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。

Transpupillary thermal therapy for age-related macular degeneration accompanied with choroidal neovascularization

Objective To investigate the therapeutic efficacy of Transpupillary thermotherapy （TTT） for age-related macular degeneration （ AMD ） accompanied with choroidal neovascularization （ CNV ）. Methods Transpupillary thermotherapy （TTT） was performed on 58 eyes of 52 patients whose illness had been diagnosed as AMD accompanied CNV by fluorescein angiography（ FFA） and indocyanine green angiography （ICGA ） with the power 130 - 160 mW/mm. The main outcome measures were visual acuity, absorption of retinal hemorrhage and reduction of leakage from CNV. The follow - up time varied from 3 months to 18 months. Results At the final follow up, the best corrected visual acuity （ BCVA ） was improved（ increase≥2 lines） in 19 eyes （32.7% ） ,stabilized in 30 eyes （51.7% ） and decreased 2 lines or more in 9 eyes （ 15.5% ）, the best corrected visual acuities （ BCVA ） were 0.3 or better in 8 eyes,0.1 - 0.3 in 15 eyes （ 25.8% ） and 0. 1 or lower in 35 eyes（60.3% ）. No discomfort was found in all the patients during the treatment. The central visual acuity in 3 eyes of 3 patients whose retinal focus turned slightly gray decreased 2 - 3 lines and recovered completely after 2 years. New hemorrhage occurred in 2 eyes at the first week after treatment and retinal layer hole was found at the third months after the treatment. At the final follow up, there were scarring tissue organized or thickened in 9 eyes （ 17.3% ） ,new hemorrhage occurred in 6 eyes （ 10.3% ） and complete absorption of retinal hemorrhage in 18 eyes （81,8% ）. The results of FFA and ICGA demonstrated that CNV complete closure or partial closure in 40 eyes （ 76.9% ）, CNV aggravation in 5 eyes （ 9. 6% ） and CNV recurrence in 9 eyes（5.8% ）. Conclusion TTT is a safe ,effective and relatively cheap treatment for AMD accompanied with CNV. Early diagnosis and early treatment of CNV is very significant for raising and maintaining useful visual activity,and it is more suitable to apply in our country nowa