Retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization

PURPOSE: To report a case of retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization. METHODS: Case report. A 74-year-old woman with exudative age-related macular degeneration and classic subfoveal choroidal neovascularization RE underwent photodynamic therapy with verteporfin. RESULTS: Ophthalmoscopy and fluorescein angiography RE disclosed a retinal pigment epithelial tear in the area of photodynamic therapy. CONCLUSION: This case presents the first report of a retinal pigment epithelial tear after photodynamic therapy with verteporfin for subfoveal choroidal neovascularization in age-related macular degeneration.     

Retinal pigment epithelium changes after photodynamic therapy for choroidal neovascularization in pathological myopia

PURPOSE: To describe changes in the retinal pigment epithelium (RPE) induced by photodynamic therapy (PDT) in eyes with subfoveal choroidal neovascularization (CNV) associated with pathological myopia (PM). METHODS: We carried out an open-label, prospective, interventional case series including 26 patients affected by subfoveal CNV in PM who underwent PDT with a 12-month follow-up. Particular attention was paid to the detection of changes at the RPE level in the areas exposed to the laser compared with baseline conditions. RESULTS: The median age of the patients was 58.5 years and the median duration of symptoms was 2 weeks. A pigmentary zone was present before PDT in 20 eyes (77%), incompletely encircling the CNV in all but two of the 20 eyes. At the end of the follow-up, the CNV in all eyes was seen to be completely or incompletely encircled by a band of hyperpigmentation, which was surrounded by RPE alterations, including depigmentation in all cases and atrophic changes in 14 eyes. CONCLUSIONS: After PDT, alterations in the RPE develop in myopic eyes. These include accentuation of the pigmentary zone surrounding the CNV and progressive atrophic changes. Further studies are needed to correlate post-PDT RPE damage with longterm visual outcome.     

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.     

Retinal pigment epithelial tear after transpupillary thermotherapy for choroidal neovascularization

PURPOSE: To describe two patients who developed a retinal pigment epithelial tear after transpupillary thermotherapy for choroidal neovascularization. METHOD: Case reports. RESULTS: Retinal pigment epithelial (retinal pigment epithelium) tear developed in 2 (8%) of 25 eyes after transpupillary thermotherapy for occult choroidal neovascularization associated with age-related macular degeneration. In both eyes, the retinal pigment epithelium tear developed between the treatment session and first post-treatment examination. In both eyes, the visual acuity was unchanged, but the complication of retinal pigment epithelium tear may result in decreased visual acuity when transpupillary thermotherapy is performed in an eye with good initial visual acuity. CONCLUSION: Retinal pigment epithelium tear appears to occur more frequently after transpupillary thermotherapy for poorly defined choroidal neovascularization than after conventional laser photocoagulation for poorly defined choroidal neovascularization.     

频域OCT在光动力疗法治疗病理性近视脉络膜新生血管中的应用

目的 评价频域光学相干断层扫描(optical coherence tomography,OCT)检查在光动力疗法(photodynamic therapy,PDT)治疗病理性近视所致的黄斑区脉络膜新生血管(choriodal neovascularization,CNV)中的临床应用价值.方法 对比分析21例26眼病理性近视患者PDT治疗前后频域OCT图像中黄斑中心凹层间厚度及外层高反射厚度,观察不同时期OCT的形态变化.结果 26眼CNV生长方式均属于Ⅱ型.PDT治疗后6个月18眼视网膜层间厚度恢复,视网膜下液吸收,CNV反光团逐渐缩小或纤维化,中心凹形态恢复.黄斑中心凹层间厚度治疗后1周(339.96±74.40)μm增加,治疗后1个月(267.78±33.39)μm开始下降,且差异均有统计学意义(均为P＜0.05).外层高反射厚度与术前(247.33±49.31)μm相比,从治疗后1个月(226.73±83.15)μm开始明显减少,但仅治疗后6个月(165.15±22.90)μm时差异有统计学意义(P=0.042).结论 频域OCT对病理性近视CNV行PDT治疗前后视网膜形态结构的连续观察具有重要意义,为临床治疗提供一种安全、无损伤的检测方法.     

光动力疗法治疗病理性近视所致黄斑部CNV的临床疗效观察

目的:评价光动力疗法(photodynamic therapy,PDT)治疗病理性近视所致黄斑部脉络膜新生血管(choroidal neovascularization,CNV)的临床疗效。方法:回顾性分析20例21眼临床确诊为病理性近视合并CNV患者的临床资料,对比分析PDT治疗前后患者最佳矫正视力(BCVA)、固视性质,FFA/ICGA和OCT等检查结果的变化。结果:PDT治疗后随访6mo,1例患者PDT治疗后3mo因玻璃体积血行玻璃体切除手术,未继续随访。其余患者BCVA与治疗前相比明显提高,差异具有统计学意义(P<0.05)。PDT治疗前中心固视3眼,中心外固视18眼,随访期间固视性质未发生改变。FFA/ICGA检查显示,PDT治疗后3mo,CNV病灶渗漏停止或渗漏减少者18眼(86%),持续渗漏2眼(10%),1眼出现玻璃体积血。PDT治疗后6mo,CNV病灶渗漏停止或渗漏减少者19眼(90%),持续渗漏1眼(5%),OCT显示CNV缩小,组织水肿减轻。结论:PDT治疗可以部分或完全封闭病理性近视所致脉络膜CNV,减少CNV引起的视力下降危险性。     

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）     

Prognostic factors influencing visual outcome of photodynamic therapy for subfoveal choroidal neovascularization in pathologic myopia

Purpose

To examine the influence of age, lesion size, degree of myopia, and baseline visual acuity on the visual outcome of patients with pathologic myopia and choroidal neovascularization (CNV) who received photodynamic therapy (PDT) with verteporfin.

Design

Retrospective, noncomparative consecutive case series.

Methods

Forty-three eyes of 41 patients were treated in a two-year time span; 36 eyes of 36 patients who had received PDT for CNV due to pathologic myopia were examined for the above-mentioned factors 24 months after first treatment.All patients had been treated according to the Verteporfin in Photodynamic Therapy (VIP) study criteria. Patients were examined in two- to three-month intervals with Snellen visual acuity, biomicroscopy, and fluorescein angiography.

Results

Baseline visual acuity and age were both prognostic factors for visual outcome (P = .0097, P = .0055). Lesion size (greatest linear dimension) at baseline, refractive error, or the number of treatments had no influence on the outcome.

Conclusion

Age and baseline visual acuity have an effect on visual outcome in patients receiving PDT due to CNV secondary to pathologic myopia. Younger patients and patients with higher baseline visual acuity had a better treatment outcome.     

Choroidal neovascularization in pathologic myopia: three-year results after photodynamic therapy

PURPOSE: To examine whether the encouraging functional results one year after photodynamic therapy (PDT) can be maintained up to three years. DESIGN: Prospective interventional case series. METHODS: Highly myopic eyes that had been treated with PDT for subfoveal choroidal neovascularization and had been observed at least 36 months were included. Distance acuity (Early Treatment of Diabetic Retinopathy charts), reading acuity (Jaeger charts), 10-degree static threshold perimetry, fluorescein angiography, and optical coherence tomography were performed. The main outcome measures were the differences of the values among the baseline and the month 12 and the month 36 examinations. RESULTS: Twenty eyes of 18 patients were included: 15 patients were female, and 3 patients were male. The average age was 64 years (range, 36 to 85 years). The mean distance acuity was 43 letters at baseline and 53 letters after 12 months and after 36 months. The mean reading acuity changed from mean J10.8 to mean J8.1 after 12 months and to mean J9.85 after 3 years. The mean defect decreased from mean 13.5 dB at baseline to mean 12.5 dB after 12 months and mean 11.2 dB after 36 months. The maximum retinal thickness decreased from mean 360 mum at baseline to mean 259 mum after one year and mean 238 mum after 36 months. CONCLUSION: Distance acuity and central visual field showed stabilization after the month 12 examination up to the month 36 examination. The reading acuity decreased between the month 12 and the month 36 examinations, which might be related to an increase of retinal atrophy.     

Outcome of photodynamic therapy in choroidal neovascularization due to pathologic myopia and related factors

To evaluate the outcome of photodynamic therapy (PDT) and the factors influencing its outcome in patients with subfoveal choroidal neovascularization (CNV) due to pathologic myopia. Twenty-three eyes of 21 consecutive patients who received PDT for subfoveal CNV due to pathologic myopia and who were followed for >12 months were included in the study. The relationship between the factors that might affect the treatment outcome were evaluated. Mean age was 48.7 ± 16.0 years (23–74 years). Mean follow-up was 23.2 ± 7.7 months (15–41 months). Mean logMAR visual acuity was 0.85 ± 0.24 before treatment, 0.89 ± 0.37 at 12 months, and 0.92 ± 0.46 at the final visit. Mean logMAR visual acuity did not change significantly at 12 months or at the final visit (P = 0.47 and 0.36, respectively). The baseline visual acuity strongly correlated with the final visual acuity (P = 0.001). Age showed an inverse correlation with change in logMAR visual acuity at 12 months (P = 0.01). PDT prevented significant visual loss in eyes with subfoveal CNV due to pathologic myopia. Better initial visual acuity resulted in better final visual acuity. Younger age was correlated with better treatment outcome at 12 months.     

病理性近视黄斑部脉络膜新生血管光动力疗法治疗后光相干断层扫描观察结果分析

目的评价光相干断层扫描(OCT)检查在病理性近视(PM)所致的黄斑部脉络膜新生血管(CNV)光动力治疗(PDT)中的临床应用价值。方法对比分析25例PM患者28只患眼PDT治疗前后OCT图像中黄斑区视网膜高度及CNV复合体厚度,观察CNV与黄斑中心凹的关系。结果治疗前22只眼表现为CNV伴视网膜神经上皮水肿;2只眼为CNV合并神经上皮浆液性浅脱离;6只眼为CNV合并有视网膜层间出血。17只眼CNV位于中心凹处,11只眼位于中心凹旁。治疗后CNV强反光团逐渐缩小,神经上皮水肿或出血吸收,黄斑视网膜高度和CNV复合体厚度均显著降低(P值分别为0.02、0.03)。CNV复发表现为OCT图像中强反光团扩大,神经上皮水肿增厚,伴或不伴视网膜层间出血。结论OCT检查对于判定PM所致CNV的活动性以及决定是否进行PDT治疗和重复治疗有重要的辅助作用。     

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。     

Retinal pigment epithelial tears after intravitreal bevacizumab injection for predominantly classic choroidal neovascularization

PURPOSE: To detect retinal pigment epithelium (RPE) tears in predominantly classic choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with intravitreal bevacizumab injections. METHODS: Forty consecutive patients with predominantly classic CNV secondary to AMD were treated with 1.25 mg of intravitreal bevacizumab. Patients were evaluated with visual acuity (VA) measured with Early Treatment Diabetic Retinopathy Study charts, optical coherence tomography, and fluorescein angiography. RESULTS: Three patients developed a RPE tear after the first injection. The first patient had been treated with verteporfin therapy and VA remained unchanged. In the other two cases the CNV was naive and VA improved since the foveal center was not involved by the tear and macular edema was reduced. CONCLUSIONS: RPE tears can occur following intravitreal bevacizumab injections in patients with predominantly classic CNV although VA is not always affected.     

脉络膜新生血管性疾病光动力疗法治疗后中心视野光敏感度改变

目的 :观察光动力疗法治疗脉络膜新生血管 (choroidalneovascularization ,CNV)性疾病患眼早期中心视野光敏感度的改变。方法 :对 2 3例 (2 3只眼 )经荧光素眼底血管造影及吲哚青绿脉络膜血管造影证实患有脉络膜新生血管性疾病的患者进行PDT治疗 ,其中湿性型老年黄斑变性 16例 (16只眼 ) ,中心性渗出性脉络膜视网膜病变 5例 (5只眼 ) ,高度近视 2例 (2只眼 )。在PDT治疗前及治疗后 3天、7天、1个月及 3个月 ,分别采用瑞士Interzeag公司Octopus10 1型全自动静态视野仪M2黄斑阈值测试程序和 32阈值测试程序 ,对各患眼中心 10°及 30°视野平均敏感度 (meansensitivity ,MS)及平均缺损 (meandefect,MD)进行测定并比较。结果 :PDT治疗后 3个月 ,2只眼 (8 70 % )视力提高≥ 2行 ,其余各眼视力无改变。与PDT治疗前比较 ,治疗后 3天、7天、1个月及 3个月黄斑区 10°MS、MD均无显著性改变 (P >0 0 5 ) ,但 7天、1个月及 3个月中心 30°视野MS较治疗前明显提高 (P <0 0 5 ) ,MD明显下降 (P <0 0 5 )。结论 :PDT治疗CNV性疾病早期可有效改善黄斑区外的视网膜光敏感性     

Verteporfin photodynamic therapy for extrafoveal choroidal neovascularisation in pathologic myopia

Background To report long-term functional and morphological outcome of verteporfin photodynamic therapy (PDT) for classic extrafoveal choroidal neovascularisation (CNV) secondary to pathologic myopia.Methods This retrospective case series included three eyes of three consecutive patients with classic extrafoveal CNV secondary to pathologic myopia, who underwent PDT at a tertiary retinal referral centre. Change in visual acuity and fluorescein leakage was the main outcome criteria.Results The patients were followed up an average of 36 months (33–40 months). In all eyes increase of visual acuity (one eye 1 ETDRS line, two eyes 2 ETDRS line) and no fluorescein leakage of the CNV were seen.Conclusions PDT can achieve long-term improvement of the visual acuity and morphological stability in selected cases with classic extrafoveal CNV in pathologic myopia. Large scale randomised studies are warranted for assessment of the benefit of PDT in such eyes.Presented partly as a poster at the ARVO Meeting in Fort Lauderdale, May, 2003.     

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     

PDT治疗病理性近视黄斑部CNV的多焦视网膜电图变化观察

目的:应用多焦视网膜电图(multifocal electroretinogram,mfERG)评价光动力疗法(photodynamic therapy,PDT)治疗病理性近视(pathological myopia,PM)合并黄斑下脉络膜新生血管(choroidal neovascularisation,CNV)早期视网膜功能的改变.方法:经临床确诊的继发于PM的CNV患者30例(30眼),根据CNV的位置将患眼分为中心凹下CNV组(19例19眼)和旁中心凹CNV组(11例11眼),在治疗前及治疗后1wk;1和3mo对各患眼6个环状视网膜区域的N1,P1波潜伏期和平均反应密度进行检测.结果:中心凹下CNV组治疗后1和3mo时mfERG3～5环N1、P1波振幅密度值与治疗前均显著提高(P＜0.05).旁中心凹CNV组治疗后1wk和1mo3～5环N1波振幅密度值与治疗前对比均有明显提高(P＜0.05),3mo3～4环N1波振幅密度值显著提高(P＜0.05),治疗后1wk;1和3mo3～4环P1波振幅密度值与治疗前比均有明显提高(P＜0.05).结论:mfERG显示PDT治疗能有效改善继发于PM的CNV患眼黄斑中心凹外的视功能.