光动力治疗中心性渗出性脉陇视网膜炎的临床观察

目的光动力疗法(photodynamic therapy,PDT)对中心性渗出性脉络膜视网膜炎(central exudative chorioretinopathy CEC)的临床治疗观察。方法14例,14只眼经眼底检查、荧光眼底血管造影(fundus fluorescein angiography,FFA)、吲哚青绿血管造影(indocyanine green angiography,ICGA)检查确诊为中心性渗出性脉络膜视网膜炎(central exudative chorioretinopathy,CEC)的患者14只眼进行治疗,患者年龄18-38岁,平均年龄28.2岁,最佳矫正视力0.1-0.5之间,光敏剂苯丙扑啉衍生物单酸。6mg/m2静脉滴注10min,开始静脉用药后15min,通过裂隙灯用强度为50J/cm2,波长为689nm激光,照射83s。治疗后患者尽可能避光48-72h,治疗后7d开始复查,随访3个月,并在3个月时进行眼底检查、FFA、ICGA等全面检查。结果治疗后,10只眼(71.4%)视力有明显提高,7只眼(50%)在1个月左右时视力有所波动。OCTFFAICGA检查结果显示,光动力治疗后大部分病例CNV静止或萎缩,但一部分病例仍可见CNV残骸及局部的色素上皮囊样变性。多焦视网膜电图(multifocal electroretinography mERG)1-5环N1、P1波振幅密度值与治疗前均有显著差异(P<0.05),PDT治疗后7d的mfERGN1波、P1波幅密度与治疗前比较均无明显差异(P>0.05)。两组PDT治疗前后各时间点mfERGN1波、P1波潜峰时无显著差异(P>0.05)。结论PDT治疗中心性渗出性脉络膜视网炎(CEC)有波动现象。PDT治疗早期观察对黄斑神经上皮感觉层损伤不明显。PDT治疗中心性渗出性脉络膜视网炎(CEC)短期疗效满意。

Clinical observation of central exudative chorioretinopathy treated with phtodynamic therapy

Objective To assess the clinical curative effects of patients with central exudative chorioretinopathy (CEC) after photodynamic therapy ( PDT). Methods fourteen CEC patients (14 eyes) 18-38 years old (mean 28.2 years old) with best corrected visual acuity from 0.1 to 0.5 diagnosised through fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were treated with PDT .All cases were assigned to benzoporphyrin derivative mono acid (BPD) (6 mg per square meter of surface area), administered via intravenous infusion of 30 ml over 10 minutes. Fifteen minutes after the start of the infusion, a laser light at 689 nm delivered 50 J/cm2 at an intensity of 600 mW/cm2 over 83 seconds on CNV. Patients keeped away from light 48-72 hours. re-examination started from 7days and follow up to 3 months after PDT, examination of fundus and FFA, ICGA, OCT were detected in 3 months after PDT. Results The visual acuity in 10 (71.4%)eyes was improved 15days after PDT, and in 7 (50%) eyes was astable 1 months after PDT. OCT, FFA and ICGA result display that CNV was quiescing or atrophied in the bulk of cases and in some cases CNV remnant and pigmented epithelium cystoid degeneration could be seen. multifocal electroretinography N1 and P1 wave 1-5 ring peak amplitude densities change significantly 1 months and 3months sfter PDT (P<0.05), N1 and P1 wave peak amplitude densities in the ring 1-6 did not change significantly 7 d after PDT treatment (P>0.05), N1 and P1 wave peak latency in the ring 1-6 did not change significantly in different periods (P>0.05). Conclusion fluctuation phenomenon could be seen in CEC treated with PDT. There was not significant damage of macular neural epithelium in earlier period of PDT treatment. short-term curative effect of CEC treated with PDT was satisfied.