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…     

Optical coherence tomography guided retreatment of photodynamic therapy

AIM: To evaluate the results of a retreatment modality of photodynamic therapy (PDT) based on optical coherence tomography (OCT) and fluorescein angiography (FA). To quantify the effect of PDT with the help of measurement of the retinal thickness. METHODS: Eyes with predominantly classic subfoveal choroidal neovascularisation (CNV) due to age related macular degeneration were included. PDT was performed every three months, when needed. OCT, FA, and measures of distance acuity were performed at baseline, after 6 weeks, 3 months, and from then on every 3 months. A control group of a consecutive series of eyes that had been retreated based only on FA results was installed. RESULTS: Forty eyes of 38 patients were included. The average age was 73 years. The maximum retinal thickness decreased from 404 mum at baseline to 281.6 mum at month 12. Furthermore there was a significant decrease of retinal thickness in both subgroups. The number of retreatments was reduced, when activity was diagnosed using OCT and FA. (2.4 v 4.0). The distance acuity correlated significantly with the maximum retinal thickness (p=0.0042). CONCLUSION: Information about the activity of a neovascular lesion can be obtained with the help of OCT. The retreatment modalities can be optimised by using OCT and FA and the number of retreatments can be reduced.     

Comparison of fluorescein angiography and optical coherence tomography for patients with choroidal neovascularization after photodynamic therapy

PURPOSE: To investigate retinal morphology by means of fluorescein angiography (FA) and optical coherence tomography (OCT) in patients who had undergone photodynamic therapy (PDT) with verteporfin at their 3-month-interval examination. METHODS: Sixty patients with predominantly classic choroidal neovascularization (CNV) secondary to age-related macular degeneration were evaluated with FA and OCT 3 months after their last PDT. FA images were evaluated in a masked fashion for staining of and leakage from the lesion and also for cystoid loculation of fluorescein in the macula. OCT was used to evaluate foveal thickness and the presence of subretinal fluid or cystoid spaces within the retina, also in a masked fashion. RESULTS: The median age of the 60 patients was 78 years, and the median visual acuity of the eyes examined was 20/100. The median number of previous PDT sessions was 2. Fluorescein staining was seen in 57 eyes (95%), and fluorescein leakage was seen in 50 eyes (83%). Cystoid loculation of fluorescein was seen in 21 eyes (35%). By OCT, cystoid spaces in the macula were seen in 42 patients (70%), and subretinal fluid was seen in 15 patients (25%). Leakage seen shown by FA was correlated with the OCT finding of cystoid spaces but not with the OCT finding of subretinal fluid. Some patients had leakage during FA that did not have any observable induced OCT abnormality attributable to fluid accumulation. CONCLUSIONS: After PDT leakage from CNV seen during FA is associated with intraretinal fluid, often seen in loculated cystoid spaces, but not with subretinal fluid.     

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。     

Follow-up of age-related macular degeneration patients treated by photodynamic therapy with optical coherence tomography 3

Background Photodynamic therapy (PDT) has been described to effectively reduce or delay severe vision loss in eyes with predominantly classic form of choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). Optical coherence tomography 3 (OCT3) is a non-invasive diagnostic procedure which provides information about retinal thickness and volume at the posterior pole, as well as about the presence of certain structures under the retina.Methods Prospective interventional study. Eleven eyes (9 patients) with AMD and CNV were treated with Verteporfin PDT. A complete ophthalmologic examination was performed. Fluorescein angiography (FA) and OCT3 scans were performed before treatment and 1, 2, 4, and 12 weeks after it.Results Two different patterns of changes were observed. One group (7 eyes) showed changes in the amount of subretinal fluid (decrease, increase, and finally stable decrease), with a reduction in the CNV and the appearance of a subretinal band of hyperreflective tissue. The second group (4 eyes) showed little or no changes in retinal thickness, fluid, or reflectivity.Conclusion Changes observed in OCT3 scans represent variations in retinal thickness, fluid, and CNV after PDT. OCT3 provides a useful tool in the follow-up and measurement of changes appeared in eyes with CNV associated to AMD after treatment with PDT.     

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)     

Effect of posterior juxtascleral triamcinolone acetonide on the efficacy and choriocapillaris hypoperfusion of photodynamic therapy

Purpose To evaluate the effect of posterior juxtascleral triamcinolone acetonide (TA) injection combined with photodynamic therapy with verteporfin (PDT) for treating exudative age-related macular degeneration (AMD), the best-corrected visual acuity (BCVA), the retreatment rates and the rate of choroidal hypoperfusion were investigated. Methods A total of 67 eyes with subfoveal choroidal neovascularization (CNV) due to AMD were included. Forty-four eyes underwent PDT alone (PDT-alone group), and 23 eyes underwent PDT with the posterior juxtascleral injection of TA (PDT+TA group). Every 3 months after the PDT, the eyes were evaluated with regard to BCVA and requirement for retreatment by fluorescein angiography (FA) with the aid of optical coherence tomography (OCT). Choroiocapillaris hypoperfusion was assessed by indocyanine green angiography (ICGA) at 3 and 12 months. All patients completed a 1-year follow-up. Results At the baseline, there was no difference in lesion type, size or visual acuity between the two groups. At 1 year, the change in BCVA was −0.0811 logarithm of the minimum angle of resolution (LogMAR) in the PDT-alone group, compared with −0.0432 logMAR in the PDT+TA group. There was no significant difference in the change in BCVA between the two groups (P = 0.6910). The PDT+TA group required a lower mean number of treatments (1.64 compared with 2.34 [P = 0.0223]) and showed a higher rate of choriocapillaris occlusion at 3 months, but no significant difference at 1 year (P = 0.9243) Conclusions Fewer retreatments were required in the TA+PDT group. There was no significant difference in the change in BCVA between the two groups. Adjacent TA may promote short-term choriocapillaris hypoperfusion.     

Photodynamic therapy with verteporfin in patients with age-related macular degeneration and juxtafoveal choroidal neovascularization

PURPOSE: To investigate the effects of photodynamic therapy (PDT) on juxtafoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD) in a clinical patient material. METHODS: Thirty eyes in 30 consecutive patients with AMD and a juxtafoveal CNV underwent PDT with verteporfin with standard parameters. The patients were followed up for 12 months and retreated every 12 weeks in the event of leakage from CNV. Nineteen patients (63.3%) had a predominantly classic CNV, eight (26.7%) had a 100% occult CNV and three (10%) had a minimally classic lesion. In 27 patients (90%) the lesion was < or = 3 MPS (Macular Photocoagulation Study) disc diameters and < or = 3 MPS disc areas. RESULTS: There was a positive correlation between duration of symptoms and loss of visual acuity at 12 months (p < 0.02). For predominantly classic lesions, there was a positive correlation between duration of symptoms and lesion size (p < 0.005). At 12 months, leakage had stopped after 3.3 +/- 0.9 treatments in 80% of the patients. Visual acuity remained stable in 63.3% of the patients. CONCLUSION: Photodynamic therapy appears to be beneficial in patients with AMD and juxtafoveal 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)     

光动力疗法联合玻璃体腔曲安奈德注射治疗脉络膜新生血管

目的观察光动力疗法(PDT)联合玻璃体腔曲安奈德(TA)注射治疗老年黄斑变性和病理性近视引起的脉络膜新生血管(CNV)的近期疗效和安全性。方法16例经过视力、眼压、荧光素眼底血管造影(FFA)以及光相干断层扫描(OCT)等检查确诊的CNV患者的16只患眼进行PDT联合玻璃体腔TA注射治疗。其中,渗出型老年黄斑变性14例14只眼,病理性近视2例2只眼。16只眼中,12只眼在PDT治疗后72 h行玻璃体腔TA注射,4只眼在PDT 3个月~1年(平均9个月)后行玻璃体腔TA注射。第1年的平均治疗次数为1.1次。联合治疗后,采用与治疗前相同的条件和检查方法进行随访观察,随访时间3~18个月,平均随访时间18.6个月。对比观察治疗前后患者的最佳矫正视力、眼压、CNV病灶渗漏情况以及黄斑区视网膜厚度变化。结果16只眼中,7只眼视力提高,占43.8%;9只眼视力稳定,占56.2%。FFA显示CNV病灶在联合治疗后渗漏停止或减轻,OCT显示黄斑区视网膜水肿消退或减轻。1只眼暂时性眼压升高,占6.3%。经药物短期治疗后恢复正常。结论PDT联合玻璃体腔TA注射可以安全有效地治疗CNV,延缓视力下降,并且可以减少重复治疗的次数。     

Inter-observer agreement for spectral- and time-domain optical coherence tomography image grading: a prospective study

The purpose of this study was to compare inter-observer agreement of Stratus? OCT versus Spectralis? OCT image grading in patients with neovascular age-related macular degeneration (AMD). Thirty eyes with neovascular AMD were examined with Stratus? OCT and Spectralis? OCT. Four different scan protocols were used for imaging. Three observers graded the images for the presence of various pathologies. Inter-observer agreement between OCT models was assessed by calculating intra-class correlation coefficients (ICC). In Stratus? OCT highest interobserver agreement was found for subretinal fluid (ICC: 0.79), and in Spectralis? OCT for intraretinal cysts (IRC) (ICC: 0.93). Spectralis? OCT showed superior interobserver agreement for IRC and epiretinal membranes (ERM) (ICC_Stratus?: for IRC 0.61; for ERM 0.56; ICC_Spectralis?: for IRC 0.93; for ERM 0.84). Increased image resolution of Spectralis? OCT did improve the inter-observer agreement for grading intraretinal cysts and epiretinal membranes but not for other retinal changes.     

Veränderungen neovaskulärer Membranen und normaler Aderhautgefäße nach mehrfacher photodynamischer Therapie

PURPOSE: ICG angiography (ICGA) was used to document the effect of repeated PDT (verteporfin) on size and leakage of choroidal neovascularisation in age-related macular degeneration (AMD) and treatment-related side effects on the choroid. METHODS: Forty-two patients were followed over 24 months in a clinical trial for PDT in AMD. The ICGAs were performed every 3 months with a confocal laser scanning system. Patients received repeated verteporfin treatment. At each control visit, the patients were retreated if leakage was present in fluorescein angiography (FA). RESULTS: A continuous, highly significant reduction in CNV size and leakage area was found over 24 months. The initial CNV size dropped by 23% from 3.86 mm2 to 2.98 mm2. The leakage area in the late phase of the angiogram decreased by 30.3% from 5.0 mm2 to 3.5 mm2. A significant side effect of PDT on the choroid was documented by an increased hypofluorescent area in ICGA. The maximum size of the hypofluorescent area was reached after 12 months. At month 24, the choroidal fluorescence showed recovery in respect to area and intensity of fluorescence. But hypofluorescence surrounding the CNV lesion was already present in 40 out of 42 eyes before treatment. CONCLUSION: The ICGA confirms that repeated PDT treatments lead to a significant reduction in CNV size and leakage area over as long as 2 years. CNV lesions are surrounded by choriocapillary hypofluorescence in ICGA. PDT causes further hypoperfusion of the choroid but in the long-term significant recovery of choroidal perfusion was shown.     

Combined photodynamic therapy with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization

PURPOSE: To examine combined photodynamic therapy (PDT) with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). DESIGN: Noncomparative case series. PARTICIPANTS: Twenty-six eyes of 26 patients with CNV secondary to AMD. Thirteen with CNV, without restriction to type, were not treated with prior PDT and were called the Newly Treated group. Thirteen patients with prior PDT therapy who experienced visual loss during treatment with PDT alone comprised the remainder and were termed the Prior PDT group. METHODS: Patients with CNV were treated with PDT immediately followed by an intravitreal injection of 4 mg of triamcinolone acetonide. Visual acuity was measured by Early Treatment Diabetic Retinopathy Study protocol refraction. Need for retreatment was based on fluorescein angiographic evidence of leakage at 3-month follow-up intervals. MAIN OUTCOME MEASURES: Visual acuity and retreatment rate. RESULTS: Of the 13 patients in the Newly Treated group the mean visual acuity change at 3 months was an improvement of 1.9 lines, and 4 (30.8%) had an improvement of at least 3 lines. Two patients (15.4%) required retreatment at 3 months. At the 6-month follow-up, available for 12 patients in the Newly Treated group, the mean visual acuity change from baseline was an improvement of 2.4 lines, 4 patients (33%) had an improvement of at least 3 lines and 1 patient required retreatment. At both time points the visual acuity was significantly greater than at baseline (P = 0.023 and P = 0.007, at the 3-month and 6-month time points, Wilcoxon signed ranks test) for patients in the Newly Treated group. Among the 13 patients in the Prior PDT group, the mean change in visual acuity from baseline at the 3-month follow-up was 0.31 lines and 1 patient (7.7%) had an improvement of at least 3 lines. Six-month follow-up was available for 11 patients in the Prior PDT group and the mean change from baseline visual acuity was 0.1 lines and 1 patient (9.1%) experienced an improvement of 3 or more lines. No patient in the Prior PDT group required retreatment at 3 or 6 months. At the 3-month and 6-month time points the visual acuity was not significantly different than the baseline acuity in the Prior PDT group. No patient in either group at any time point experienced a loss of visual acuity of 3 or more lines. Five patients (19.2%), 3 in the Newly Treated group and 2 in the Prior PDT group, required monodrop therapy to control their intraocular pressure. No patient developed endophthalmitis. CONCLUSION: Although the number of patients in this pilot study was limited, the improvement of acuity and the lack of fluorescein leakage in these patients suggest combination therapy with PDT and intravitreal triamcinolone acetonide, particularly when used as first-line therapy, merits further investigation.     

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.     

光动力疗法治疗渗出型老年性黄斑变性四年临床观察总结

目的 总结4年来光动力疗法（PDT）治疗渗出型老年性黄斑变性(AMD)的临床疗效，以评价PDT的长期治疗效果。 方法 回顾73例经双目间接检眼镜、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)检查确诊的渗出型AMD患者的95只患眼行PDT治疗前后的临床资料，对比分析其视力、眼底像、FFA、ICGA和光相干断层扫描(OCT)检查结果的变化。73例患者平均年龄67.8岁，就诊时最佳矫正视力数指/10 cm～1.0。95只眼PDT平均治疗次数为1.5次，治疗后随访时间为3个月～4年。 结果 PDT治疗后末次随访时，39只眼视力提高≥2行，占41.1％；51只眼视力波动在1行以内，占53.7％；5只眼视力下降≥2行，占5.3％ 。所有患眼眼底出血和渗出均减轻。FFA或FFA联合ICGA检查显示：58只眼脉络膜新生血管（CNV）渗漏完全停止，转为瘢痕期，占61.05％；6只眼CNV部分闭合， 占6.32％；22只眼CNV小部分闭合，占23.16％；9只眼CNV复发，占9.47％。早期AMD患者12只眼经过1次PDT治疗后，最佳矫正视力0.6～1.5，CNV完全闭合，OCT检查显示黄斑区水肿及神经上皮脱离消失。随访时间最长达4年，未见有复发，视力保持稳定。 结论 单次和重复PDT治疗渗出型AMD长期疗效较好，安全性较高。对于早期渗出型AMD患者微小典型性CNV，单次PDT治疗可以使其完全封闭，使患者视力保持在较好的水平。 （中华眼底病杂志，2004，20：275-279）     

PDT联合血栓通治疗AMD并发脉络膜新生血管化

目的: 观察光动力疗法(PDT)联合中药血栓通注射液治疗年龄相关性黄斑变性(AMD)并发脉络膜新生血管化(CNV)的临床疗效。方法: 选择年龄相关性黄斑变性并发脉络膜新生血管化(AMD-CNV)患者17例17眼,男7例,女10例,年龄53～72岁。患者经过视力、眼压、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)和光学相干断层成像(OCT)等检查确诊。患者用PDT治疗5d后,再用500mg中药血栓通注射液静脉滴注10d,1次/d,疗程为15d,观察治疗后1,3和6mo疗效。结果: 治疗6mo,17例中视力提高8例(47%),视力稳定无明显变化6例(35%),视力下降3例(18%);12例(71%)CNV闭合且渗漏完全停止,5例(29%)CNV大部分闭合。1例出现一过性视物模糊。结论: PDT联合中药血栓通注射液治疗AMD-CNV方法简单,疗效可靠,可在临床推广应用。     

Photodynamic therapy in the treatment of chronic central serous chorioretinopathy

BACKGROUND: Central serous chorioretinopathy (CSC) is usually a benign disorder which resolves spontaneously, and requires no treatment. Nevertheless, in cases of chronic or recurrent detachment of the neurosensory retina a durable decrease of the visual acuity may be measured due to lesion of the photoreceptors. To avoid this evolution we performed a pilot study to assess the effect of photodynamic therapy (PDT) in patients with CSC without clinical normalization 6 months after the begin of the symptoms. PATIENTS AND METHODS: We report on 14 eyes in 13 patients presenting a chronic CSC without leaking point accessible for focal laser photocoagulation. The diagnosis was confirmed by fluorescein angiography (FA), and optical coherence tomography (OCT). PDT with verteporfin was performed according to the protocol used for treating choroidal neovascularization in age-related macular degeneration. RESULTS: One month after PDT, leakage on FA and detachment of the neurosensory retina on OCT had disappeared, and visual acuity had improved in all patients. CONCLUSIONS: The mechanism of action of PDT in chronic CSC is still hypothetical. PDT should decrease the passage of fluid towards the retina by affecting the choroidal blood flow, and allow a better resorption of the subretinal fluid. PDT could be an alternative to treat patients with chronic CSC.     

Measurement of greatest linear diameter for choroidal neovascular membrane using optical coherence tomography

PURPOSE: Correlation of greatest linear diameter (GLD) of choroidal neovascularization (CNV) measured by fundus fluorescein angiography (FA) with optical coherence tomography (OCT). DESIGN: Retrospective noninterventional observational case series. METHODS: Patients who underwent verteporfin therapy for subfoveal classic CNV were assessed. GLD of CNV was calculated manually from mean of 6 line scans. GLD measured on OCT and FA was correlated by assessing the agreement of the two techniques by interclass correlation and Bland and Altman technique. RESULTS: Twenty-seven eyes of 27 patients with subfoveal classic CNV were included. The mean age was 49.3 +/- 18.6 years. The mean GLD calculated on FA was 1973.3 microm and OCT was 2024.2 microm. Substantial agreement was observed between GLD measured on FA and OCT (Inter-Class Correlation [ICC] = 0.77%; 95% confidence interval, 0.56 to 0.89). CONCLUSIONS: GLD measured on OCT correlates to FA measurement. This method could be beneficial where FA is contraindicated while contemplating photodynamic therapy (PDT).     

抗血管内皮生长因子单克隆抗体Ranibizumab联合光动力疗法治疗渗出型年龄相关性黄斑变性的临床观察

目的 观察抗血管内皮生长冈子单克隆抗体Ranibizumab玻璃体腔注射联合光动力疗法（PDT）治疗渗出型年龄相关性黄斑变性（AMD）的临床疗效和安全性.方法 回顾性系列病例研究.确诊为渗出型AMD并首次接受Ranibizumab玻璃体腔注射联合PDT治疗的患者32例（41眼）,均进行了糖尿病早期治疗研究（ETDRS）视力表、彩色眼底照像、荧光素眼底血管造影（FFA）和（或）吲哚青绿血管造影（ICGA）、光学相干断层扫描（OCT）等检查,确诊为渗出型AMD后采用PDT（光辐射率600 mW/cm2,光能量50 J/cm2,光照时间83 s）治疗,48-72 h后玻璃体腔注射Ranibizumab 0.5 mg（0.05 ml）,随后根据每个月检查情况决定是否再次治疗,重复治疗时单独注射Ranibizumab 0.5 mg,或联合PDT,或单独PDT.采用配对t检验比较治疗前后视力（ETDRS字母数）、视网膜厚度,对脉络膜新生血管（CNV）病灶渗漏情况进行计数,求百分比.结果 随诊12-39个月.在治疗后第12个月检查时,41眼ETDRS视力表字母数较治疗前平均提高9.1个字母（t=-4.14,P＜0.01）,重复Ranibizumab注射（2.0±1.1）次/眼,重复PDT治疗（0.2±0.8）次/眼.末次检查时,41眼ETDRS视力表字母数较治疗前平均提高8.9个字母（t=-3.74,P＜0.01）,重复Ranibizumab注射（2.7±1.2）次/眼,重复PDT治疗（0.3±0.7）次/眼.9眼（22%）CNV渗漏完全停止,27眼（66%）渗漏范围减少,3眼（7%）无明显变化或范围扩大,2眼（5%）有新病灶发生.OCT检查显示视网膜厚度较治疗前平均下降119.11μm（t=4.419,P＜0.01）.并发症与单独Ranibizumab或PDT治疗相比无增加.结论 Ranibizumab玻璃体腔注射联合PDT治疗渗出型AMD可使视力提高,视网膜水肿明显减轻,CNV病灶渗漏停止或减少,具有良好的疗效和较高的安全性.     

Optical Coherence Tomography Findings Following Photodynamic Therapy of Idiopathic Subfoveal Choroidal Neovascularization

The authors assessed the clinical course of idiopathic choroidal neovascularization (CNV) by optical coherence tomography (OCT) after photodynamic therapy (PDT) with verteporfin in nine eyes of eight patients. Different OCT patterns were observed at the active, intermediate, and cicatricial stages. The active leakage on late frames of FA in five eyes, was defined as cystoid macular edema. OCT seems to be useful for evaluating the clinical course and response to PDT.