力疗法的疗效观察

目的观察光动力疗法（PDT）对特发性脉络膜新生血管（CNV）的治疗效果。方法对61例（61只眼）经荧光素眼底血管造影（FFA）和吲哚氰绿眼底血管造影（ICGA）确诊的特发性CNV患者行PDT治疗,观察比较治疗前后眼底形态、视力、视网膜厚度、FFA和ICGA图像特征。PDT平均治疗次数为1、2次。随访时间为6～36个月,平均19个月。结果末次随访时,61只眼中,有41只眼视力提高（67.2％）,15只眼视力无明显变化（24.6％）,5只眼视力下降（8.2％）。经治疗后所有患眼黄斑出血及渗出均明显减轻。FFA图像显示38只眼的CNV荧光素渗漏完全消失,CNV闭合或瘢痕形成（62．3％）;4只眼CNV部分闭合（6.6％）,14只眼CNV小部分闭合（23．0％）,5只眼CNV复发（8．2％）。6只眼经1次PDT治疗CNV完全闭合,相干光断层扫描或视网膜厚度检查可见黄斑区神经上皮脱离及视网膜水肿消失,随访时间最长3年,未见CNV复发,视力保持稳定。研究结果经多重线性回归分析,表明治疗效果与年龄有关（t=0．476,P=0．016）,即年龄每提高一岁,治疗后视力平均下降0．008（95％CI为0．002～0．015）。结论PDT对特发性CNV有较好的治疗效果,特别对年轻患者效果更好些。（中华腰科杂志,2007,43：509-513）     

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.     

光动力学疗法治疗脉络膜新生血管的护理

目的评价光动力疗法（PDT）治疗脉络膜新生血管（CNV）的注意事项及护理的重要作用。方法对24例（26只眼）行PDT治疗的患者认真按照PDT治疗CNV的要求,精心操作,观察并分析并发症发生情况。结果 24例患者无严重并发症发生,3例发生一过性背痛。PDT能有效降低年龄相关性黄斑变性（AMD）、病理性近视（PM）及特发性脉络膜新生血管（CNV）等患者中、重度的视力丧失。结论在治疗过程中,根据患者的病情和心理情况,做好相关系统疾病的护理和耐心细致的心理护理,准确的静脉操作,对不良反应及时的处理,对患者的健康教育、耐心解释和患者的积极配合是PDT成功治疗的关键。     

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。     

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.     

玻璃体内注射康柏西普治疗特发性脉络膜新生血管

目的　观察玻璃体内注射康柏西普治疗特发性脉络膜新生血管（idiopathic choroidal neovascularization,ICNV）的临床疗效。方法　对2015年6月至2017年10月于我院确诊并行玻璃体内注射0.05 mL（0.5 mg）康柏西普治疗的20例20眼ICNV患者的临床资料进行回顾性分析,所有患者均采用1+PRN治疗策略,第1次随访时间为首次注射后1周,以后每月随访1次,均完成6个月的随访。记录CNV病灶渗漏情况、最佳矫正视力（best corrected visual acuity,BCVA）、黄斑中心凹视网膜厚度（central macular retinal thickness,CRT）、眼部及全身不良反应等。结果　20眼中,玻璃体内注射1～3（1.60±0.68）次,其中注射1次者10眼,注射2次者8眼,注射3次者2眼。治疗前BCVA为（55.15±6.82）个字母数,治疗后1周、1个月、3个月、6个月分别为（61.50±6.16）个字母数、（71.00±5.10）个字母数、（73.90±6.75）个字母数、（77.95±5.12）个字母数,治疗前患者CRT为（342.75±36.39）μm,治疗后1周、1个月、3个月、6个月分别为（301.15±32.16）μm、（231.85±30.25）μm、（240.05±56.99）μm、（229.75±48.18）μm,治疗后各时间点BCVA及CRT与治疗前相比差异均有统计学意义（均为P＜0.05）。随访6个月时,17眼病灶渗漏停止,3眼病灶渗漏面积明显缩小,20眼均未出现新的病灶。所有患眼在随访期间均未发生青光眼、眼内炎、白内障进展、视网膜脱离等眼部严重并发症或全身不良反应。结论　玻璃体内注射康柏西普治疗ICNV安全有效。     

光动力疗法对病理性近视合并脉络膜新生血管患者的疗效观察

目的 观察光动力疗法（PDT）对病理性近视合并脉络膜新生血管（CNV）患者的疗效和安全性。方法回顾性分析2003年6月至2006年4月行PDT治疗的27例（32只眼）病理性近视合并CNV患者的临床资料,比较患者治疗前后视力、荧光素眼底血管造影（FFA）及相干光断层扫描（OCT）图像变化。结果27例患者的年龄为18～59岁,平均40岁;单眼CNV22例,双眼CNV5例;黄斑中心凹下CNV29只眼,旁中心凹CNV3只眼;近视度数为-6D～-12D,随访时间6个月至3年。末次随访时,视力提高两行以上者4只眼（12．5％）,保持稳定者27只眼（84．4％）,下降2行以上者1只眼（3．1％）;视物变形消失者29只眼（90．6％）。FFA检测显示伴有漆纹样裂纹者12只眼,CNV完全闭合者17只眼,部分闭合者9只眼,未闭合者6只眼。27例患者PDT治疗的平均次数为1．3次。结论PDT治疗病理性近视患者的CNV疗效满意,安全性较高,能显著降低中度和重度近视患者的视力下降,且症状明显减轻,可提高病理性近视患者的视觉生活质量。（中华跟科杂志,2007,43：638-641）     

Predictors of 1‐year visual outcome in neovascular age‐related macular degeneration following intravitreal ranibizumab treatment

Purpose: To describe predictors of visual outcome in patients treated with intravitreal ranibizumab for choroidal neovascularisation (CNV) in age‐related macular degeneration (AMD). Methods: Retrospective review of 279 patients with CNV in AMD who fulfilled MARINA/ANCHOR study eligibility criteria and were treated with repeated intravitreal injections of ranibizumab 0.5 mg in routine clinical practice, beginning with three initial injections at 4‐week intervals followed by individualized retreatment for the subsequent 9 months. Study parameters included best‐corrected visual acuity (BCVA) and morphological characteristics. Results: Mean BCVA relative to baseline was +4.7 (p < 0.0001), +4.2 (p < 0.0001)and ?0.4 (p > 0.667) Early Treatment Diabetic Retinopathy Study letters after 3, 6 and 12 months, respectively, after a mean of 5.1 injections when the proportion of patients with BCVA ≥70 letters had doubled compared with baseline. Predictive factors for BCVA ≤35 letters after 12 months were BCVA ≤35 letters at baseline and month 3 (p < 0.0001) while BCVA ≥70 letters at month 12 was associated with BCVA ≥70 letters at baseline and month 3 (p < 0.001) and with total lesion size <4 DA (p = 0.0147). Conclusion: Under a ranibizumab regimen with substantially fewer injections than with fixed four‐weekly injection regimens, BCVA was improved compared with the natural history of neovascular AMD, but did not achieve the visual gain observed in randomized clinical trials using fixed 4‐week retreatment. Visual acuity at month 3, after the initial fixed‐interval injections, was the strongest predictor of BCVA at month 12.     

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。     

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。     

EXTEND III: Efficacy and safety of ranibizumab in South Korean and Taiwanese patients with subfoveal CNV secondary to AMD

BACKGROUND: The purpose of this study was to investigate the efficacy and safety of intravitreal ranibizumab 0.5?mg in South Korean and Taiwanese patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: This was a 12-month, open-label, single-arm, multi-center, phase III study. Ninety-five patients (Taiwanese: 51; South Korean: 44) were included in the study. Key outcome measures assessed included: mean change in best-corrected visual acuity (BCVA) from baseline to months 4 (primary endpoint) and 12 (secondary endpoint); other secondary endpoints comprising categorized mean change in BCVA from baseline at month 4 and month 12, mean change in BCVA from baseline at month 4 and month 12 per baseline characteristics; and incidence of ocular and non-ocular adverse events and serious adverse events (SAEs) at month 12. RESULTS: The mean BCVA change improved significantly (p?相似文献   

PDT联合玻璃体腔注射ranibizumab治疗病理性近视继发CNV

目的：评价光动力疗法（ photodynamic therapy,PDT）联合玻璃体腔注射 ranibizumab 治疗病理性近视（ pathologic myopia,PM ）所致的黄斑部脉络膜新生血管（ choroidal neovascularization,CNV）的临床疗效。 方法：临床确诊为PM合并CNV患者32例32眼,随机选取16例16眼为PDT治疗（ PDT组）,另16例16眼为PDT联合玻璃体腔注射ranibizumab治疗组（联合组）,两组黄斑水肿无显著性差异。对比分析治疗前及治疗后1,6 mo患者最佳矫正视力（ best corrected visual acuity,BCVA）、光学相干断层扫描（ optic coherence tomograph,OCT）及眼底荧光血管造影（ fundus fluorescein angiography,FFA）的变化。结果：治疗后1 mo与治疗前相比：PDT组BCVA平均值提高,黄斑中心厚度（ fovea centralis thickness, CMT ）平均值降低,差异具有统计学意义（ P〈0.05）;联合组BCVA平均值明显提高,CMT平均值明显降低,差异具有显著统计学意义（ P〈0.01）;两组组间比较BCVA变化、CMT变化差异具有统计学意义（P〈0.05）。治疗后6mo与治疗前相比, PDT组BCVA平均值提高,CMT平均值降低,差异具有统计学意义（P〈0.05）;联合组BCVA平均值明显提高,CMT 平均值明显降低,差异具有显著统计学意义（ P〈0.01）;两组组间比较BCVA变化、CMT变化差异具有统计学意义（ P〈0.05）。治疗后6 mo 和1 mo 相比：PDT 组与联合组BCVA平均值、CMT 平均值差异均无统计学意义（ P〉0.05）。 FFA检查显示：治疗后1mo,PDT组 CNV病灶渗漏停止或渗漏减少者11眼（69%）,持续渗漏5眼（31%）;联合治疗组 CNV病灶渗漏停止或渗漏减少者13眼（81%）,持续渗漏3眼（19%）。治疗后6 mo：PDT 组CNV病灶渗漏停止或渗漏减少者10眼（62.5%）,持续渗漏4眼（25%）,2眼（12.5%）出现渗漏复发;联合治疗组CNV病灶渗漏停止或渗漏减少者15眼（94%）,持续渗漏1眼（6%）。 结论：PDT治疗与PDT联合玻璃体腔注射ranibizuma     

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.     

One-year results of photodynamic therapy for small predominantly classic choroidal neovascular membranes secondary to age-related macular degeneration

PURPOSE: To determine the visual and angiographic outcomes of patients with small predominantly classic choroidal neovascular membranes (CNV) undergoing photodynamic therapy (PDT). METHODS: The subjects were a cohort of patients with age-related predominantly classic CNV with lesion size of greatest linear diameter of 2000 microm or less treated with PDT. Lesion size and visual acuity were recorded at baseline and at 3-month intervals. Visual treatment failure was defined as either loss of at least 15 letters or visual acuity less than 35 letters on a modified Early Treatment Diabetic Retinopathy Study chart. Lesion treatment failure was defined as increase in greatest linear diameter (GLD) of at least 500 microm. RESULTS: Twenty-five eyes of 25 patients were included. Visual treatment failure occurred in 16 and mean visual acuity dropped from 58 letters to 34 letters (p<0.0001). In 11 of these patients this occurred within the first 3 months. Lesion treatment failure occurred in 18 patients. Mean GLD increased from 1331 to 2935 microm (p<0.0001). Early growth of the lesion was associated with poor visual outcome with growth in GLD in the first 3 months of 310 microm in patients without eventual visual treatment failure and 1131 microm in patients with eventual visual failure (p=0.027). CONCLUSIONS: Small predominantly classic lesions commonly cause visual deterioration if treated with PDT alone. In the first year over 50% may lose at least 15 letters or drop below 35 letters, with most visual loss occurring in the first 3 months. Visual loss is associated with early lesion growth.     

Impact of lesion size on photodynamic therapy with verteporfin of predominantly classic lesions in age related macular degeneration

AIM: To determine if photodynamic therapy (PDT) outcomes are related to lesion size in patients with subfoveal predominantly classic choroidal neovascularisation (CNV) secondary to age related macular degeneration (AMD). METHODS: According to greatest linear dimension (GLD) of the entire lesion determined with fluorescein angiography (FA) patients were divided into two groups. In the first group GLD was <3000 microm and in the second one GLD was 3000-5000 microm. All eyes were treated with standard PDT with the verteporfin protocol. The primary outcome was the proportion of eyes in both groups that did not show significant leakage in FA at the end of follow up. Secondary outcomes were changes in GLD and in best corrected visual acuity (BCVA). RESULTS: 64 patients (mean (SD) age, 76.7 (7.7) years; range 58-95 years) were recruited to participate in the study. All participants in the study completed the follow up time (mean 16.6 months). 24 patients (75%) in the group of smaller lesions (n = 32) compared with 15 patients (46.8%) in the group of larger lesions (n = 32) did not show significant leakage in FA at the end of follow up (p = 0.02). A GLD increase >1000 microm was recorded in nine eyes (28.1%) in the group of smaller lesions and in 16 eyes (50%) in the group of larger lesions (p = 0.07). 22 eyes (68.7%) in the group of smaller lesions compared with 19 eyes (59.3%) in the group of larger lesions lost less than three lines of vision (p = 0.06). Relevant side effects related to verteporfin therapy were not recorded, except for four patients (6.2%) with infusion related back pain. CONCLUSIONS: These results suggest that lesion size at baseline may be a prognosis factor in PDT in patients with subfoveal predominantly classic CNV secondary to AMD. There are no relevant side effects or safety concerns derived from verteporfin therapy.     

光动力联合玻璃体腔注射Avastin治疗病理性近视脉络膜新生血管后视功能变化

目的 观察单独光动力疗法（PDT）及单次PDT联合玻璃体腔注射Avastin治疗病理性近视（PM）脉络膜新生血管（CNV）的疗效。方法 回顾性系列病例研究。经荧光素眼底血管造影（FFA）/吲哚青绿血管造影（ICGA）及光学相干断层扫描（OCT）确诊为PM继发黄斑区CNV,且CNV处于活动期患者38例（38眼）纳入本研究。非随机分组行单独PDT及单次PDT联合玻璃体腔注射Avastin治疗,其中单独PDT治疗组21例（21眼）,单次PDT联合玻璃体腔注射Avastin治疗组17例（17眼）。治疗前利用糖尿病视网膜病变早期治疗研究（ETDRS） 视力表检查患者可读取的字母数,微视野计（MP-1）检查黄斑区中心20°平均光敏感度（MS）,OCT测量黄斑中心凹视网膜神经上皮层厚度。治疗后1、3、6个月随访,检查眼底并对比两组治疗前后及两组之间可读取字母数、黄斑中心凹神经上皮层厚度及MS值。若CNV再次渗漏,则需重复治疗。采用独立样本t检验及配对t检验进行分析。结果 治疗后6个月,单独PDT治疗组及单次PDT联合玻璃体腔注射Avastin治疗组可读取字母数、黄斑中心凹视网膜厚度及MS较治疗前有显著改善,差异有统计学意义（单独PDT治疗组：t=-4.45、10.72、-8.62,P<0.01;单次PDT联合玻璃体腔注射Avastin治疗组：t=-9.28、8.72、-11.54,P<0.01）。治疗后1、3、6个月,两治疗组间可读取字母数及黄斑中心凹视网膜厚度比较差异无统计学意义（P>0.05）;单次PDT联合玻璃体腔注射Avastin治疗组MS值高于单独PDT治疗组,差异有统计学意义（t=-2.86、-2.15、-2.50,P<0.05）。结论 单次PDT联合玻璃体腔注射Avastin治疗较单独PDT治疗能稳定、改善PM性CNV患者视网膜敏感度,但需随机、大样本研究证实。