经瞳孔温热疗法治疗渗出型老年性黄斑变性的临床疗效观察

目的
评价经瞳孔温热疗法(transpupillary thermotherapy,TTT)治疗渗出型老年性黄斑变性（age-related macular degeneration, AMD）的临床疗效。
方法
回顾分析62例确诊为AMD的患者的62只患眼TTT治疗的临床资料。62例AMD患眼中，行荧光素眼底血管造影(fundus fluorescein angiography，FFA)检查者58例，吲哚青绿血管造影(indocyanine green angiography ,ICGA)检查者42例，光相干断层成像术(optic coherence tomography, OCT)检查者56例。激光治疗机波长为810 nm，光斑0.5～3.0 mm,能量60～400 mW,照射时间60 s。62例患者治疗后随访观察1～10个月，平均随访观察时间4.8个月，分析末次随访视力与治疗前视力以及OCT复查资料。
结果
视力不变者43例，占69.4%；进步者15例，占24.2%；下降者4例，占6.5%。51例OCT复查者中，黄斑水肿不变者29例，占56.96%；好转者18例，占38.3%；恶化者4例，占7.8%。视力改善与OCT黄斑水肿的形态改善相一致者38只眼，占OCT检查者的74.5%；视力改善滞后于黄斑水肿形态改善者13只眼，占25.5%。再次行TTT治疗者18只眼，占接受TTT治疗者的29.0%。治疗随访期间无明显治疗副作用。
结论
TTT治疗能使大部分渗出性AMD患眼视力稳定或提高，使用安全，但激光治疗参数尚需进一步探索。
(中华眼底病杂志, 2002, 18: 180-183)     

经瞳孔温热疗法治疗年龄相关性黄斑变性

经瞳孔温热疗法(TTT)是近年来应用于脉络膜新生血管(CNV)治疗的一种新方法。本文对12例12眼AMD患者行TTT后的近期疗效作初步分析。     

经瞳孔温热疗法治疗年龄相关性黄斑变性

年龄相关性黄斑变性（AMD）是老年人致盲的常见原因。根据其临床表现可分为干性和湿性。湿性AMD以视网膜色素上皮（RPE）下有活跃的脉络膜新生血管（CNV）为主要特征，而引起视力下降的主要原因是CNV引起的黄斑区反复出血、渗出、瘢痕改变，视力预后极差。经瞳孔温热疗法（TTT）是一种治疗继发于AMD的CNV的较新方法，采用直径可调节的大光斑，穿透深的激光连续照射，使靶组织缓慢升温，在消除CNV病灶的同时又相对保存病变表面视网膜的结构和功能。就TTT治疗AMD的应用发展、特点、临床疗效、治疗方法以及可能出现的并发症等作一综述。     

玻璃体腔注射Ranibizumab联合经瞳孔温热疗法治疗年龄相关性黄斑变性

目的：观察玻璃体腔注射Ranibizumab联合经瞳孔温热疗法( TTT)治疗渗出型年龄相关性黄斑变性的临床疗效及安全性。方法：选取来我院就诊并通过病史、临床症状及眼底血管照影(FFA/ICGA)和光学相干断层扫描(OCT)等辅助检查确诊的渗出型年龄相关性黄斑变性的患者160例(160眼),随机分为联合组和对照组,联合组给予单次行玻璃体腔注射Ranibizumab,7d后行TTT治疗,对照组仅行TTT治疗,随访1a,分别于治疗后1wk;1,6mo;1a,观察患者的最佳矫正视力、散瞳后眼底的变化及眼底血管照影( FFA/ICGA)及OCT的检查。
　　结果：观察期末,联合组最佳矫正视力提高34例(42.50%),对照组最佳矫正视力提高16例(20.00%),差异具有统计学意义(P<0.05)。治疗后1wk;1,6mo;1a联合组和对照组的荧光渗透有效率分别为(88.75%,62.50%);(91.25%,65.00%);(86.25%,61.25%);(78.75%,51.25%)。治疗后1 wk;1,6 mo;1 a联合组和对照组黄斑中心厚度分别为：(347.43±36.96)μm 和(423.58±29.03)μm;(287.78±34.16)μm和(387.14±32.98)μm;(301.75±37.21)μm和(415.40±31.38)μm;(326.17±27.39)μm 和(436.44±35.49)μm,两组相比,差异具有统计学意义(P<0.05)。结论：玻璃体腔注射Ranibizumab联合经瞳孔温热疗法治疗渗出型年龄相关性黄斑变性,能够使患者的视力得到改善,病灶渗漏停止或减轻,促进黄斑区出血、水肿及渗出的吸收,安全、疗效可靠,是一种有效的临床治疗方法。     

老年性黄斑变性的经瞳孔温热治疗

经瞳孔温热治疗（transpupillary thermotherapy，TTT）作为一种治疗眼底病的新方法已日益发挥出其独特的作用，根据其能使脉络膜新生血管闭塞的作用，近年来用于老年黄斑变性（age-related macular degeneration，AMD）的治疗，并取得可喜进展。现介绍TTT的历史发展、原理以及在AMD治疗中的临床应用现状及前景。     

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。     

经瞳孔温热疗法治疗湿性年龄相关性黄斑变性的参数研究

目的评价三种不同参数的经瞳孔温热疗法(transpupillarythermotherapy,TTT)治疗湿性年龄相关性黄斑变性(age-relatedmaculardegeneration,ARMD)的疗效。方法2002年4月～2005年1月在我科确诊为ARMD渗出型患者24例32眼,男性17例25眼,女性7例7眼,年龄47～84岁(平均67.96岁)。其中17位患者(隐匿性CNV9眼、典型性及典型性为主型10眼)接受TTT治疗,按采取的能量参数分为100%能量组(7眼)、80%能量组(5眼)、70%能量组(7眼),其余7例13眼不接受任何治疗手段的患者作为无治疗组列为观察对象。术后对眼底改变、视力、眼底血管造影复查,随访6～37个月(平均21.65个月)观察疗效并进行统计分析。结果至末次复查时所有接受TTT治疗的19只患眼的出血、水肿、渗出消失、病灶斑痕化。100%能量组,80%能量组以及70%能量组视力提高的患眼比例相比较,均无统计学显著差异(分别为p=0.523,p=1.000,p=1.000)。治疗组(包括100%能量组,80%能量组以及70%能量组)与无治疗组视力下降的患眼比例相比较,有统计学显著差异(p=0.002)。治疗组与无治疗组视力提高的患眼比例相比较,无统计学显著差异(p=0.361)。结论TTT对隐匿型和经典型CNV均有稳定患眼视力的作用。目前选择该研究中80%能量组的参数,可以在安全性和有效性上得到进一步完善,仍有待更多病例的证实。     

经瞳孔温热疗法治疗老年黄斑变性合并脉络膜新生血管

目的观察经瞳孔温热疗法（TTT）治疗老年性黄斑变性（AMD）合并脉络膜新生血管（CNV）的疗效。方法应用810nin半导体激光，对52例（58只眼）经荧光素眼底血管造影（FFA）和吲哚青绿脉络膜血管造影（ICGA）确诊的AMD合并黄斑区CNV患者进行TIT治疗。激光功率130～160mW／mm光斑直径。根据视力、视网膜出血和CNV渗漏变化作为疗效评定标准，随访3～18个月。结果末次随访矫正视力提高1〉2行者19只眼（32．7％），不变30只眼（51．7％），下降〉12行者9只眼（15．5％）；其中视力〉0．3者8只眼（13．7％），0．1～0．3者15只眼（25．8％），〈0．1者35只眼（60．3％）。所有患者治疗过程中无不适反应，有3例（3只眼）病灶处视网膜可见轻微发灰，中心视力下降2～3行，2个月后完全恢复。1周时2例（2只眼）出血增加，2～3个月时2例（2只眼）出现视网膜色素上皮撕裂。末诊时9只眼（17．3％）机化瘢痕形成或增厚；22只眼视网膜出血中完全吸收18只眼（81．8％）；6只眼（10．3％）出现新出血。FFA和ICGA复查，CNV闭合荧光渗漏消失或减轻40只眼（76．9％）；加重5只眼（9．6％）；新出现3只眼（5．8％）。结论TIT是治疗AMD合并CNV的一种安全、有效、价格相对便宜的方法，早期诊断、治疗CNV对提高和保存有用视力意义重大，目前更适合国内应用。     

经瞳孔温热疗法治疗老年黄斑变性所致黄斑中心凹下脉络膜新生血管的长期观察

目的:评价经瞳孔温热疗法(TTT)治疗年龄相关性黄斑变性(AMD)所致黄斑中心凹下脉络膜新生血管(CNV)的长期疗效。方法:AMD所致黄斑中心凹下脉络膜新生血管14例14眼。平均年龄67.1岁。记录详尽的眼科检查结果,拍摄彩色眼底相,并行黄斑部光学相干断层成像(OCT)检查。在初诊及随后的复诊中行眼底荧光素血管造影和吲哚青绿血管造影。TTT的治疗参数为:时间1min,光斑大小2 ~3mm,激光能量650 ~800mW。随诊时间5 ~64mo,平均28.6mo。结果:在14眼中,典型性CNV有10眼,典型为主性有2眼,1眼为少量典型性,1型隐匿性CNV有1眼。共4例患者出现治疗后出血,均在短期内吸收。有1眼在治疗后立刻出现了黄斑无灌注区。多数患眼在随诊中可见渗出逐渐减少。在平均28.6mo的随诊中,14只患眼,有5眼视力提高,8眼保持稳定,1眼视力下降。结论:经瞳孔温热疗法在AMD患者中能封闭黄斑中心凹下的CNV,促进网膜下积液的迅速吸收,从而稳定患者的视力。它可以作为一种治疗典型和典型为主性黄斑中心凹下脉络膜新生血管的激光治疗手段。     

Visual function following transpupillary thermotherapy with adjusted laser parameters for the treatment of exudative age-related macular degeneration: a pilot study

PURPOSE: To evaluate the efficacy of transpupillary thermotherapy (TTT) using adjusted laser parameters for the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration. METHODS: TTT was performed on patients with CNV using a diode laser (810 nm) for 60 s in a subthreshold manner. Power settings were varied between 460 and 1200 mW, depending on lesion size, presence of pigment epithelial detachment and the amount of fundal pigmentation and subretinal fluid. LogMAR visual acuity, contrast sensitivity (Pelli-Robson) and metamorphopsia (Amsler chart) were assessed prior to and 6 months following treatment. Subjects also self-administered the National Eye Institute 25-Item Visual Function Questionnaire. RESULTS: Thirty occult/minimally classic and eight predominantly classic membranes were treated with TTT. At 6 months, absence or significant reduction of fluorescein leakage was observed in 20 (53%) patients. Stabilization of vision (loss of less than 15 letters) was observed in 25/30 (83%) eyes with occult/minimally classic CNV and 5/8 (63%) eyes with predominantly classic CNV. Improvement of contrast sensitivity was noted in 15 (35%) eyes, in 10 (26%) eyes it remained unchanged and in 13 (34%) eyes it deteriorated. There was no statistically significant effect of TTT on the National Eye Institute 25-Item Visual Function Questionnaire composite or subscale scores. CONCLUSIONS: TTT using adjusted parameters depending on fundal characteristics appears to be effective in stabilizing subjective and objective visual ability in a considerable number of patients with subfoveal CNV due to age-related macular degeneration. Larger-scale studies are required to confirm the benefit of this technique as opposed to the natural history of occult CNV.     

Long-term efficacy of transpupillary thermotherapy for subfoveal choroidal neovascularization in age-related macular degeneration

AIM: To determine the long-term efficacy of transpupillary thermotherapy (TTT) in the treatment of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD). METHODS: Fourteen eyes of 14 patients with subfoveal CNV secondary to AMD were treated with diode laser (810nm) TTT. The mean age was 67.1 years. Complete ophthalmic examination was done, color fundus photographs and macular optical coherence tomography scans were taken, fluorescein and indocyanine green angiography were performed during initial and at subsequent follow-up examinations. Treatment was given in one minute using 2-3mm spot sizes, and laser power settings were between 650-800mW. The follow-up period was between 5 and 64 months and the mean was 28.6 months. RESULTS: There was subfoveal classic CNV in 10, predominantly classic CNV in 2, minimally classic CNV in 1, and type 1 occult CNV in one of the fourteen eyes. Four patients were noted to have post-treatment hemorrhage which was absorbed in a short time. Macular non-perfusion occurred in one patient immediately after treatment. Most of the eyes demonstrated a decrease in exudation during the follow-up. With a mean follow-up of 28.6 months, visual acuity improved in 5, remained the same in 8 and decreased in 1 of the 14 eyes. CONCLUSION: Transpupillary thermotherapy is shown to close subfoveal CNV with rapid resolution of subretinal fluid while maintaining visual function in patients with AMD. It may be performed as an alternative laser treatment in classic and predominantly classic subfoveal choroidal neovascularization due to AMD.     

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.     

Comparison of photodynamic therapy and transpupillary thermotherapy for subfoveal choroidal neovascularization due to age-related macular degeneration

BACKGROUND: The purpose of this study was to compare photodynamic therapy (PDT) against subthreshold transpupillary thermotherapy (TTT) with a diode laser for subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD). METHODS: Patients with subfoveal choroidal neovascularization secondary to AMD were offered PDT as an initial intervention. If they declined PDT, then TTT was offered. RESULTS: We evaluated and followed 115 consecutive patients for an average of 1 year. The primary outcome measure was visual acuity, but the interventions were also compared on the basis of lesion size and angiographically determined lesion activity. Baseline comparisons between the 2 treatment groups showed significant differences in pretreatment visual acuity, lesion size, and lesion composition. Univariate analysis of outcomes demonstrated equivalence between the treatment groups in final lesion size, angiographic activity, and visual acuity. Multivariate analysis also demonstrated equivalence between the treatment groups in final visual acuity while controlling for age, pretreatment visual acuity, and lesion category. Predominantly classic lesions were associated with poorer visual outcomes. INTERPRETATION: The PDT and TTT groups were equivalent in terms of all outcome parameters evaluated.     

康柏西普治疗渗出性年龄相关性黄斑变性的临床观察

目的:分析康柏西普治疗渗出性年龄相关性黄斑变性(age-related macular degeneration,ARMD)的临床疗效.方法:选择2016-01/2017-01我院眼科收治的渗出性ARMD患者21例21眼为研究对象,所有患者均行玻璃体腔内注射康柏西普0.05mL(0.5mg).术后随访3mo,观察术前、术后1wk,1、3mo最佳矫正视力(best corrected visual acuity,BCVA)和黄斑中心凹视网膜厚度(central macular thickness,CMT)的变化.结果:术前和术后1wk,1、3mo患者BCVA分别为0.9±1.4、0.7±1.2、0.5±1.1、0.4±0.9.手术前后患者BCVA具有时间差异性(F=49.12,P<0.001).术后1wk,1mo分别与术前比较差异均无统计学意义(P>0.05);术后3 mo与术前比较,差异有统计学意义(P<0.05).术后3mo,视力改善19眼,视力不变2眼.术前、术后1wk,1、3 mo患者CMT分别为404.25±68.76、354.25±43.12、271.75±32.30、218.30±24.70μm.手术前后患者CMT具有时间差异性(F=2487.45,P<0.001).术后1wk,1、3 mo分别与术前比较,差异均有统计学意义(P<0.001).未发现与药物有关的全身不良反应及眼部并发症.结论:玻璃体腔内注射康柏西普治疗渗出性ARMD疗效显著.