OCT对光动力疗法治疗CNV的疗效评估

Therapeutic effects of photodynamic therapy for treating choroidal neovascularization by optic coherent tomography

摘要:

目的：观察光学相干断层扫描(optical coherence tomography，OCT)评估光动力疗法(photodynamic therapy，PDT)治疗老年黄斑变性(age-related macular degeneration，AMD)、病理性近视(pathological myopia， PM)和中心性渗出性脉络膜视网膜病变(central exudative chorioretinopathy，CEC)引起的脉络膜新生血管(choroidal neovascularization，CNV)视网膜的疗效和安全性。

方法：回顾分析2010-01/2012-12经视力、眼压、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)和OCT检查，临床确诊为有CNV形成的临床患者资料，共53例53眼符合条件纳入观察。患者经PDT治疗后，每3mo进行随访复查，复发的患者再次进行PDT治疗。对比分析治疗前与治疗后1a患者最佳矫正视力(BCVA)及黄斑中心视网膜厚度(central macular thickness，CMT)的改变。

结果：截止随访结束时，患者经PDT治疗后，最佳矫正视力均比治疗前提高35例，视力稳定无明显变化15例，视力下降3例； 所有患者眼底渗漏均减轻，经FFA检查42例患者CNV闭合且渗漏完全停止，11例患者CNV大部分闭合。治疗前后患者视力及CMT改变均有统计学意义。整个治疗及随访中所有患者均未见与接受PDT治疗相关的眼部和全身不良反应。

结论：PDT治疗AMD患者CNV能够在1a内保持视力的稳定，且严重不良事件的发生率低，是AMD 患者CNV治疗的安全有效方法。

Abstract:

AIM: To evaluate the clinical efficacy and safety of photodynamic therapy(PDT)on choroidal neovascularization(CNV)caused by age-related macular degeneration(AMD), pathological myopia(PM), and central exudative chorioretinopathy(CEC).

METHODS: A retrospective observation on the clinical data of 53 AMD patients(53 eyes)from January 2010 to December 2012, diagnosed CNV through fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA)and optic coherence tomography(OCT), treated with PDT. The changes of best corrected visual acuity(BCVA)and central macular thickness(CMT)were compared before and 1a after treatment.

RESULTS: At the last follow-up, the BCVA was improved in 35 cases, stabilized in 15 cases and decreased in 3 cases. Fundus hemorrhage and exudation reduction after PDT was observed in all patients. FFA and OCT showed complete closure of CNV in 42 cases, partial closure in 11 cases. The visual acuity and CMT changes were statistically significant. No serious adverse event related to PDT.

CONCLUSION: PDT is helpful for maintaining the visual acuity of wet-AMD within 1a and the incidence of the adverse response is low, which suggest that PDT is an effective and safe treatment for CNV in patients of AMD.