光动力疗法治疗国人常见脉络膜新生血管疾病的二年随访观察

目的研究光动力疗法（PDT）治疗年龄相关性黄斑变性（AMD）、病理性近视（PM）和特发性脉络膜新生血管形成（CNV）三种国内常见CNV相关疾病的长期效果和安全性。设计回顾性病例系列。研究对象2005年6月至2007年12月西京医院眼科确诊的CNV患者91例（101眼）。方法患者经常规PDT治疗，治疗后每3个月进行复查，复发的患者再次行PDT治疗。观察治疗前与治疗后12、24个月时患者的最佳矫正视力（BCVA，ETDRS视力表）、荧光素眼底血管造影（FFA）图像上CNV病灶情况、治疗次数及不良事件等。患者治疗后均完成24个月随访。主要指标BCVA，CNV病灶大小和活动性。结果AMD、PM和特发性CNV的平均治疗次数分别为1．50、1．38和1．19次。AMD组治疗后BCVA和CNV病灶大小均无明显变化，保持稳定；PM组和特发性CNV组视力提高（分别为7．0和7．7个字母，7．6和11．6个字母），并且CNV病灶缩小。三组病例视力稳定和提高者12个月时分别为77．1％、76．2％和87．5％；24个月时为79．2％、81．0％和87．5％。CNV进展者12个月时各组分别为18．8％、19．0％和12．5％；24个月时为14．6％、14．3％和6．2％。除3例（2．2％）AMD患者因玻璃体积血和视网膜色素上皮撕裂导致眼部严重不良反应外，未发现其他严重不良反应。结论在2年的随访期间，PDT可安全有效地改善或稳定我国临床常见CNV患者的视功能，控制病变进展。

Two-year outcomes of photodynamic therapy for choroidal neovascularization in Chinese patients

Objective To evaluate the clinical effects and safety of photodynamic therapy （PDT） for choroidal neovascularization （CNV） in age-related macular degeneration （AMD）, pathological myopia （PM） and idiopathic CNV. Design Retrospective case series. Participants 91 cases （101 eyes） clinically diagnosed as CNV in Xijing Hospital from June 2005 to December 2007. Methods All patients received routine PDT protocols. After treatment, the follow-up period was 3 months intervals through two years. If necessary, re- treatment was administered. The best corrected visual acuity （BCVA）, greatest linear dimension （GLD） and leakage level of CNV lesion were compared among baseline, 12-month visit and 24-month visit. Besides, adverse events and treatment times were evaluated at the same time. Main Outcome Measures BCVA, GLD and leakage level of CNV lesion. Results The mean times of PDT treatment for AMD, PM and idiopathic CNV were 1.50, 1.38 and 1.19, respectively. Compared to baseline, BCVA and GLD were stable at the 12th month and the 24th month after PDT in AMD group. In PM and idiopathic CNV group, the mean letter score of BCVA increased 7.0, 7.7 letters and 7.6, 11.6 letters respectively with reduction of corresponding mean GLD of lesion. In above three groups, 77.1%, 76.2% and 87.5% eyes avoided more than 5 letters of visual loss at the 12th month; the corresponding percentages were 79.2%, 81.0% and 87.5% at the 24th month. Moreover, the percentages of progressive CNV were 18.8%, 19.0%, 12.5% at the 12th month and 14.6%, 14.3%, 6.2% at the 24th month respectively. Three cases of AMD had serious adverse responses because of sudden vitreous hemorrhage and retinal pigment epithelium tear. Conclusions PDT could improve or stabilize the visual function of AMD, PM and idiopathetie CNV patients, as well as control the progression of disease. It is safe and effective for CNV patients during the two-year follow-up period.