PDT联合玻璃体腔注射Avastin治疗病理性近视CNV

目的：观察光动力疗法（photodynamic therapy, PDT）联合玻璃体腔注射Avastin治疗并发脉络膜新生血管(choroidal neovascularization, CNV)的病理性近视（pathologic myopia, PM）的安全性和临床疗效。方法：并发黄斑中心凹下CNV的PM 患者17例17眼纳入治疗。PDT按照国际标准进行。3d后在表面麻醉下给予1.5mg Avastin玻璃体腔注射。治疗后第1，3，6，12mo各随访1 次, 随访时间为6~16mo。复查视力、眼压、眼底检查、眼底彩照、FFA、OCT。治疗前、后对比行配对样本t检验统计分析，P<0.05为差异有统计学意义。结果：末次随访时，视力提高2行以上者4眼（23.53%），视力提高1行者5眼（29.41%），视力不变者8眼(47.06%)，无视力下降者。术前BCVA：0.02～0.3（logMAR值:平均1.007±0.103），术后BCVA：0.02～0.5（logMAR值:平均0.873±0.100）（P＜0.01）。术前平均眼压为15.26±0.76mmHg，术后平均眼压为14.97±0.69mmHg（P＞0.05）。FFA检查显示:10眼CNV 完全闭合，占58.82%，其余7眼CNV大部分闭合，占41.18%。CMT：术前平均为: 194.67±12.74μm，术后平均为：132.07±8.32μm,差别有统计学意义（P＜0.01）。结论：PDT联合玻璃体腔注射Avastin治疗并发CNV的PM安全有效，使CNV渗漏停止或减轻，视网膜水肿消退或减轻，但不同年龄的患者视力预后差别大，老年患者视力预后差，可能与其本身的进行性脉络膜视网膜萎缩有关。但尚需进一步大样本的临床随机对照研究来证实。

Clinical investigation of photodynamic therapy and intravitreal Avastin for choroidal neovascularization due to pathologic myopia

AlM:To evaluate the efficacy and safety of photodynamic therapy (PDT) and intravitreal Avastin for choroidal neovascularization (CNV) due to pathologic myopia(PM). METHODS: Seventeen patients(17 eyes) with subfoveal CNV caused by pathologic myopia received PDT followed by an intravitreal injection of 1.5mg Avastin three days later. Verteporfin PDT was performed using the recommended standard. All patients were followed clinically and with fundus flourescein angiography(FFA) and optical coherence tomography(OCT) at baseline and 1 month, 3, 6, 12 months after treatment. The best-corrected visual acuity (BCVA) was measured and the OCT findings were examined before and 1 month, 3, 6, 12 months after treatment. Follow-up time varied from 6 months to 16 months (mean, 10.3 months). The BCVA levels were converted to logMAR equivalents and datas were analyzed using the paired t-test (SPSS 14.0), and P<0.05 was considered statistically significant. RESULTS: At the last visit,the mean BCVA(logMAR)was 1.007±0.103 before treatment and 0.873±0.100 at the last visit (P<0.01). The BCVA improved more than two lines in 4 eyes (23.53%), improved one line in 5 eyes (29.41%) and stabilized (no change) in 8 eyes (47.06%) and none decreased. FFA showed CNV complete closure in 10 eyes (58.82%) , partial closure in 7 eyes (41.18%).The central macular thickness (CMT) on OCT images decreased from 194.67±12.74μm at baseline to 132.07±8.32μm after treatment(P<0.01). No complication occurred. CONCLUSlON: PDT and intravitreal Avastin for CNV caused by PM was effecetive with an significantly improvement in BCVA, FFA and OCT. But visual prognosis was found to be influenced by age at treatment.