光动力疗法治疗老年性黄斑变性的临床研究

目的
观察光动力疗法(photodynamic therapy,PDT)对渗出型老年性黄斑变性(age-related macular degeneration,AMD)脉络膜新生血管(choroidal neovascularization,CNV)进行单次和多次治疗的临床疗效。
方法
20例经双目间接立体检眼镜、荧光素眼底血管造影(fundus fluorescein angiography, FFA)、吲哚青绿血管造影(indocyanine green angiography, ICGA)检查确诊的AMD患者的31只患眼纳入治疗。患者年龄47～88岁，平均年龄68.1岁，最佳矫正视力在数指/10 cm～0.6之间。光敏剂苯并卟啉衍生物单酸(benzoporphyrin derivative mono acid, BPD)(中国诺华公司)6 mg／m 2静脉滴注10 min，开始静脉用药后15 min，通过裂隙灯用强度为50 J／cm2的689 nm激光(德国Zeiss公司)照射83 s。治疗后患者尽可能避光48 h。治疗后2周开始复查，每3个月随访1次，随访时间最短3个月，最长18个月，平均随访12个月。FFA和(或)ICGA显示病灶范围扩大、或渗漏增加，即进行重复PDT治疗。其中1只眼进行了4次治疗, 4只眼进行了2次治疗，其余26只眼均只进行了1次治疗。
结果
治疗后13只眼视力明显改善(视力提高≥2行)，占41.9%；17只眼视力稳定不变(视力波动在1行以内)，占54.8%；1只眼视力下降2行，占3.2%。所有患眼于PDT治疗后眼底出血和渗出均减轻；FFA或FFA+ICGA检查显示：PDT治疗后2周，CNV的渗漏明显减少或完全停止，复发或扩大的CNV经多次PDT治疗后，渗漏逐渐减少，3例5只眼渗漏完全停止。光相干断层成像术(optic coherence tomography, OCT)检查显示CNV周围视网膜脉络膜的水肿以及神经上皮脱离、色素上皮脱离明显好转。20例患者在PDT治疗过程中及治疗后未发生任何全身和局部不良反应。
结论
单次和重复PDT治疗可以部分或完全封闭AMD 的CNV，多次PDT治疗可以封闭CNV，降低AMD引起视力下降的危险性。PDT治疗不影响病灶周围的正常视网膜和脉络膜组织，对视力无损害。
(中华眼底病杂志, 2002, 18: 175-179)

Clinical study of photodynamic therapy for age-related macular degeneration

Objective
To study the clinical results and safty of photodynamic therapy (PDT) after single and multi-treatments of patients with subfoveal choroidal neovascularization (CNV) caused by wet age related macular degeneration (AMD).

Methods
From July, 2000 to July, 2001, 20 wet AMD patients (31 eyes) 47 88 years old (mean 68.2 years old) with best-corrected visual acuity from FC/10 cm to 0.6 diagnosed through optic coherence tomography (OCT), 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 body 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 (Zeiss company, German) delivered 50 J/cm2 at an intensity of 600 mW/cm2 over 83 seconds on CNV. Visual acuity, photochrome of ocular fundus, OCT, FFA, ICGA were used to evaluate the effects of photodynamic therapy with BPD. Follow-up of these patients was planned 1-2 week and every 3 month after PDT. Once the lesion area progressed, PDT was applied again. Tweenty cases (31 eyes) were followed up from 3 to 18 months (average 12 month).In 1 affected eye, PDT was applied fow 4 times, 4 eye for 2 times, and the other 26 eyes for 1 time.
Results
The visual acuity in 13 (41.9%) eyes was improved (increase≥2 lines) after PDT. Stabilized (±1 line) in 17 (54.8%) eyes and decreased 2 lines（attributed to the recur of CNV ）in 1 (3.2%) eye. After PDT, the fundus haemorrhage and fluid leakage reduced. FFA and ICGA showed. cessation and obvious reduction of fluorescein leakage from CNV in all patients 2 weeks after photodynamic therapy, and retreatment decreased the leakage step by step. Fluorescein leakage from at least a portion of the CNV reappeared by 1-3 month after treatment in some cases. OCT also showed the reduction of the size of CNV, moreover, the edema of surrounding retina and choriodal and serous neural epithelial detachment recovered obviously. No side affect during and after PDT was noticed.
Conclusions
PDT with BPD can achieve short-term effect on part or total cessation of fluorescein leakage from CNV without loss of vision or growth of classic CNV in patients with age-related macular degeneration, retreatment of PDT was also effective.

(Chin J Ocul Fundus Dis, 2002, 18: 175-179)