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.     

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.     

A prospective study of visual function and quality of life following PDT in patients with wet age related macular degeneration

AIMS: (1) A prospective study to assess visual function measures and quality of life (QoL) in patients with wet age related macular degeneration (AMD) treated with photodynamic therapy (PDT). (2) To assess if PDT prevents severe visual loss (loss of six or more lines of distance visual acuity) in the treated eye. METHODS: 48 of 51 recruited patients with predominantly classic subfoveal choroidal neovascularisation (CNV) secondary AMD who were treated with PDT were followed up for 1 year. Assessment included distance and near visual acuity, contrast sensitivity, vision related quality of life and fluorescein angiography. Photodynamic therapy using Visudyne was carried out according to standard protocol. Patients were followed up every 3 months and treatment repeated if there was significant leakage from CNV. RESULTS: At the 12 month follow up, 71% (n = 34) of the patients lost less than three lines of best corrected distance visual acuity. Although there were significant decreases in some of the QoL items tested, patients were significantly less anxious and more independent outdoors at the 12 month follow up. CONCLUSION: This study is in keeping with published literature with PDT preventing severe visual loss in two thirds of treated patients with predominantly classic CNV.     

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)     

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…     

光动力疗法治疗渗出型老年性黄斑变性的初步报告

目的 观察单次光动力治疗(photodynamic therapy,PDT)对渗出型老年性黄斑变性(age-related macular degeneration,AMD)脉络膜新生血管(choroidal neovascularization,CNV)的近期治疗效果。 方法 回顾分析经荧光素眼底血管造影(fundus fluorescein angiography, FFA)、吲哚青绿脉络膜血管造影(indocyanine green angiography, ICGA)以及光学相干断层扫描(optic coherence tomography,OCT)检查确诊的5例渗出型AMD患者的7只患眼行PDT治疗前及治疗后随访观察1周和1个月时的临床资料,主要以视力、FFA及(或)ICGA、OCT的改变为观察指标,评价PDT对渗出型AMD的治疗效果。 结果 7只患眼在治疗后1个月视力均无下降。治疗后1周时除1只眼在ICGA后期仍可观察到CNV有轻微渗漏外,其余6只眼FFA及(或)ICGA均显示CNV渗漏停止;OCT检查显示CNV有不同程度缩小,CNV周围视网膜脉络膜水肿及神经上皮脱离明显好转。但在治疗后1个月时观察到有2只眼在原渗漏病灶处又有渗漏灶出现。 结论PDT 治疗可以在短期内封闭AMD的CNV,使其停止渗漏,且不影响视力。(中华眼底病杂志,2000,16:213-216)     

Photodynamic therapy with delayed light application for the treatment of bilateral subfoveal choroidal neovascularization in age-related macular degeneration

PURPOSE: To determine if photodynamic therapy (PDT) with delayed light application at 17 minutes after the start of infusion was effective in the second eyes of patients with bilateral subfoveal classic choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: The records of 20 patients with bilateral subfoveal classic CNV secondary to AMD who were treated with bilateral PDT in the same session were reviewed. Treatment for the second eye of patients was begun 120 seconds after termination of treatment for the first eye. This time interval was necessary for applying the contact lens and entering the new laser parameters, and it was kept constant in all cases. Best-corrected visual acuity (BCVA), ophthalmologic examinations, fluorescein and indocyanine angiograms were used to evaluate the results of PDT. Follow-up time ranged from 6 to 12 months with a mean of 8.7 (+/-2.1) months. RESULTS: Mean (+/-SD) treatment sessions were 1.7 (+/-0.6) in first eyes and 1.7 (+/-0.5) in second eyes. Among first eyes, BCVA improved in 7 of the 20 eyes (35%); stabilized in 7 eyes (35%); and worsened in 6 eyes (30%). Among second eyes, BCVA improved in 5 of the 20 eyes (25%); stabilized in 8 eyes (40%); and worsened in 7 eyes (35%). CONCLUSIONS: In most cases, bilateral PDT in the same session achieved cessation of fluorescein leakage from CNV without loss of vision or growth of CNV in the second eyes of patients with bilateral subfoveal classic CNV secondary to AMD. Further studies with a larger number of patients and longer follow-up are necessary to confirm whether bilateral PDT in the same session is beneficial for bilateral subfoveal classic CNV related to AMD.     

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）     

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.     

Photodynamic therapy

Photodynamic therapy with Verteporfine (Visudyne Novartis Ophthalmics) achieves a photo occlusion of subfoveal choroidal neovascularization (CNV) resulting from age-related macular degeneration (AMD) in phase 1 and 2 studies. Thereafter, two international randomized clinical trials evaluated the product's efficacy in term of visual acuity. Eyes with neovascular lesions due to AMD of less than 5,400 micro, in size involving the fovea and presenting well-defined CNV on fluorescein angiography could be included when visual acuity was between 5 and 1/10. Six hundred and nine patients were subsequently randomized either to Verteporfine or to placebo (proportion 2:1). A follow-up of 3 months made it possible to consider retreatment when a fluorescein leakage was observed. Functional and angiographic results demonstrated the efficacy of PDT with Verteporfine in comparison with placebo at each examination during follow-up. A visual acuity decrease of less than 15 letters on ETDRS (or 3 lines or approximately 1.5/10) occured less frequently in the treated group with PDT (61% out of 402 treated eyes compared with 46% of 207 placebo eyes). Subgroup analysis of predominantly well-defined CNV (involving 50% or more of the total of the exsudative lesion) showed even more favourable effects (67% of treated eyes versus 39% of placebo eyes). Conversely, when well-defined CNV extended to a smaller area, the results were not significant. The most frequent side effect was Verteporfine extravasation at the injection site. As dynamic phototherapy with Verteporfine limits the decrease in visual acuity always occurring in the natural history of CNV caused by AMD, it is desirable that patients presenting subfoveal predominantly well-defined lesions benefit from this new treatment approach.     

光动力疗法治疗老年黄斑变性临床初步观察

目的　观察应用光动力疗法 (photodynam ic therapy,PDT )单次治疗渗出型年龄相关性黄斑变性 (age- related m acu-lar degeneration,A MD )并发脉络膜新生血管 (choroidal neovascularization,CN V )的近期治疗效果。方法　以眼底检查、视力、眼底荧光血管造影 (FFA)、吲哚青绿脉络膜血管造影 (ICG)和光学相干断层成像技术 (O CT)等影像学检查为观察指标 ,总结PDT治疗 15例 16眼 A MD合并的典型 CNV后 1周和 1个月随访的短期治疗效果 ,从而评价 PDT治疗 CNV的安全性和短期治疗效果。结果　治疗后 1周和 1个月分别有 6眼和 10眼视力不同程度提高 ,1眼因新出血视力略有下降 ,无证据表明与治疗有关。 15例 16眼治疗后荧光渗漏均有不同程度的减弱或消退 ,其中 7例 8眼渗漏完全消退 ,1月后复查无复发 ;其余 8例8眼荧光渗漏明显减轻。全部 15例治疗过程中未发生任何不良反应 ;仅 3例治疗后主述有一过性轻度视力紊乱。结论　光动力疗法单次治疗渗出型年龄相关性黄斑部变性并发的脉络膜新生血管膜短期疗效满意、安全 ,对视力无损害。     

Chorioretinal anastomosis as unfavourable prognostic factor during photodynamic therapy

BACKGROUND: The aim of this study was the documentation of chorioretinal anastomosis in neovascular age-related macular degeneration (AMD) and correlation with functional and angiographic results following photodynamic therapy (PDT). METHOD: A total of 100 patients presenting with neovascular AMD and indication for PDT based on the presence of predominantly classic choroidal neovascularization (CNV), underwent ophthalmoscopic and angiographic screening for chorioretinal anastomosis. Conventional PDT using verteporfin was performed according to the recommended standard procedure.The pre- and post-treatment status at 3 and 6 months post-PDT in all patients and at 1 week in selected patients was documented with respect to the central visual acuity test (ETDRS), ophthalmoscopy as well as fluorescein (FA) and indocyanine green angiography (ICGA). RESULTS: A primary chorioretinal anastomosis was found in 6% ( n=12) of all eyes with CNV and classic PDT indication. Mean visual loss within the first 6 months after therapy was 3 lines indicating lack of visual stabilization according to the PDT study criteria.Furthermore, an increase in visual acuity could not be documented in any case.Angiography demonstrated continuous progression of CNV size although PDT had been uneventful. The characteristic initial occlusion of the CNV with homogeneous hypofluorescence was absent angiographically at 1 week post-PDT.The anastomosis was detected by ICGA in all eyes and by ophthalmoscopy or optical coherence tomography (OCT) in most eyes. DISCUSSION: Chorioretinal anastomosis is not a rare finding associated with predominantly classic CNV.The presence of anastomosis appears to be an unfavourable prognostic factor during PDT. If a chorioretinal shunt is suspected evaluation by ICGA and/or OCT should be performed and the indication for PDT should be rediscussed.     

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。     

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。     

Outcomes in verteporfin photodynamic therapy for choroidal neovascularisation--'beyond the TAP study'

AIMS: To report on the clinical efficacy of verteporfin photodynamic therapy (PDT) in the treatment of choroidal neovascularisation (CNV) in an NHS setting and to compare treatment rates and outcomes with those in the published literature. PATIENTS AND METHODS: Patients with a visual acuity of 6/60 or better Snellen equivalent and predominantly classic or classic/no occult CNV within 200 microm of the centre of the fovea were enrolled and followed for a minimum of 12 months. Assessment at baseline and all follow-up visits comprised refraction protocol logMAR visual acuity, contrast sensitivity, and stereoscopic fluorescein angiography. RESULTS: A total of 170 eyes of 159 patients were enrolled with CNV due to: 147 age-related macular degeneration (AMD) (90 classic/no occult, 21 recurrent after confluent laser, 36 predominantly classic with occult), 10 pathological myopia, and 13 others. Response to treatment (loss of < 15 letters) at 12 months was 73% overall, 76% in AMD, 70% in classic/no occult, and 89% in predominantly classic. The mean number of treatments in the first year was 2.7. Contrast sensitivity was unchanged. CONCLUSIONS: Verteporfin PDT delivered in a NHS setting can be at least as effective as and requires fewer treatments than reported in the literature.     

光动力学治疗脉络膜新生血管的临床观察

目的观察光动力学治疗继发于不同病因的黄斑中心凹下或中心凹旁脉络膜新生血管的疗效和安全性。方法回顾16例16眼经荧光血管造影、吲哚青绿造影证实活动性脉络膜新生血管,继发于老年性黄斑变性4眼,病理性近视6眼和中心性渗出性脉络膜视网膜病变6眼。比较PDT治疗前后最佳矫正视力,散瞳前置镜眼底检查以及荧光血管造影和脉络膜血管造影的资料。典型性为主型CNV14眼,轻微典型性CNV1眼,隐匿性CNV1眼。CNV位于黄斑中心凹下12眼,黄斑中心凹旁4眼。光动力学治疗方案参照TAP制定的标准。结果随访时间:1~14个月,平均(5±4.28)个月。1次治疗14眼,重复治疗2次1眼,3次1眼。最终患眼视力提高8眼,保持不变8眼。FFA检查示CNV渗漏停止1眼,渗漏减少10眼,渗漏无明显减少5眼,渗漏面积较治疗前明显缩小(P<0.05)。CNV复发3眼。仅1例在输液时发生光敏剂渗漏,但未发生光敏反应。治疗后视网膜一过性出血增加3眼。结论光动力学治疗为继发于不同病因的黄斑中心凹下或中心凹旁CNV患者提供一种安全有效的治疗选择。部分患者治疗后短时间内复发,PDT治疗CNV的长期疗效有待进一步观察。     

光动力疗法治疗老年性黄斑变性的临床研究

目的
观察光动力疗法(photodynamic therapy,PDT)对渗出型老年性黄斑变性(age-related macular degeneration,AMD)脉络膜新生血管(choroidal neovascularization,CNV)进行单次和多次治疗的临床疗效。
方法
20例经双目间接立体检眼镜、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)检查确诊的AMD患者的31只患眼纳入治疗。患者年龄47～88岁，平均年龄68.1岁，最佳矫正视力在数指/10 cm～0.6之间。光敏剂苯并卟啉衍生物单酸(benzoporphyrin derivative mono acid, BPD)(中国诺华公司)6 mg／m 2静脉滴注10 min，开始静脉用药后15 min，通过裂隙灯用强度为50 J／cm2的689 nm激光(德国Zeiss公司)照射83 s。治疗后患者尽可能避光48 h。治疗后2周开始复查，每3个月随访1次，随访时间最短3个月，最长18个月，平均随访12个月。FFA和(或)ICGA显示病灶范围扩大、或渗漏增加，即进行重复PDT治疗。其中1只眼进行了4次治疗, 4只眼进行了2次治疗，其余26只眼均只进行了1次治疗。
结果
治疗后13只眼视力明显改善(视力提高≥2行)，占41.9%；17只眼视力稳定不变(视力波动在1行以内)，占54.8%；1只眼视力下降2行，占3.2%。所有患眼于PDT治疗后眼底出血和渗出均减轻；FFA或FFA+ICGA检查显示：PDT治疗后2周，CNV的渗漏明显减少或完全停止，复发或扩大的CNV经多次PDT治疗后，渗漏逐渐减少，3例5只眼渗漏完全停止。光相干断层成像术(optic coherence tomography, OCT)检查显示CNV周围视网膜脉络膜的水肿以及神经上皮脱离、色素上皮脱离明显好转。20例患者在PDT治疗过程中及治疗后未发生任何全身和局部不良反应。
结论
单次和重复PDT治疗可以部分或完全封闭AMD 的CNV，多次PDT治疗可以封闭CNV，降低AMD引起视力下降的危险性。PDT治疗不影响病灶周围的正常视网膜和脉络膜组织，对视力无损害。
(中华眼底病杂志, 2002, 18: 175-179)     

Variable outcome of photodynamic therapy for choroidal neovascularization associated with choroidal nevus

PURPOSE: To report five cases of classic choroidal neovascularization (CNV) associated with choroidal nevus treated with photodynamic therapy (PDT) with verteporfin. METHODS: The patients underwent an ophthalmologic evaluation, including fluorescein angiography and indocyanine green angiography. Clinical and angiographic data were retrospectively analyzed to evaluate visual acuity outcomes and both clinical evolution and angiographic evolution. RESULTS: Two patients presented with subfoveal CNV, and three had juxtafoveal CNV. The mean follow-up was 25.8 months. Visual outcomes were extremely variable. Indeed, best-corrected visual acuity decreased in three eyes, stabilized in one case, and improved in the other case. The number of PDT sessions necessary to obtain CNV stabilization with cessation of fluorescein leakage varied from one to six. CONCLUSION: Bearing in mind that both the natural history and the post-PDT outcome may be extremely variable, further studies are needed to assess the real benefit of PDT for classic CNV secondary to choroidal nevus.     

光动力疗法治疗渗出性年龄相关性黄斑变性

目的观察光动力疗法(photodynamic therapy,PDT)治疗渗出性年龄相关性黄斑变性(age-related macular degeneration,AMD)的疗效。方法回顾分析经荧光素眼底血管造影(fundus fluorescein angiography,FFA)、吲哚菁绿血管造影(indocyanine green angiography,ICGA)以及光学相干断层扫描(optical coherence tomography,OCT)检查确诊的21例(31眼)渗出性AMD患者PDT治疗前及治疗后的临床资料,主要以视力、FFA及(或)ICGA、OCT的改变为观察指标,评价PDT对渗出性AMD的治疗效果。结果治疗后13眼视力明显改善(视力提高≥2行),占41.9%;14眼视力稳定不变(视力波动在1行以内),占45.2%;4眼视力下降2行,占12.9%。大部分患眼于PDT治疗后眼底出血和渗出减轻;ICGA检查显示:PDT治疗后1周,16眼CNV的渗漏明显减少或完全停止,8眼渗漏完全停止。OCT检查显示:CNV周围视网膜脉络膜水肿以及神经上皮脱离好转。5例6眼患者在PDT治疗过程中及治疗后发生视网膜神经上皮脱离范围变大,1例1眼发生黄斑部再次大面积出血,所有病例均未发生任何全身不良反应。结论单次和重复PDT治疗可以部分或完全封闭渗出性AMD的CNV,PDT治疗对病灶周围的正常视网膜和脉络膜组织短期内有轻度影响,对视力无损害。     

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.