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。

Effect of photodynamic therapy for exudative age-related macular degeneration

Objective To evaluate the effects of photodynamic therapy(PDT) on exudative age-related macular degeneration(AMD).Methods The clinical data before and after PDT treatment in 21 patients(31 eyes) diagnosed as exudative AMD by fundus fluorescein angiography(FFA),indocyanine green angiography(ICGA) and optical coherence tomography(OCT) were retrospectively analyzed.The changes of visual acuity,FFA,ICGA,OCT were observed to evaluate the effects of PDT for exudative AMD.Results The visual acuity in 13 eyes(41.9%) significantly improved after treatment(improved ≥ 2 lines),14 eyes(45.2%) remained stable(fluctuations within 1 line),4 eyes(12.9%) decreased 2 lines.The retinal hemorrhage and exudation of most affected eyes eased after the treatment of PDT.The examination of ICGA or FFA+ ICGA showed that one week after treatment of PDT,choroidal neovascularization(CNV) leakage in 16 eyes were significantly reduced or completely stopped,leakage in 8 eyes stopped completely.OCT showed that retinochoroidal edema and retinal neural epithelial detachment surrounding the CNV improved.The altitude of retinal neural epithelial detachment during the PDT treatment became larger in 5 cases(6 eyes),1 case(1 eye) had a re-occurrence of a large area of macular hemorrhage.And any systemic and local adverse reaction was not observed in all the cases.Conclusion Single and repeated PDT can achieve partially or completely cessation of fluorescein leakage from CNV without loss of vision or growth of CNV in most patients with AMD,but had the light effect on the normal retinochoroidal tissue.