光动力疗法:一种脉络膜新生血管性疾病划时代治疗手段的应用回顾与前景展望

通过光化学反应,破坏病理性血管内皮细胞、形成血栓、导致血管萎缩的光动力疗法(PDT)是首个被证实可以有效控制渗出型老年性黄斑变性(AMD)的治疗方法,从2000年引进我国的12年来,将各种原因引起的黄斑区脉络膜新生血管(CNV)的治疗带入了一个新时代；促进了我们对CNV性疾病机制的认识；为中心性浆液性脉络膜视网膜病变、息肉状脉络膜血管病变、脉络膜血管瘤等视网膜脉络膜病变提供了新的治疗手段.然而,随着新药物和治疗方式的增加,对PDT适应证的掌握,PDT联合治疗的选择和治疗方案的优化等临床研究值得进一步探索；PDT的原理,它与个体基因组的关系以及对血管生长机制的影响等研究更是具有挑战.因此,继续从临床和基础方面探索PDT与疾病的关系,不仅可以指导临床应用,满足眼底病临床工作的现实需求,还可能为进一步揭示以CNV为代表的新生血管性疾病发生、发展规律,了解疾病的本质提供帮助.

Review and prospect forecast of photodynamic therapy which is kind of generational treatment for choroidal neovascularization

Photodynamic therapy is the first treatment confirmed to be effective in the treatment of exudative age-related macular degeneration in 2000,which had been introduced to China in the same year.The pathological new vessels were destructed by the singlet oxygen and oxygen free radical released by activated photosensitizer.In the next 12 years,it has been widely applied for the treatment of subfoveal and parafoveal choroidal neovascularization caused by all kinds of chorioretinal diseases.More than a treatment,it also help us to explore the pathogenesis of fundus disease,the capability to embolize the capillaries within the treating area let us not only understand the mechanism of central serous chorioretinopathy and polypoidal choroidal vasculopathy,but also make it a effective cure for them.However,there are still a lot of unsolved questions such as the mechanism of photodynamic therapy,the relationship with human genomic difference,and even the development of angiogenesis.Besides with the more novel medications and strategies available,we also face the appropriate application for indications,selection of combined therapy and optimization of treatment regimens.Further investigations about the photodynamic therapy and disease and their relations from both basic and clinical study will guide us the treatment in clinic and also reveal the truth of related fundus diseases deep under the surface.