光动力疗法与经瞳孔温热疗法治疗孤立型脉络膜血管瘤的疗效观察

目的 观察经瞳孔温热疗法(TTT)和光动力疗法(PDT)治疗孤立型脉络膜血管瘤(CCH)的疗效.方法 回顾性分析经眼底检查、荧光素眼底血管造影(FFA)、吲噪青绿血管造影(ICGA)、光相干断层扫描(OCT)、眼部B型超声检查确诊为CCH的患者32例33只眼的临床资料.所选病例治疗前最佳矫正视力为指数/眼前～0.2,瘤体大小2～10个视盘直径(DD),均有浆液性视网膜脱离.其中21例22只眼CCH位于除乳斑柬及黄斑拱环内区域外的后极部采用经瞳孔温热疗法(TTT)治疗.使用Iris 810 nm半导体红外激光,能量700～1200 mw,时间60 S,光斑1～3个不等;11例11只眼CCH位于乳斑束及黄斑拱环以内区域的PDT治疗.经静脉注射维速达尔15 min后采用689 nm波长半导体激光对病灶进行照射83～123 s.随访时间12～48个月,平均随访时间为25.6个月.治疗后复查视力、间接检眼镜、彩色眼底照像、FFA、ICGA、OCT和B型超声波检查,观察其疗效.结果 TTT治疗22只眼中,15只眼视力提高,7只眼视力稳定,眼底检查见视网膜平复,瘤体呈灰白色机化瘢痕,造影显示病灶无荧光渗漏,晚期机化瘢痕处呈荧光染色.OCT检查显示22只眼视网膜神经上皮脱离消失,视网膜下积液完全吸收,其瘤体部脉络膜光带反射增强,瘢痕形成;B型超声检查显示22只眼无视网膜脱离,瘤体萎缩.PDT治疗11只跟中9只眼视力提高,2只眼视力稳定,眼底检查见瘤体萎缩,色素沉着,造影显示荧光渗漏消失;OCT显示视网膜下液完全吸收,B型超声检查11只眼瘤体萎缩.结论 TTT与PDT治疗CCH有效但适用部位有所不同.两种方法均可使瘤体萎缩,稳定或提高患者的视力.

Therapeutic effect of photodynamic therapy and transpupillary thermotherapy on circumscribed choroid hemangioma

Objective To observe the therapeutic effect of photodynamic therapy (PDT) and transpupillary thermotherapy (TTT) on circumscribed choroid hemangioma (CCH).Methods Clinical data of 32 patients (33 eyes) with CCH diagnosed by ocular fundus examination,fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA),optical coherence tomography (OCT) and B-ultrasound examination were retrospectively analyzed.Before the therapy the selected cases had best corrected visual acuity (BCVA) of finger-counting/15 cm-0.2,the sizes of 2-10 disc diameter (DD) and serous retinal detachment.Twenty-one patients (22 eyes) whose tumor located at the posterior pole except for the papillomacular bundle and arch ring area underwent TTT.The parameters of TTT included:Iris 810 nm infra red diode laser,700-1200 mW,60 s,and 1-3 spots.Eleven patients (11 eyes) with tumor located at the posterior pole except for the papillomacular bundle and arch ring area underwent.After 15 minutes of intravenous injection with Visudyne,laser irradiation with the wavelength of 689 nm was performed with the time of 83-123 s.The follow-up period was 12-48 months with the mean of 25.6 months.BCVA and results of indirect ophthalmoscopy,fundus photogrphy,FFA,ICGA,OCT and B-ultrasound examination were exanmined and anlyzed.Results In the 22 eyes in TTT group,the BCVA improved in 15 and kept unchanged in 7;the results of fundus examinations showed healed retina and atrophy tumor with grey-white organized scar;the results of FFA revealed no fluorescence leakage and scar fluorescence dyeing of the lesion in later period;the results of OCT indicated disappeared retinal detachment,completely absorbed subretinal liquid and increased reflection of ehoroid tumor with sear;the results of D-ultrasound examination showed no retinal detachment and atrophy tumor.In 11 eyes in PDT group,the BCVA improved in 9,unchanged in 2;the results of fundus examinations showed atrophy tumor with pigmentation;the results of FFA revealed disappeared fluorescence leakage;the results of OCT indicated completely absorbed subretinal liquid;the results of B-ultrasound examination showed atrophy tumor.Conclusions Both TTT and PDT can make the tumor atrophy,improve BCVA or keep it still;but apply to different area.