多灶性脉络膜炎并发中心凹下脉络膜新生血管的光动力治疗

目的 观察光动力疗法( PDT)为主的综合疗法对多灶性脉络膜炎(MC)并发脉络膜新生血管(CNV)的疗效.方法 临床确诊为MC并发中心凹下CNV并接受PDT等综合治疗的8例9只眼纳入研究.其中,男性1例1只眼,女性7例8只眼.年龄25～54岁,平均年龄(41.8±10.6)岁.所有患者均进行最佳矫正视力(BCVA)、裂隙灯显微镜、间接检眼镜、荧光素眼底血管造影、光相干断层扫描检查.BCVA为20/333到20/50,转换成最小视角对数(logMAR)后其平均值为0.68±0.32;CNV平均面积为(0.767±0.445) mm2;黄斑中心凹视网膜平均厚度为(355.2±65.2)μm.其中行单纯PDT者4只眼,联合口服糖皮质激素2只眼,玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab(商品名Avastin)者1只眼,后Tenon囊下注射曲安奈德者2只眼.治疗后随访3～22个月,平均随访(14.0±5.7)个月.对比分析治疗前后BCVA、CNV面积和中心凹视网膜厚度.结果 末次复诊时,BCVA为20/250到20/25,logMAR平均值为0.58±0.37,与治疗前比较,差异无统计学意义(t=1.890,P=0.095).其中,3只眼视力提高3行,占33.3％;1只眼视力提高1.5行,占11.1％;4只眼视力稳定,占44.4％;1只眼视力下降1.5行,占11.1％；无下降超过3行者.CNV平均面积为(0.684±0.371) mm2,与治疗前比较,差异无统计学意义(t=0.996,P=o.349).黄斑中心凹视网膜平均厚度为(295.3±79.4)μm,与治疗前比较,差异无统计学意义(t=2.242,P=0.055).结论 PDT为主的综合治疗可有效稳定MC并发CNV患者的视力,尤其是联合抗血管内皮生长因子药物或糖皮质激素后.

Photodynamic therapy for subretinal choroidal neovascularization in patients with multifocal choroiditis

Objective To observe the clinical effect of photodynamic therapy (PDT)based comprehensive treatment for choroidal neovascularization (CNV) in patients with multifocal choroiditis (MC).Methods Nine eyes of 8 MC patients (7 females and 1 male) with CNV who had undergone PDT based comprehensive treatment were enrolled in this study.The patients aged from 25 to 54 years with the mean of (41.8±10.6) years.The examinations of best-corrected visual acuity (BCVA),slit lamp microscope,indirect ophthalmoscopy,fundus fluorescein angiography and optical coherence tomography were performed.The BCVA ranged from 20/333 to 20/50 (mean logMAR 0.68±0.32).The mean CNV area was (0.767±0.445) mm2.The central retinal thickness (CRT) was (355.2±65.2) μm.Among the 8 patients,4 eyes received only PDT,2 eyes received PDT and oral corticosteroid,1 eye received PDT and intravitreal injection of 1.25 mg bevacizumab,2 eyes received PDT and subtenon injection of 40 mg triamcinolone acetonide.The follow-up period ranged from 3 to 22 months,with the mean of (14.0± 5.7)months.The BCVA,mean CNV area and CRT before and after treatment were analyzed.Results By the end of last visit,the BCVA improved to 20/250 to 20/25 (mean logMAR 0.58±0.37),but the difference was not statistically significant (t=1.890,P=0.095).Visual acuity improved 3 lines in 3 eyes (33.3 ％),improved 1.5 lines in 1 eye ( 11.1 ％),unchanged in 4 eyes (44.4 ％ ) and decreased 1.5 lines in 1 eye (11.1 ％ ).The mean CNV area decreased to (0.684 ± 0.371) mm2,but the difference was not statistically significant (t=0.996,P=0.349).The CRT decreased to (295.3±79.4) μm,but the difference was not statistically significant (t=2.242,P=0.055).Conclusion PDT can stabilize visual acuity in patients with subretinal CNV secondary to MC,especially when combined with intravitreal injection of anti-vascular endothelial growth factor drugs or steroid.