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目的:报道经玻璃体腔内注射高剂量曲安奈德(triamcinolone acetonide,TA)联合光动力学疗法(photodynamic therapy,PDT)治疗老年性黄斑变性( age related macular degeneration, AMD)的脉络膜新生血管(choroidal neovascularization,CNV)后发生的脉络膜毛细血管萎缩。方法:我们采用非随机回顾性干涉治疗病例。在阿利坎特学院眼科,连续观察51眼(实验组)玻璃体腔内的注射(19.4±2.1)mg/0.1mL TA联合PDT治疗AMD的全部中心凹下型CNV患者,经过2a的随访,检查黄斑部脉络膜毛细血管和视网膜色素上皮细胞(RPE)萎缩情况。同时,采用单独PDT治疗的连续30眼患者作为对照组,其年龄,性别和AMD的CNV类型及大小与实验组相匹配。结果:随访24mo后,在治疗区域21/47眼(45%,实验组)和7/30眼(23%,对照组)发展成黄斑部RPE和脉络膜毛细血管萎缩(P=0.04,卡方检验)。实验组平均最大萎缩区域的直径为(5044±1666)μm,而对照组为(4345±1550)μm。在实验组中,RPE萎缩患者的平均最佳矫正视力为(0.87±0.33),而非RPE萎缩患者的平均最佳矫正视力为(0.66±0.26) (P=0.11,秩和U检验)。结论:玻璃体腔内注射大剂量TA联合PDT治疗可能会增加RPE和脉络膜毛细血管萎缩的风险。
OBJECTIVE: To report the effect of choroidal neovascularization (TA) combined with intravitreal injection of high dose triamcinolone acetonide (TA) combined with photodynamic therapy (PDT) on age related macular degeneration (AMD) , CNV) occurred after choroidal capillary atrophy. Methods: We used nonrandomized retrospective interventions to treat cases. In the Department of Ophthalmology, University of Alicante, 51 patients (experimental group) undergoing intravitreal injection of (19.4 ± 2.1) mg / 0.1 mL TA combined with PDT for all subfoveal CNV patients undergoing AMD were followed up for visualization of macular Department of choroidal capillaries and retinal pigment epithelial cells (RPE) atrophy. Meanwhile, 30 consecutive patients treated with PDT alone served as a control group, whose age, sex, and AMD type and size of CNV matched the experimental group. RESULTS: After 24 months of follow-up, macular RPE and choroidal capillary atrophy were developed in 21/47 eyes (45% of the experimental group) and 7/30 eyes (23% of the control group) in the treated area (P = 0.04, Chi-square test ). The average diameter of the largest atrophy in the experimental group was (5044 ± 1666) μm, while that in the control group was (4345 ± 1550) μm. In the experimental group, the mean best corrected visual acuity was (0.87 ± 0.33) for patients with atrophic atrophy and 0.66 ± 0.26 for non-RPE atrophic patients (P = 0.11, rank sum U test). Conclusions: Intravitreal injection of large doses of TA combined with PDT may increase the risk of RPE and choroidal capillary atrophy.