经瞳孔温热疗法治疗高度近视眼的脉络膜新生血管

目的：评价经瞳孔温热疗法(tmmpupillary ther-motherapy,TTT)治疗高度近视眼的黄斑区脉络膜新生血管膜(choroidal meovascularization,CNV)的疗效。方法：对17例21眼黄斑区具有QⅣ的高度近视患者进行TTT治疗，并定期随访，观察治疗前后视力、眼底、眼底荧光造影(fundus fluores-cein angiogmphy，FFA)及吲哚青绿眼底血管造影(indocyanine green angiogaphy，ICGA)的变化。结果：治疗后21眼中视力提高仅4眼，稳定8眼，下降9眼。治疗过程中有4眼发生脉络膜出血，1眼治疗后CNV仍反复生长。最终有16眼眼底出血渗出的情况得到改善。结论：经瞳孔温热疗法可以减少因脉络膜新生血管膜而引起的出血及渗出，加速疤痕化，对封闭黄斑区CNV有一定的疗效，但高度近视患者的CNV进行TTT治疗时能量较难控制，容易出血，对中心视力的恢复有一定的影响，应谨慎选择治疗方式。     

经瞳孔温热疗法治疗老年性黄斑变性的疗效观察

目的 观察经瞳孔温热疗法(transpupillary thermotherapy,TTT)治疗渗出型老年性黄斑变性(age—related macular degeneration，AMD)隐匿型脉络膜新生血管(choroidal neovascularization，CNV)的效果。方法 对28例34眼经眼底荧光血管造影(fundus fluorescein angiography，FFA)及吲哚青绿血管造影(indocyanine green angiography，ICGA)确诊的继发于渗出型AMD的隐匿型CNV行TTT治疗，并主要以视力、眼底检查、FFA及ICGA改变为指标，评价TTT治疗渗出型AMD的效果。结果 随访3～20个月，平均6.65个月，视力提高19眼，视力稳定13眼，视力下降2眼，视网膜水肿基本消退6眼，水肿明显减轻21眼，水肿无明显变化5眼，2眼水肿加重，出血吸收22眼，8眼出血减少，出血无明显变化者2例，另有2眼发生少量新鲜视网膜深层出血，第1次治疗后复查FFA及ICGA，10眼CNV消失，19眼CNV渗漏减轻，3眼无明显变化，2眼CNV增大。结论 TTT治疗可使大部分AMD患者视力稳定或提高，是一种极具潜力的治疗方式，但对其确切疗效的评价。尚需与自然病程及其他治疗方法对比。     

TTT治疗CNV临床疗效的监测指标

目的：用经瞳孔温热疗法(Transpupillary Thermotherapy，TTT)治疗黄斑区脉络膜新生血管膜(Choroidal Neovascularization。CNV)，对其临床疗效的监测指标进行评估。方法：对75例86眼黄斑区具有CNV的患者进行TTT治疗，定期随访，以治疗前后的中心视力、Amsler表、眼底检查、视网膜厚度分析仪(Retinal Thickness Analyzer，RTA)、眼底荧光造影(Fundus fluoreseein Angiography，FFA)及吲哚青绿眼底血管造影(Indocyanine Green Angiography，ICGA)等作为疗效检测指标，进行评估。结果：100％的患者得到视力、Amsler表、眼底的随访检查，并显示治疗后视力提高23眼，稳定4l眼，下降22眼，69眼眼底检查发现出血渗出明显减少或消失。55例(73％)58眼得到RTA的随访，其中48眼显示治疗后视网膜水肿减轻或消退。45例(60％)53眼得到造影随访，FFA显示43眼荧光渗漏减少或消失，ICGA显示37眼CNV萎缩或消失。结论：经瞳孔温热疗法可以减少因脉络膜新生血膜而引起的出血渗出。加速疤痕化。其疗效的监测可通过各种检查方法获得，了解它们各自的优缺点，可以帮助我们在今后的前瞻性研究中，选择合适的疗效观察指标。     

TTT治疗CNV临床疗效的监测指标

目的：用经瞳孔温热疗法(Transpupillary Thermotherapy，TT)治疗黄斑区脉络膜新生血管膜(Choroidal Neovascularization，CNV)。对其临床的监测指标进行评估。方法：对75例86眼黄斑区具有CNV的患者进行TTT治疗，定期随访，以治疗前后的中心视力、Amsler表、眼底检查、视网膜厚度分析仪(Retinal Thickness Analyzer，RTA)、眼底荧光造影(Fundus fluorescein Angiography，FFA)及吲哚青绿眼底血管造影(Indocyanine Green Angiography，ICGA)等作为疗效检测指标，进行评估。结果：100％的患者得到视力、Amsler表、眼底的随访检查，并显示治疗后视力提高23眼，稳定41眼，下降22眼，69眼眼底检查发现出血渗出明显减少或消失。55例(73％)58眼得到RTA的随访，其中48眼显示治疗后视网膜水肿减轻或消退。45例(60％)53眼得到造影随访，FFA显示43眼荧光渗漏减少或消失，ICGA显示37眼CNV萎缩或消失。结论：经瞳孔温热疗法可以减少因脉络膜新生血膜而引起的出血渗出，加速疤痕化，其疗效的监测可通过各种检查方法获得，了健它们各自的优缺点，可以列们在今后的前瞻性研究中，选择合适的疗效观察指标。     

经瞳孔温热疗法治疗中心性渗出性脉络膜视网膜病变的初步观察

目的:探讨经瞳孔温热疗法(transpupillary thermotherapy,TTT)治疗中心性渗出性脉络膜视网膜病变(central exudative chorioretinopathy,CEC)的临床效果.方法:对眼底荧光素血管造影(fundus fluorescein angiography,FFA)和吲哚青绿血管造影(indo cyanine green angiography,ICGA)检查确诊的CEC患者的18只患眼进行TTT治疗.采用810nm半导体激光,光斑0.8～2.O mm,照射时间60s,能量80～300 mW,对FFA和ICGA图像所显示的脉络膜新生血管(choroidal neo vascularization,CNV)进行照射,照射区未出现颜色变化.对比分析患者治疗前后的视力、眼底、FFA结果.结果:治疗后视力提高者6眼,占33%;无变化者12眼,占67%.自觉症状有程度不同的改善者16眼,眼底检查病变减轻者10眼.13眼复查眼底血管造影,其中8眼脉络膜新生血管(choroidalneovascularization,CNV)明显消退、渗漏减轻.结论:TTT治疗CEC效果良好,值得临床推广应用.     

中心性渗出性脉络膜视网膜病变的治疗

中心性渗出性脉络膜视网膜病变（CEC）也称为特发性脉络膜新生血管,多见于中青年,表现为黄斑区孤立的脉络膜新生血管（CNV）。CNV可引起黄斑部的反复出血、渗出、瘢痕形成,严重影响患者的中心视力。该病病因不明,治疗主要针对CNV,目前临床治疗CEC的方法主要有：光动力疗法（PDT）、抗血管内皮生长因子（VEGF）类药物、糖皮质激素类药物、联合治疗、经瞳孔温热疗法（TTT）、激光治疗、放射治疗、手术治疗、中医治疗及基因治疗。就各种治疗方法及其机制等进行综述。     

光动力疗法治疗中心性渗出性脉络膜视网膜病变疗效观察

目的 评价光动力疗法(photodynamictherapy,PDT)治疗中心性渗出性脉络膜视网膜病变(centralexudativehorioretinopathy,CEC)的临床疗效.方法 对比分析中心性渗出性脉络膜视网膜病变所致黄斑部脉络膜新生血管(choroidaineovascularization,CNV)患眼21例,治疗前与单次PDT治疗后3个月的视力、眼底、固视性质、光学相干断层扫描(optic coherence tomograph,OCT)图像及荧光素钠血管造影(fundus fluoresein angiography,FFA)、吲哚菁绿血管造影(indocyanine greenan giography,ICGA)的变化.结果 PDT治疗后3个月11只眼视力提高(52.38%),10只眼视力稳定(47.62%),其中5例由偏心固视恢复为中心固视.眼底检查可见出血渗出明显减少,部分患者完全吸收.FFA联合ICGA检查显示CNV病灶渗漏停止10只眼(47.62%),渗漏减少10只眼(47.62%);OCT检查表现为CNV缩小.组织水肿减轻.结论 PDT治疗可以部分或完全封闭中心性渗出性脉络膜视网膜病变所致的CNV,减少CNV引起的视力下降的危险性.     

经瞳孔温热疗法治疗中心性渗出性脉络膜视网膜炎的疗效观察

目的 探讨经瞳孔温热疗法(TTT)治疗中心性渗出性脉络膜视网膜炎(CEC)的临床效果.方法 对荧光素眼底血管造影(FFA)和吲哚青绿脉络膜血管造影(ICGA)检查确诊的CEC患者13例(13只眼)进行TTT治疗.采用810nm半导体激光,光斑0.8～2.0mm,照射时间60 s,能量80～260 mW,对FFA和ICGA图像所显示的脉络膜新生血管(CNV)进行照射,照射区未出现颜色变化或呈淡灰色.随访6～40周,对比分析患者治疗前后的视力、眼底、FFA和ICGA检查结果.结果 最终所有患者症状均得到改善,FFA和ICGA显示8只眼CNV缩小或闭塞,治疗后视力提高4只眼,稳定8只眼,下降1只眼.结论 TTT对CEC有较好的治疗效果.     

脉络膜新生血管经TTT治疗前后微视野变化

目的 应用微视野检查技术评价经瞳孔温热疗法（TTT）治疗脉络膜新生血管（CNV）前后的视功能变化.方法 12例13只经荧光素眼底血管造影证实有CNV的年龄相关性黄斑病变（AMD）和高度近视患眼,在接受TTT治疗前后分别行微视野检查.结果 TTT治疗前,6眼有相对暗点,7眼有绝对暗点.治疗后与治疗前相比较,6眼TTT前检出相对暗点的患眼中,治疗后视力提高者4眼,1眼视力下降,1眼视力无明显变化;6眼中5眼TTT治疗后激光照射处视网膜的光敏度提高,1眼降低.所有被检出有绝对暗点的患眼治疗后视力均无明显变化,视网膜的光敏度不变.结论 微视野检查能客观评估TTT治疗CNV的疗效.     

经瞳孔温热疗法治疗病理性近视性脉络膜新生血管的临床观察

目的:观察经瞳孔温热疗法(TTT)治疗病理性近视合并中心凹下脉络膜新生血管(CNV)的疗效.方法:采用半导体810nm红外激光对荧光素眼底血管造影(FFA)和吲哚青绿血管造影(ICGA)检查确诊的高度近视合并CNV患者15例15眼进行治疗.治疗后每月复查1次,随访1～3 mo.随访时检查视力、眼底出血和渗出吸收、CNV闭合情况.结果:15眼治疗后均无即刻视力下降或其他不适.末诊时与初诊视力相比,73.3%无变化,26.7%增加.所有病灶渗漏减少或消失,出血基本吸收,CNV部分闭塞并纤维化.OCT检查激光后CNV厚度变薄.有3例患者3眼脉络膜萎缩灶扩大,2例2眼病灶瘢痕化.结论:TTT对治疗高度近视合并CNV有一定效果,但存在病灶疤痕化及脉络膜萎缩灶较治疗前扩大的问题.     

低能量TTT联合曲安奈德球后注射治疗中心性渗出性脉络膜视网膜病变

目的: 探讨低能量经瞳孔温热疗法(transpupillary thermotherapy,TTT)联合曲安奈德(triamcinolone acetonide,TA)球后注射治疗中心性渗出性脉络膜视网膜病变(central exudative chorioretinopathy,CEC)的临床效果及安全性。方法: 对14例14眼CEC患者首先球后注射TA40mg/1mL+20g/L利多卡因0.5mL,然后于注射后1wk时再使用810nm半导体激光进行低能量TTT治疗(激光参数分别为:光斑直径0.8～3.0mm,照射时间60s,能量120～360mW),采用矫正视力、直接检眼镜、荧光素眼底血管造影(fundus fluorescein angiography,FFA)及光相干断层扫描(optical coherence tomography,OCT)来观察治疗后的效果及不良反应,随访3～12mo。结果: 治疗后视力提高者5眼(36%),无变化者8眼(57%),视力下降者1眼(7%)。12眼在治疗2wk后黄斑区出血、渗出明显减少,其中5眼在1mo后完全吸收,7眼在3mo后完全吸收,2眼眼底出现明显的黄斑瘢痕形成。治疗后3mo时,FFA检查发现CNV渗漏明显消退、减轻者7眼,无明显变化者5眼,2眼CNV扩大或渗漏增强;OCT检查发现12眼黄斑水肿均有不同程度改善,CNV强反射区域减小或者稳定,另2眼黄斑水肿加重、CNV扩大。结论: 低能量TTT联合TA球后注射对CEC有较好的治疗效果,临床上值得应用。     

Photodynamic therapy with verteporfin following transpupillary thermotherapy for CNV evolving from an initially occult to a predominantly classic form, in patients with AMD

The purpose of this paper is to evaluate photodynamic therapy (PDT) in the management of choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) that converted from occult CNV to classic CNV after treatment with transpupillary thermotherapy (TTT). One hundred and fifty-four eyes of 130 patients with symptomatic occult CNV were treated between June 2000 and August 2001. We have analyzed data from patients treated with PDT because of a conversion from occult to classic CNV after TTT. The results were that twenty-four of 154 eyes developed a predominantly classic CNV; 20 eyes of 19 consecutive patients were treated with PDT with verteporfin. The mean follow-up period was 10 months. The mean delay for retreatment with TTT was 3 months; 3 eyes initially presented a pure occult CNV, 15 a minimally classic CNV, 1 an occult CNV with pigment epithelial detachment, and 1 a large macular subretinal hemorrhage with a subfoveal focal hot spot. The average classic component within a lesion before TTT was 20%. Recurrence of classic CNV was noted in the first 3 months for 14 eyes. Visual acuity improved in 5 eyes by >/=2 lines, and in 2 eyes by 1 line; 4 of 20 eyes had stabilized visual acuity; 7 eyes had a visual acuity decline of >/=2 lines; 2 eyes lost 1 line. All patients had reduction of metamorphopsia and reduction of exudation; 14 eyes had a little subretinal fibrosis and some partially atrophic areas; 6 eyes had slightly increased leakage in the late phase of the angiogram. In conclusion, association of TTT and PDT appears to be safe and may help practitioners to manage some difficult cases. This study seems to confirm the great efficacy of PDT in CNV with recent activity.     

Photodynamic therapy with verteporfin following transpupillary thermotherapy for CNV evolving from an initially occult to a predominantly classic form,in patients with AMD

The purpose of this paper is to evaluate photodynamic therapy (PDT) in the management of choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) that converted from occult CNV to classic CNV after treatment with transpupillary thermotherapy (TTT). One hundred and fifty-four eyes of 130 patients with symptomatic occult CNV were treated between June 2000 and August 2001. We have analyzed data from patients treated with PDT because of a conversion from occult to classic CNV after TTT. The results were that twenty-four of 154 eyes developed a predominantly classic CNV; 20 eyes of 19 consecutive patients were treated with PDT with verteporfin. The mean follow-up period was 10 months. The mean delay for retreatment with TTT was 3 months; 3 eyes initially presented a pure occult CNV, 15 a minimally classic CNV, 1 an occult CNV with pigment epithelial detachment, and 1 a large macular subretinal hemorrhage with a subfoveal focal hot spot. The average classic component within a lesion before TTT was 20%. Recurrence of classic CNV was noted in the first 3 months for 14 eyes. Visual acuity improved in 5 eyes by ≥2 lines, and in 2 eyes by 1 line; 4 of 20 eyes had stabilized visual acuity; 7 eyes had a visual acuity decline of ≥2 lines; 2 eyes lost 1 line. All patients had reduction of metamorphopsia and reduction of exudation; 14 eyes had a little subretinal fibrosis and some partially atrophic areas; 6 eyes had slightly increased leakage in the late phase of the angiogram. In conclusion, association of TTT and PDT appears to be safe and may help practitioners to manage some difficult cases. This study seems to confirm the great efficacy of PDT in CNV with recent activity.     

经瞳孔温热疗法治疗中心性渗出性脉络膜视网膜炎的疗效观察

目的 探讨经瞳孔温热疗法(traspupillary thermotherapy, TTT)治疗中心性渗出性脉络膜视网膜炎(central exudative chorioretinopathy,CEC)的临床效果。 方法 对荧光素眼底血管造影(fundus fluorescein angiography,FFA)和吲哚青绿血管造影(indocyanine green angiography,ICGA)检查确诊的CEC患者的12只患眼进行TTT治疗。采用810 nm半导体激光，光斑0.5～2.0 mm，照射时间55～60 s，能量200～350 mW，对 FFA和ICGA图像所显示的脉络膜新生血管(choroidal neovascularization,CNV)进行照射，照射区未出现颜色变化或呈淡灰色。对比分析患者治疗前后的视力、眼底、FFA和ICGA检查结果。 结果 TTT治疗后0.5～3个月后所有患眼视力都有不同程度提高，视力提高5行以上者4只眼，占33.3%；3～5行者 5只眼，占41.7%；1～2行者 3只眼，占25.0%。治疗后10只眼行FFA和ICGA复查，其中FFA复查荧光素渗漏消失7只眼，减轻3只眼；ICGA复查CNV消失或明显缩小8只眼，CNV无变化2只眼。 结论 TTT治疗CEC效果良好，值得临床推广应用。 (中华眼底病杂志, 2002, 18: 187-189)     

Transpupillary thermotherapy of occult choroidal neovascularization in age-related macular degeneration

Purpose. To evaluate the efficacy of transpupillary thermotherapy (TTT) in management of occult subfoveal choroidal neovascularization (CNV) in exudative age-related macular degeneration (AMD). Methods. Retrospective chart review of eyes that were treated with TTT and had at least 12 weeks of follow-up. Base-line and final ETDRS visual acuity and fluorescein angiography (FA) were compared. Results. For the 48 eyes which met inclusion criteria, mean pre-operative visual acuity was 20/128 (range: 20/50–20/500). Average follow-up was 27 weeks (range: 12 weeks–55 weeks). At 3 months after treatment, 12 eyes (25%) improved 2 lines or more, 18 eyes (37.5%) had no change or 1 line of visual improvement, and 18 eyes (37.5%) worsened 1 or more lines. No significant adverse event was noted during treatment. Three eyes developed large submacular hemorrhage within 2 months of treatment. Based on clinical examination and FA, 61% of the eyes appeared to have reduction of subretinal fluid compared to pre-operative evaluations. Conclusion. Visual acuity was stable or improved in 62.5% of eyes in our series and the treatment was well tolerated. Longer follow up and larger number of patients would be required to evaluate the ultimate benefit of TTT in management of occult CNV due to AMD.     

Transpupillary thermotherapy of occult choroidal neovascularization in age-related macular degeneration

PURPOSE: To evaluate the efficacy of transpupillary thermotherapy (TTT) in management of occult subfoveal choroidal neovascularization (CNV) in exudative age-related macular degeneration (AMD). METHODS: Retrospective chart review of eyes that were treated with TTT and had at least 12 weeks of follow-up. Base-line and final ETDRS visual acuity and fluorescein angiography (FA) were compared. RESULTS: For the 48 eyes which met inclusion criteria, mean pre-operative visual acuity was 20/128 (range: 20/50-20/500). Average follow-up was 27 weeks (range: 12 weeks-55 weeks). At 3 months after treatment, 12 eyes (25%) improved 2 lines or more, 18 eyes (37.5%) had no change or 1 line of visual improvement, and 18 eyes (37.5%) worsened 1 or more lines. No significant adverse event was noted during treatment. Three eyes developed large submacular hemorrhage within 2 months of treatment. Based on clinical examination and FA, 61% of the eyes appeared to have reduction of subretinal fluid compared to pre-operative evaluations. CONCLUSION: Visual acuity was stable or improved in 62.5% of eyes in our series and the treatment was well tolerated. Longer follow up and larger number of patients would be required to evaluate the ultimate benefit of TTT in management of occult CNV due to AMD.     

Low power transpupillary thermotherapy of choroidal neovascularization

PURPOSE: To assess the effectiveness of low power transpupillary thermotherapy (TTT) for choroidal neovascularization (CNV). METHOD: We performed TTT on 55 eyes of 55 patients with subretinal CNV between April 2001 and December 2002, and observed them after therapy for more than 6 months. The laser power ranged from 80 to 320 mW when the spot size was 3 mm. We evaluated visual acuity, subretinal fluid (SRF), and CNV size. RESULTS: Visual acuity improved by 2 lines or more in 16 eyes (29%), was unchanged in 19 eyes (35%), and decreased in 20 eyes (36%). SRF decreased in 30 eyes (54%), was unchanged in 13 eyes (24%), and increased in 12 eyes (22%). CNV diminished in 33 eyes (60%), was unchanged in 10 eyes (18%), and became enlarged in 12 eyes (22%). CONCLUSIONS: Low power TTT can be an effective treatment for subgroups of patients with subfoveal CNV.