经瞳孔温热疗法治疗病理性近视性脉络膜新生血管的临床观察

目的:观察经瞳孔温热疗法(TTT)治疗病理性近视合并中心凹下脉络膜新生血管(CNV)的疗效.方法:采用半导体810nm红外激光对荧光素眼底血管造影(FFA)和吲哚青绿血管造影(ICGA)检查确诊的高度近视合并CNV患者15例15眼进行治疗.治疗后每月复查1次,随访1～3 mo.随访时检查视力、眼底出血和渗出吸收、CNV闭合情况.结果:15眼治疗后均无即刻视力下降或其他不适.末诊时与初诊视力相比,73.3%无变化,26.7%增加.所有病灶渗漏减少或消失,出血基本吸收,CNV部分闭塞并纤维化.OCT检查激光后CNV厚度变薄.有3例患者3眼脉络膜萎缩灶扩大,2例2眼病灶瘢痕化.结论:TTT对治疗高度近视合并CNV有一定效果,但存在病灶疤痕化及脉络膜萎缩灶较治疗前扩大的问题.

Clinical observation of transpupillary thermotherapy for choroidal neovascularization in pathologic myopia

AIM:To investigate the therapeutic efficacy of laser transpupillary thermotherapy(TTT) for pathologic myopia accompanied with subfoveal choroidal neovascularization(CNV). METHODS:Fifteen patients(15 eyes) diagnosed as high myopia accompanied with subfoveal CNV by fundus fluorescein angiography(FFA) and indocyaninegreen angiography(ICGA) were treated with diode 810 laser. During the follow-up of 1-3 months,visual acuity,haemorrhage in ocular fundus,absorption of exudation and the closure of CNV were examined in every month after the treatment. RESULTS:No immediate decrement of visual acuity or any other discomforts were found in the treated eyes after the treatment. The mean visual acuity in the last diagnosis was increased in 26.7% eyes and remained unchanged in 73.3% eyes compared with that in the first diagnosis. The leakage in focus of infection was decreased or vanished. Hemorrhage was absorbed and CNV partly blocked and fibrous degenerated in all patients. CNV was thinned after laser detected by opitical coherence tomography(OCT). Choroidal atrophy was expanded in 3 patients(3 eyes). Focus of infection was scarred in 2 patients(2 eyes). CONCLUSION:TTT is an effective treatment for CNV in high myopia,but it has the drawback of scar formation and choroidal atrophy ampliation.