经瞳孔温热疗法治疗限局性脉络膜血管瘤

限局性脉络膜血管瘤是位于眼底后极部的相当少见的错构性血管瘤 ,常因并发浆液性视网膜脱离或肿瘤位于中心凹下及黄斑囊样水肿而使视力下降。于 1 996年 6月至 1 997年 7月 ,对并发浆液性视网膜脱离并引起视力下降的 8例限局性脉络膜血管瘤 ,由同一眼科医师进行了经瞳孔温热疗法 (ｔｒａｎｓｐｕｐｉｌｌａｒｙｔｈｅｒｍｏｔｈｅｒａｐｙ ,ＴＴＴ)治疗。所用激光种类为红外二级管激光 ,波长为 81 0ｎｍ ,光斑直径为 1 2ｎｍ、2 0ｎｍ和3 0ｎｍ ,激光输出系统与裂隙灯相匹配。治疗前点扩瞳剂及表面麻醉剂 ,光斑直径依据脉络膜血管瘤的大小…     

经瞳孔温热疗法治疗三种眼底良性肿瘤

目的 观察经瞳孔温热疗法（TTT）治疗三种眼内良性肿瘤的疗效。 方法 通过最佳矫正视力、眼压、视野、眼前节和眼底检查以及彩色眼底照相、荧光素钠和吲哚青绿血管造影、B型超声、光相干断层扫描（OCT）、CT等检查确诊的眼内良性肿瘤患者17例20只眼。男12例，女5例，右眼8只，左眼12只。其中，视盘血管瘤3例3只眼，平均视力为0.17，2只眼曾行手术放液;脉络膜血管瘤9例9只眼，平均视力为0.39，其中4例为首诊病例，5只眼曾做过激光光凝治疗，肿瘤未全平复，尚有浆液性视网膜脱离;脉络膜骨瘤5例8只眼，平均视力为0.20，其中3只眼合并黄斑出血。TTT用810 nm半导体红外激光，光斑3.0 mm，按肿物大小连接照射1～5个光斑。功率360～1200 mW，时间60～80 s。1～3次为1疗程，2次治疗之间间隔时间1个月;需要时再作1疗程治疗。治疗后定期随访观察，时间为3～36个月，平均随访时间14.5个月。 结果 随访结束时平均视力，视盘血管瘤患者为0.27，脉络膜血管瘤患者为0.46，脉络膜骨瘤患者为0.31。视盘血管瘤3只眼瘤体的红色部位缩小，表面纡曲扩张的血管变平直，视盘周围出现脉络膜萎缩弧，视网膜下浆液性渗出消失。脉络膜血管瘤9只眼瘤体透红光区消失，视网膜下积液消退，治疗区色素增生。脉络膜骨瘤8只眼中视网膜下积液吸收，肿瘤颜色由黄红变为黄白，并出现色素和薄的瘢痕，合并黄斑出血者出血消失。所有患眼治疗后未出现严重并发征。 结论 TTT治疗视盘血管瘤、脉络膜血管瘤和脉络膜骨瘤，无论首次接受治疗或补充以前治疗均获一定效果。 (中华眼底病杂志, 2006, 22:181-184)     

经瞳孔温热疗法治疗孤立性脉络膜血管瘤一例

脉络膜血管留是在先天血管发育不良基础上发展的良性肿瘤，可孤立出现于眼底后极部，或弥漫侵入大部分脉络膜，其治疗方法包括微波治疗、外放射治疗、激光光凝等。最近，我院采用经瞳孔温热疗法（rtanspupillary thermotherapy,TTT)成功治疗1例孤立性脉络膜血管瘤，现报告如下。     

二极管激光在治疗视网膜新生血管中的应用

目的 观察二极管激光在治疗视网膜新生血管伴有屈光间质浑浊中的光凝效果。方法 ５６例（６４眼）中糖尿病性视网膜病变２２例,视网膜静脉阻塞２０例,视网膜静脉周围炎１４例。４２眼伴有不同程度的晶状体、玻璃体浑浊,但能见眼底。治疗前常规行荧光素眼底血管造影。行全视网膜光凝或病变区限局性播散性光凝,一般做１～５次。有１０眼玻璃体浑浊重或伴有视网膜脱离术前无法光凝者在玻璃体视网膜手术的术中进行光凝。结果 光凝     

光动力疗法治疗孤立性脉络膜血管瘤临床疗效观察

目的 评价光动力疗法(PDT)治疗孤立性脉络膜血管瘤的临床效果.方法 经眼底检查、荧光素眼底血管造影、B超及OCT检查确诊的孤立性脉络膜血管瘤患者21例21只眼,伴有不同程度渗出性视网膜脱离和黄斑水肿.患者术前最佳矫正视力为HM/眼前～0.8,B超检查瘤体最大直径6.7～15.6mm(平均8.9mm).光敏剂为维替泊芬,激光波长689nm,功率密度600mW/cm2,曝光时间166s.结果 所有患者经1～2次(平均1.3)光动力治疗,光斑直径4200～7500μm,1～5个光斑(平均1.5个).随访6～73个月,最佳矫正视力提高者7只眼(33.3%),视力稳定者14只眼(66.7%),无视力明显下降病例.B超检查显示瘤体变小甚至萎缩,FFA、OCT显示渗出性视网膜脱离及黄斑水肿吸收.结论 光动力疗法治疗孤立性脉络膜血管瘤安全有效,可使瘤体萎缩,视网膜内积液及视网膜下液吸收,保存或提高患者视力.     

经瞳孔温热疗法治疗视网膜大动脉瘤的疗效观察

目的观察经瞳孔温热疗法(TTT)治疗视网膜大动脉瘤的疗效。方法采用经瞳孔温热疗法对视网膜大动脉瘤24例(24只眼)进行治疗。根据荧光素眼底血管造影(FFA)显示的瘤体大小及荧光渗漏情况,采用810 nm激光照射,激光功率、光斑直径和曝光时间为500～1000 mW、800～1200μm和60 s。结果经1年随访,视力增进2行以上者9只眼。视力提高1行者8例,视力不变者5例,视力下降1～2行者2例。3个月后FFA显示:24例瘤体完全萎缩,无荧光素渗漏。结论 TTT治疗视网膜大动脉瘤安全、有效。     

经瞳孔温热疗法在眼科应用的研究进展

经瞳孔温热疗法(transpupillary thermotherapy,TTT)是运用810激光,经瞳孔传输热量至脉络膜和视网膜色素上皮,主要用于后极部多种体积较小的脉络膜视网膜肿瘤的一种新方法.国内外已开始用于治疗脉络膜黑色素瘤、视网膜母细胞瘤、视网膜血管瘤、脉络膜血管瘤等眼底肿瘤.近年来,TTT试图以阈下反应来治疗脉络膜新生血管等.文中就TTT在眼科临床应用的研究历程和最新进展作一综述.     

脉络膜血管瘤治疗的新进展

脉络膜血管瘤是一种较为少见的良性肿瘤,其病变多发生在眼底后极部,瘤体渗液及侵及黄斑区可导致视网膜脱离等并发症,造成视力损害。脉络膜血管瘤可分为孤立性脉络膜血管瘤和弥漫性脉络膜血管瘤。前者并发症较少,而后者多表现为Sturge-weber症。目前对于脉络膜血管瘤的治疗主要是通过:光凝术、放射治疗、经瞳孔温热疗法、光动力学疗法等。我们旨在介绍各种疗法的现状及最新进展,探索治疗脉络膜血管瘤的最安全有效的方法。     

光动力疗法与经瞳孔温热疗法治疗孤立型脉络膜血管瘤的疗效观察

目的 观察经瞳孔温热疗法(TTT)和光动力疗法(PDT)治疗孤立型脉络膜血管瘤(CCH)的疗效.方法 回顾性分析经眼底检查、荧光素眼底血管造影(FFA)、吲噪青绿血管造影(ICGA)、光相干断层扫描(OCT)、眼部B型超声检查确诊为CCH的患者32例33只眼的临床资料.所选病例治疗前最佳矫正视力为指数/眼前～0.2,瘤体大小2～10个视盘直径(DD),均有浆液性视网膜脱离.其中21例22只眼CCH位于除乳斑柬及黄斑拱环内区域外的后极部采用经瞳孔温热疗法(TTT)治疗.使用Iris 810 nm半导体红外激光,能量700～1200 mw,时间60 S,光斑1～3个不等;11例11只眼CCH位于乳斑束及黄斑拱环以内区域的PDT治疗.经静脉注射维速达尔15 min后采用689 nm波长半导体激光对病灶进行照射83～123 s.随访时间12～48个月,平均随访时间为25.6个月.治疗后复查视力、间接检眼镜、彩色眼底照像、FFA、ICGA、OCT和B型超声波检查,观察其疗效.结果 TTT治疗22只眼中,15只眼视力提高,7只眼视力稳定,眼底检查见视网膜平复,瘤体呈灰白色机化瘢痕,造影显示病灶无荧光渗漏,晚期机化瘢痕处呈荧光染色.OCT检查显示22只眼视网膜神经上皮脱离消失,视网膜下积液完全吸收,其瘤体部脉络膜光带反射增强,瘢痕形成;B型超声检查显示22只眼无视网膜脱离,瘤体萎缩.PDT治疗11只跟中9只眼视力提高,2只眼视力稳定,眼底检查见瘤体萎缩,色素沉着,造影显示荧光渗漏消失;OCT显示视网膜下液完全吸收,B型超声检查11只眼瘤体萎缩.结论 TTT与PDT治疗CCH有效但适用部位有所不同.两种方法均可使瘤体萎缩,稳定或提高患者的视力.     

脉络膜骨瘤的临床表现和治疗探讨

目的探讨脉络膜骨瘤的临床表现和治疗效果。方法脉络膜骨瘤患者12例（18只眼）,其中男性5例,女性7例;8只右眼,10只左眼。患者均行常规眼部检查：包括最佳矫正视力、眼压、视野、眼前节和眼底检查。专项检查：包括彩色眼底照相、荧光素眼底血管造影（FFA）和（或）吲哚氰绿眼底血管造影（ICGA）、B超、CT、视野和眼电生理检查。对患者进行如下治疗：（1）服用抗感染和维生素类药物,临床随诊观察。（2）采用多波长氪激光光凝治疗。（3）采用经瞳孔温热疗法（TTT）,治疗次数一般为1—5次,两次治疗间隔时间为1个月。全部患者均预约定期随诊,随诊期为1至26年,中位数为2．5年。结果（1）服用药物并定期随访者共6例（8只眼）。随访过程中,发现脉络膜骨瘤增大缓慢,生长边缘呈伪足状前移,瘤体增大。随诊时间最长者1例,26年后复诊肿瘤已自行消退。（2）激光光凝治疗2例（4只眼）,术后脉络膜骨瘤边缘出现光凝色素斑,其中2只眼在近视乳头和黄斑处仍有少许浆液性渗出和视网膜浅脱离,1只眼有黄斑出血,FFA检查显示有脉络膜新生血管（CNV）形成,2例患者经TTT补充治疗后病情好转。（3）单用TTT治疗4例（6只眼）,其中1例（1只眼）有黄斑出血,FFA和ICGA检查显示有CNV渗漏,经TTT治疗后好转;1例（2只眼）,经TTT治疗后肿瘤处浆液渗出减少,有青灰色素和薄的机化瘢痕增生。结论脉络膜骨瘤在自然病程中缓慢生长,有伪足样边缘。激光光凝有一定效果。TTT可单独用于治疗或辅助激光光凝之不足,特别适用于合并有黄斑中心凹下CNV的患眼。     

Transpupillary thermotherapy in the management of circumscribed choroidal hemangioma

Laser photocoagulation and various radiation therapy methods have been used in the treatment of circumscribed choroidal hemangioma that produce visual loss. Recently, transpupillary thermotherapy has been employed in the management of choroidal hemangioma. Thirty-six cases of choroidal hemangioma treated with transpupillary thermotherapy are reviewed. Twenty-eight cases were reported in the literature and 10 cases were managed by the author. Transpupillary thermotherapy has been used as a primary treatment (36 cases) or secondary treatment (2 cases) for choroidal hemangioma. The goal of transpupillary thermotherapy is to achieve resolution of exudative detachment of the fovea and improvement of vision. In all eyes the foveal detachment subsided. In 26 eyes having pretreatment visual acuity >or=0.05 (20/400), the visual acuity increased in 20 (77%) eyes and remained unchanged in 6 (23%) eyes. After transpupillary thermotherapy, 16 (42%) cases showed complete regression, 20 (53%) demonstrated partial regression, and in 2 (5%) there was no change in tumor thickness at follow-ups ranging from 2 to 44 months. Complications of transpupillary thermotherapy of choroidal hemangioma included cystoid macular edema (3 eyes), preretinal fibrosis (2 eyes), focal iris atrophy (3 eyes), and retinal vascular occlusion (1 eye). Although the follow-up in many studies is limited, transpupillary thermotherapy has not been associated with any significant complications.     

Transpupillary thermotherapy in the management of circumscribed choroidal hemangioma

PURPOSE: To report a case of circumscribed choroidal hemangioma effectively managed with transpupillary thermotherapy. METHOD: A 53-year-old man affected by extramacular circumscribed choroidal hemangioma had sustained a decline in visual acuity caused by subretinal fluid exudation into the macular area. Multiple attempts at treatment with scatter photocoagulation over the surface of the lesion for several years had been unsuccessful in reducing tumor-related exudation. The patient was examined on referral and underwent a single session of treatment employing transpupillary thermotherapy. The course of the lesion after treatment was documented with fundus photography and ultrasonography. RESULT: Complete atrophy of the choroidal hemangioma with resorption of subretinal fluid was documented over the 6 months after transpupillary thermotherapy, with improvement in visual acuity. CONCLUSION: Transpupillary thermotherapy is an effective alternative to conventional scatter photocoagulation or radiation therapy for precise ablation of circumscribed choroidal hemangioma.     

A case of choroidal hemangioma with bullous exudative retinal detachment treated successfully by transpupillary thermotherapy]

BACKGROUND: Choroidal hemangioma associated with bullous retinal detachment may be difficult to treat, due to varying results with conventional laser photocoagulation, radiotherapy, or surgical drainage. Here we report on a case of extensive bullous retinal detachment secondary to circumscribed choroidal hemangioma that was resolved after combined treatment with vitrectomy, silicone oil tamponade, and transpupillary thermotherapy. CASE: A 29-year-old woman presented with a large choroidal hemangioma in her right eye associated with serous retinal detachment. The tumor measured 8 disc diameters in size and was located in the inferotemporal macula, abutting the fovea. RESULTS: Laser photocoagulation of the tumor was unsuccessful in inducing absorption of subretinal fluid. Because of progressive bullous retinal detachment, surgery was performed consisting of external drainage of subretinal fluid, vitrectomy, endolaser photocoagulation of the tumor, and silicone oil tamponade. The silicone oil was removed four weeks postoperatively at which time almost complete resolution of the retinal detachment was observed. However, retinal detachment recurred eight weeks later, and transpupillary thermotherapy was then applied to the tumor. By four weeks after transpupillary thermotherapy, total reabsorption of subretinal fluid, visual acuity improvement, and decreased height of the choroidal hemangioma were noted. CONCLUSION: Transpupillary thermotherapy is an effective treatment for serous retinal detachment associated with choroidal hemangioma.     

Transpupillary thermotherapy of subfoveal occult choroidal neovascularization

Choroidal neovascularization secondary to age-related macular degeneration is a leading cause of vision loss in adults. Although most patients present with occult CNV, treatment has focused on the small percentage of eyes with well-delineated, classic CNV. Transpupillary thermotherapy is a recent advancement in the management of occult CNV. Transpupillary thermotherapy acts in a subthreshold manner by slightly raising the choroidal temperature. A recent pilot study demonstrated that 56% of treated eyes remained stable one year after treatment with only 25% losing two lines of visual acuity. The TTT4CNV study will further evaluate the effectiveness of transpupillary thermotherapy in a randomized, double-blind trial.     

Choroidal vascular changes after transpupillary thermotherapy for choroidal melanoma

OBJECTIVE: To evaluate choroidal vascular alterations after transpupillary thermotherapy used as the sole treatment for choroidal melanoma. DESIGN: Prospective noncomparative interventional case series. PARTICIPANTS: Forty-five eyes of 45 patients affected by malignant choroidal melanoma treated with transpupillary thermotherapy alone with more than 1 year of follow-up. INTERVENTION: Transpupillary thermotherapy was performed through a panfunduscopic contact lens using an 810-nm diode laser. MAIN OUTCOME MEASURES: Dynamic/static fluorescein and indocyanine green angiography were performed at scheduled intervals (24 hours, at 3-month intervals during the first year, and every 6 months thereafter) after transpupillary thermotherapy. Visual acuity, clinical evaluation, fundus photographs, and ultrasonographic examination were also performed. RESULTS: The mean follow-up was 30.5 months (range, 12-54 months). Changes in the choroidal circulation were always confined within the treatment margins (except in one case) and characterized by occlusion of choriocapillaris (100%), patent medium and/or large choroidal vessels (76%), retinochoroidal anastomosis (11%), and progressive choroidal vascular remodeling (42%). Forty-one cases (91%) showed persistent clinical regression, and four cases (9%) recurred; recurrent cases showed retinochoroidal anastomosis. CONCLUSIONS: Transpupillary thermotherapy is suggested as a new single therapeutic modality in the treatment of selected choroidal melanomas, but more precise eligibility criteria and longer follow-up are mandatory. Patent choroidal circulation, choroidal vascular remodeling, and anastomosis after transpupillary thermotherapy might be helpful to detect recurrent tumors.     

经瞳孔温热疗法治疗中心性渗出性脉络膜视网膜炎

目的 观察经瞳孔温热疗法(transpupillary thermotherapy,TTT)对中心性渗出性脉络膜视网膜炎(central exudative chorioretinopathy,CEC)的治疗效果。 方法 使用Iris 810 nm 半导体激光对29例CEC患者进行TTT治疗，采用1.2、2.0及3.0 mm光斑，能量80～300 mW，照射时间60 s。随访4～40周，通过视力、直接检眼镜检查、荧光素眼底血管造影(fundus fluorescein angiography,FFA)及吲哚青绿血管造影(indocyanine green angiography,ICGA)观察治疗效果。 结果 治疗后视力提高者8例，占28%；无变化者19例，占65％；视力下降者2例，占7%。12例患者症状有程度不同的改善，眼底检查病变减轻者10例。20例复查眼底血管造影的患者中，12例脉络膜新生血管(choroidal neovascularization,CNV)明显消退、渗漏减轻。 结论 TTT对CEC有较好的治疗效果。 (中华眼底病杂志, 2002, 18: 184-186)     

经瞳孔温热疗法治疗孤立性脉络膜血管瘤

目的
观察经瞳孔温热疗法(transpupillary thermotherapy，TTT)治疗孤立性脉络膜血管瘤的疗效。
方法
回顾分析12例孤立性脉络膜血管瘤患者12只患眼采用TTT治疗的临床疗效。治疗使用Iris810 nm红外激光，能量220~1000 mW，光斑直径1.2、2.0、3.0 mm，照射时间1~2 min。观察治疗前后视力、视网膜下液、脉络膜血管瘤的厚度及渗漏的变化以及治疗的并发症等情况。随访6～16个月，平均随访10个月。
结果
12例脉络膜血管瘤患者中伴有周边视网膜脱离者8例，经TTT治疗后周边液体完全吸收6例，部分吸收2例。治疗后视力不变者7例、提高者3例、下降者2例。8例治疗前曾行B型超声检查者，治疗后B型超声检查7例瘤体厚度较治疗前降低，其厚度平均下降21.75%。10例治疗前行荧光素眼底血管造影检查者复查均可见瘤体的渗漏明显减轻。治疗的并发症有视网膜出血5例、视网膜皱褶1例。
结论
TTT是治疗脉络膜血管瘤的有效方法，特别适用于伴有明显视网膜脱离的患者。
(中华眼底病杂志, 2002, 18: 190-192)     

Efficacy of transpupillary thermotherapy (TTT) in the treatment of occult subfoveal choroidal neovascularization in age-related macular degeneration

PURPOSE: To determine the efficacy of transpupillary thermotherapy (TTT) in the treatment of occult subfoveal choroidal neovascularization in patients with age-related macular degeneration (ARMD). METHODS: We conducted a retrospective review of patients with ARMD treated with TTT from June, 1999 through July, 2000 at a retina referral practice. TTT was delivered through a slit-lamp using a modified diode laser at 810 nm wavelength and a spot size of 3 mm delivered at one location for a minimum of 60 seconds duration. Re-treatment was performed at 2-month intervals if indicated. RESULTS: 81 eyes of 77 patients were included in the study. Vision improved greater than one line Snellen in 18 eyes (22%), vision was stable within one line Snellen in 38 (47%), and worsened greater than one line Snellen in 25 (31%). Patients had a mean follow-up of 9 months. The average number of treatments was 1.37 (range 1 to 4). Pretreatment vision was less than or equal to 20/200 in 54% of eyes. CONCLUSIONS: Transpupillary thermotherapy may stabilize visual acuity in a majority of patients with occult subfoveal choroidal neovascularization secondary to ARMD. Proof of therapeutic benefit is best determined by a randomized clinical trial that is currently underway (TTT4CNV).