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）     

Subfoveal hemorrhage after verteporfin photodynamic therapy in treatment of choroidal neovascularization

BACKGROUND: To identify the frequency of new subfoveal hemorrhage and its impact on visual acuity 2 weeks following verteporfin photodynamic therapy (PDT) in the treatment of predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: Retrospective, noncomparative, consecutive, interventional case series. At a tertiary retinal referral center, 104 eyes of 97 consecutive patients with predominantly classic subfoveal CNV were treated by PDT. Morphological outcomes include new subfoveal hemorrhage assessed on the photo review (pretreatment, 2 and 12 weeks after PDT). Visual acuity outcomes include moderate (3-5 ETDRS lines) and severe (6 and more ETDRS lines) loss of visual acuity at 2 weeks after PDT. RESULTS: In this study, 104 eyes of 97 patients were analyzed. CNV in all eyes was secondary to AMD. New subfoveal hemorrhage was found in 22% (23/104) of the eyes 2 weeks following PDT. 17.4% (4/23) of the eyes with new subfoveal hemorrhage had moderate or severe loss of visual acuity. In such eyes the 12-week examination revealed considerable resorption of the new subfoveal hemorrhage with some improvement of visual acuity. CONCLUSIONS: In 3.8% of the eyes that underwent PDT for predominantly classic subfoveal CNV secondary to AMD, new subfoveal hemorrhage may result in moderate or severe loss of visual acuity within 2 weeks. In all eyes with new subfoveal hemorrhage, considerable resorption of the hemorrhage and some improvement of the visual acuity were seen at 12 weeks. Candidates for PDT should be informed about the low risk of this complication.     

Retinal pigment epithelial tear following photodynamic therapy for choroidal neovascularization secondary to AMD

PURPOSE: To describe retinal pigment epithelial tear following photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). DESIGN: Retrospective interventional case series. METHODS: A retrospective study in an institutional practice. We describe seven cases of retinal pigment epithelial (RPE) tear, which developed in seven eyes of seven patients following PDT. All eyes had subfoveal CNV secondary to AMD. RESULTS: Six eyes had occult subfoveal CNV, and one eye had recurrent classic subfoveal CNV. In five patients, the eye that developed the tear was the second eye, whereas the first eye had a disciform scar. In four eyes, the RPE tear developed after one PDT, in one eye the RPE tear developed after the second PDT, and in two eyes the RPE tear developed after the third PDT. In five of seven cases, there was a significant visual deterioration following the RPE tear. CONCLUSIONS: RPE tear is a complication that may occur following PDT in particular when the PDT is applied to an occult subfoveal CNV.     

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.     

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）     

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.     

PDT联合AVASTIN玻璃体腔注射治疗高度近视性黄斑区CNV观察

目的 观察光动力疗法(PDT)联合AVASTIN玻璃体腔注射治疗高度近视性黄斑区脉络膜新生血管(CNV)的临床效果.方法 经眼底荧光血管造影(FFA)和吲哚青绿(ICGA)检查确诊为高度近视性黄斑区CNV患者26例26只眼,非随机选取12例12只眼仅行光动力疗法,14例14只眼先行AVASTIN 1.25mg玻璃体腔注射,1周后行光动力治疗,治疗后1、3、6个月复诊,记录最佳矫正视力、症状变化、FFA及黄斑区的情况,对治疗前1天和治疗后6个月的最佳矫正视力、自觉症状进行比较分析.结果 6个月后,Amsler方格表检查PDT组4只眼症状消失,6只眼减轻或不变,2只眼加重;联合治疗组7只眼症状消失,6只眼减轻或不变,1只眼加重.最佳矫正视力,PDT组6只眼视力提高1行以上,4只眼视力不变,2只眼视力下降1行以上;联合治疗组10只眼视力提高1行以上,3只眼视力不变,1只眼视力下降1行以上.2组患者在消除或减轻症状、提高或稳定视力等方面进行组间Fisher精确检验,P＞0.05,差别均无统计学意义.结论 光动力疗法联合AVASTIN玻璃体腔注射治疗治疗高度近视性黄斑区CNV,在消除或减轻患者的自觉症状、提高或稳定患者的视力方面,较单纯光动力疗法(PDT)均无明显差别.     

Treatment frequency and visual outcome in subfoveal choroidal neovascularization related to pathologic myopia treated with photodynamic therapy

Background The purpose of this study was to examine the influence of treatment frequency on visual acuity of patients with PDT treatment for subfoveal predominantly classic CNV related to pathological myopia.Design Retrospective case series.Methods Thirty-seven patients with subfoveal predominantly classic CNV caused by pathologic myopia and treated with PDT were included. All patients received a full ophthalmic examination, including best-corrected visual acuity, slit-lamp biomicroscopy, fundus photography and fluorescein angiography, before first treatment and every 3 months thereafter. Photodynamic therapy was performed according to standard protocol. Main outcome measurements were visual acuity and treatment frequency.Results The number of treatments received was 3.35±1.83 (average: 1–7). In 12 eyes (32.43%); the BCVA was stable or increased during the entire follow-up period. In eight eyes (21.62%), the BCVA decreased and did not return to the baseline values. A transient loss of visual acuity (over 3–9 months) with subsequent improvement in visual function was found in 68% (17 eyes). A gain of three or more lines compared with lowest BCVA was found in 56% (14 eyes). The number of treatments did not correlate with baseline BCVA, greatest linear dimension of CNV at baseline or with the change of BCVA from baseline. In cases with transient worsening of BCVA, the recovery of visual acuity correlated significantly with the number of treatments (r=−0.522, P<0.05; Spearman rank correlation) received.Conclusion Visual acuity recovery correlates with the number of PDT re-treatments; in many cases, an improvement in visual function after temporary decrease of BCVA can be observed after re-treatment according to current treatment guidelines. The number of PDT treatments has no negative effect on the visual outcome in subfoveal CNVs caused by pathological myopia.     

Photodynamic therapy in age-related macular degeneration--results of one year observation

PURPOSE: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin in reducing the vision loss and progression of choroidal neovascularization (CNV) in patients with subfoveal CNV due to age-related macular degeneration (AMD). MATERIALS AND METHODS: 46 eyes of 46 patients with subfoveal, predominantly classic CNV caused by AMD and best-corrected visual acuity of 5/50 to 5/10 were treated with photodynamic therapy with verteporfin (Visudyne, CIBA Vision). Verteporfin was administered via intravenous infusion over 10 minutes. Fifteen minutes after the start of the infusion, a diode laser light at 689 nm (Opal Photoactivator, Coherent) was delivered over 83 seconds. Visual acuity and fluorescein angiography were performed before and after the treatment at 7 days and 1, 3, 6, 9 and 12 months after the initial-treatment. Retreatment in the same manner was applied if at follow-up examination fluorescein leakage from CNV was seen. Outcomes were compared with those of control group which consisted of 38 eyes of 38 patients of the same condition of the disease, not treated with any method. RESULTS: The lost of visual acuity was significantly reduced in the verteporfin--treated eyes compared--with controls. At the 12 month 73.91% eyes of PDT group versus 36.84% of control group (p < 0.001) lost fewer than 3 Snellen lines. The vision loss appeared to be more rapid in first 6 months of the study. During the study growth of CNV was diminished in PDT group compared with control group. CONCLUSIONS: Results show, that photodynamic therapy may be an effective method of treatment for predominantly classic subfoveal choroidal neovascularization caused by AMD. Further studies are needed to find the best modes of PDT procedure.     

Photodynamic Therapy for Age-related Macular Degeneration

PrefaceAge鄄relatedmaculardegeneration(AMD)isanimportantchallengetoophthalmologistsinthe21stcentury.Worldwide,itisthemostcom鄄moncauseoflegalblindnessamongindividualsolderthan60years[1].ItisknownthatseverevisionlossinmajorityofpatientswithAMDisduotochoroidalneovascularization(CNV).Laserphot鄄ocoagulationistheonlylong鄄termtreatmentoptionforneovascularAMDandisindicatedforextrafovealorjuxtafoveallesion.Inthesecaseslasertreatmentcancauseirreversibledamagetotheretinalpigmentepitheliumandsens…     

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。     

Subthreshold transpupillary thermotherapy for subfoveal occult choroidal neovascularization secondary to age-related macular degeneration

PURPOSE: To describe the long term outcome of patients with subfoveal, occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with subthreshold transpupillary thermotherapy. METHODS: 82 eyes of 82 consecutive patients with subfoveal occult CNV secondary to AMD were treated with subthreshold transpupillary thermotherapy. Best corrected visual acuity, fundus photography, fluorescein and indocyanine green angiography were performed. RESULTS: All patients have been followed for at least 24 months. At the final follow-up visit, 75.6% of patients had stable or improved visual acuity and 24.4% had worsened visual acuity. No overtreatment side effects were found. CONCLUSION: Subthreshold transpupillary thermotherapy seems effective in stabilizing visual acuity in patients affected by occult, subfoveal CNV even on a long-term basis.     

Fixation pattern and macular sensitivity in eyes with subfoveal choroidal neovascularization secondary to age-related macular degeneration. A microperimetry study

PURPOSE: To investigate the effects of subfoveal choroidal neovascularizzation (CNV) secondary to age-related macular degeneration (AMD) on macular functional parameters quantified with an automatic fundus perimeter. METHODS: 118 eyes of 98 consecutive patients with subfoveal CNV secondary to AMD were evaluated. Best corrected visual acuity (ETDRS charts), fundus photography, and fluorescein angiography were performed. Microperimetry (fundus-related perimetry) was used to quantify macular sensitivity and fixation pattern (location and stability). RESULTS: Of 118 eyes: 26 (21.9%) had central, 18 (15.1%) poor central and 74 (63.0%) eccentric fixation; 31 (26.0%) had stable, 42 (35.6%) relatively unstable and 45 (38.4%) unstable fixation. In 75 eyes (63.4%) a dense central scotoma was found. Angiographic classification of subfoveal CNV (occult versus classic) was not significantly related to fixation pattern (location: P = 0.274; stability: P = 0.385), and presence of dense scotoma (P = 0.41). CONCLUSION: Microperimetric quantification of macular sensitivity and fixation pattern in eyes with subfoveal CNV secondary to AMD offers new data about the impact of visual impairment in these eyes. Moreover, microperimetry improves the functional evaluation of subfoveal CNV in AMD.     

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。     

Combined photodynamic therapy and intravitreal triamcinolone injection for the treatment of subfoveal choroidal neovascularisation in age related macular degeneration: a comparative study

AIM: To evaluate the outcomes of combined intravitreal triamcinolone (IVTA) and photodynamic therapy (PDT) with verteporfin in the treatment of subfoveal choroidal neovascularisation (CNV) caused by age related macular degeneration (AMD). METHODS: 48 eyes from 48 patients with subfoveal CNV caused by AMD were prospective recruited, with 24 eyes treated with combined PDT with IVTA and compared with a control group of 24 eyes which received PDT monotherapy. In the combined treatment group, IVTA was performed immediately after PDT as an outpatient procedure. The mean number of treatments, mean logMAR best corrected visual acuity (BCVA), mean line of visual acuity changes, and proportion of patients without moderate visual loss at 1 year were compared between the combined and monotherapy groups. RESULTS: At 1 year the logMAR BCVA for the PDT with IVTA group changed from 0.88 to 0.95 (p = 0.32 compared with baseline), whereas the logMAR BCVA for the monotherapy group reduced from 0.74 to 1.09 (p<0.001 compared with baseline). A significantly higher proportion of patients who had PDT with IVTA did not develop moderate visual loss at 1 year compared with the monotherapy group (70.8% and 33.3% respectively, p = 0.009). Eyes which had combined treatment had significantly fewer lines lost compared with monotherapy alone (0.7 and 3.5 lines respectively, p = 0.015). Subgroup analysis showed that PDT with IVTA is effective in preventing visual loss in both predominately classic and occult CNV groups. The mean number of treatments for the combined and monotherapy groups was 1.5 and 1.96 respectively (p = 0.076). CONCLUSIONS: Combined PDT with IVTA appeared more effective statistically at 12 months for stabilisation of vision (<3 logMAR lines change) compared with PDT monotherapy. Further randomised control trials might be justified to conclude the efficacy of PDT with IVTA.     

Photodynamic therapy for choroidal neovascular disease: photosensitizers and clinical trials

Photodynamic therapy with visudyne for choroidal neovascular disease (CNV) has proved effective at preventing moderate to severe visual loss in eyes with subfoveal predominantly classic CNV or occult-only CNV caused by age-related macular degeneration (AMD) and in eyes with subfoveal CNV caused by pathologic myopia. PDT is not meant to improve visual acuity. It should, therefore, be used in eyes with potentially useful macular vision. Clinical trials are under way to evaluate the usefulness of early retreatment with PDT and visudyne at 6 weeks for reducing the risk for moderate visual loss in eyes with predominantly classic CNV, the efficacy of PDT with visudyne for the treatment of AMD in eyes with minimally classic CNV, and the efficacy of PDT for use with SnET2, lutetium texaphyrin, and Npe6.     

经瞳孔温热疗法和光动力疗法治疗渗出型老年性黄斑变性短期疗效比较

目的 比较经瞳孔温热疗法(TTT) 和光动力疗法(PDT)治疗渗出型 老年性黄斑变性(AMD)脉络膜新生血管(CNV)的疗效。 方法 对比分析渗出性AMD患者行PDT 治疗的35例42只眼、TTT治疗的35例40只眼治疗前和治疗后3个月的临床资料。所有患者治疗前后均进行视力 、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 。CNV类型均为黄斑中心凹下型或旁中心凹型。其中，隐匿性或隐匿性为主型的CNV44只眼 ，典型性及典型性为主型的CNV38只眼。PDT治疗的42只眼中，隐匿性或隐匿性为主型CNV19只眼，典型性或典型性为主型CNV23眼；TTT治疗的40只眼中，隐匿性或隐匿性为主型CNV25只眼，典型性及典型性为主型CNV15只眼。 结果 典型性或典型性为主型CNV治疗后1、3个月时，PDT组分别有47.8%、43.5%的患眼视力提高2行以上；TTT组分别有6.7%、6.7%的患眼视力提高2行以上。两组之间治疗后1、3个月时视力提高的比例比较，差异均有显著性的意义（χ2=7.118,P=0.0076；χ2=5.500,P=0.0190）。PDT组分别有100%、69.6%的患眼CNV荧光素渗漏停止或改善；TTT组分别有53.2%、80.0%的患眼CNV荧光素渗漏停止或改善。两组之间治疗后1个月时CNV荧光素渗漏停止或改善的比例比较，差异有显著性的意义（χ2=13.16,P=0.0003）；3个月时CNV荧光素渗漏停止或改善的比例比较，差异无显著性的意义（χ2=0.5098,P=0.4752）。隐匿性或隐匿性为主型CNV治疗后1、3个月时，PDT组分别有15.8% 、10.5%的患眼视力提高2行以上；TTT组分别有4.0%、8.0%的患眼视力提高2行以上。两组之间治疗后1、3个月时视力提高的比例比较，差异均无显著性的意义（χ2=1.816,P=0.17 78；χ2=0.0838,P=0.7728）。PDT组分别有78。9%、42.1% 的患眼CNV荧光素渗漏停止或改善；TTT组分别有52.0%、84.0%的患眼CNV荧光素渗漏停止或改善。两组之间治疗后1个月时CNV荧光素渗漏停止或改善的比例比较，差异无显著性的意义（2=3.388,P=0.0657）；3个月时CNV荧光素渗漏停止或改善的比例比较，差异具有显著性的意义（χ2=8.433,P=0.0037）。 结论 典型性及典型性为主型CNV治疗后3个月视力结果PDT优于TTT；治疗后1个月时FFA检查渗漏改善PDT明显优于TTT，但随诊至3个月时，二者疗效差异无显著性的意义。隐匿性或隐匿性为主型CNV治疗后3个月视力结果PDT与TTT差异无显著性的意义；治疗后1个月FFA检查渗漏改善改善PDT与TTT差异无显著性的意义，但随诊至3个月时，CNV渗漏消失和减少方面TTT疗效明显好于PDT。尚需要更多的病例及更长的随诊时间来评价两种治疗方法的疗效.（中华眼底病杂志，2004，20：285-288）     

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)     

Fixation pattern and macular sensitivity in eyes with subfoveal choroidal neovascularization secondary to age-related macular degeneration. A microperimetry study

Purpose. To investigate the effects of subfoveal choroidal neovascularizzation (CNV) secondary to age-related macular degeneration (AMD) on macular functional parameters quantified with an automatic fundus perimeter. Methods. 118 eyes of 98 consecutive patients with subfoveal CNV secondary to AMD were evaluated. Best corrected visual acuity (ETDRS charts), fundus photography, and fluorescein angiography were performed. Microperimetry (fundus-related perimetry) was used to quantify macular sensitivity and fixation pattern (location and stability). Results. Of 118 eyes: 26 (21.9%) had central, 18 (15.1%) poor central and 74 (63.0%) eccentric fixation; 31 (26.0%) had stable, 42 (35.6%) relatively unstable and 45 (38.4%) unstable fixation. In 75 eyes (63.4%) a dense central scotoma was found. Angiographic classification of subfoveal CNV (occult versus classic) was not significantly related to fixation pattern (location: P = 0.274; stability: P = 0.385), and presence of dense scotoma (P = 0.41). Conclusion. Microperimetric quantification of macular sensitivity and fixation pattern in eyes with subfoveal CNV secondary to AMD offers new data about the impact of visual impairment in these eyes. Moreover, microperimetry improves the functional evaluation of subfoveal CNV in AMD.