多次经瞳孔温热疗法的湿性年龄相关性黄斑变性视网膜色素上皮和脉络膜萎缩:病例报告

目的:报告1例湿性年龄相关性黄斑变性(AMD)在多次经瞳孔温热疗法(TTT)后,脉络膜新生血管(CNV)消退,但发生了视网膜色素上皮(PRE)和脉络膜的萎缩并伴低视力.方法:复习包括眼底照相、眼底荧光素血管造影(FFA)、靛青绿血管造影和干涉光断层扫描在内的临床资料.结果:男性72岁主诉左眼视物模糊,FFA证实为黄斑部息肉状脉络膜血管病变.其左眼的CNV未经任何治疗在6 a间保持0.1的视力.约2 a后,右眼出现一片CNV.在此后3a内,病灶保持或大(3×5 PD)或小(1×2 PD)并伴有明显渗出和出血,先后做了7次TTT,参数为80～280 mW、2 mm光斑、曝光60 s,每次间隔3 mo以上.CNV病灶最终消退,但黄斑部遗留白色区,视力由0.3降至0.04.结论:TTT可使CNV病灶消退,但可发生明显的RPE和脉络膜萎缩,这无益于视力.如果对亚洲患者应用TTT,其参数可低于120 mW/mm,限于2次.

Retinal pigment epithelial and choroidal atrophy in wet age-related macular degeneration treated with multiple transpupillary themotherapy:A case report

AIM: To report a case of wet age-related macular degeneration (AMD) treat with multiple transpupillary themotherapy (TTT) and choroidal neovascularization (CNV) disappeared but retinal pigment epithelial (PRE) and choroidal atrophy occurred with a low vision at the end point.METHODS: Clinical data including fundus hotographs, fundus fluorescein angiography (FFA), indocyanine angiography (ICGA) and optical coherence tomography(OCT) was reviewed.RESULTS: A 72-year-old man complained about blurred vision of his left eye and FFA revealed polypoidal choroidal vasculopathy (PCV) in the macula. His left eye had stable vision of 0.1 for 6 years without any treatment of CNV. About 2 years later, his right eye presented a piece of CNV. During the period of 3 years, the lesion remained more (3×5 PD) and less (1×2PD) in size with remarkable exudates and bleeding, and 7 sessions of TTT were applied with 80-280mW, 2mm of spot, and 60 seconds exposure and with the interval of 3 months or more. The CNV lesion finally disappeared, but there left a white area in the macula and vision decreased from 0.3 to 0.04.CONCLUSION: Although CNV lesion can be eliminated by TTT, obvious atrophy of RPE cells and the choroids can happen and this may not be of help for patient vision. It suggests that the parameters of TTT will be lower than 120 mW/mm and limited less two sessions if applicable, especially for Asia people.