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目的观察分析光动力疗法(PDT)治疗后的黄斑区脉络膜新生血管(CNV)的病灶特点。方法对经间接检眼镜、荧光素眼底血管造影(FFA)、吲哚青绿脉络膜血管造影(ICGA)、光学相干断层扫描(OCT)检查确诊的黄斑区脉络膜新生血管患者34例(38眼)进行光动力疗法,静脉注射维速达尔15min后根据病灶大小用689nm激光照射83s。治疗后患者避光5d。观察治疗后1周及1个月的视力、眼底改变、OCT检查结果 ,1个月时的FFA改变。结果 34例随访患者视力较治疗前无下降。其中治疗1周后视力上升(2行或2行以上)18眼,不变20眼;1个月后视力较1周时提高12眼,不变25眼,下降(2行或2行以上)1例。治疗后1周黄斑区出血(根据眼底镜检查及眼底彩照)明显减少13眼,出血范围无明显变化12眼,出血范围明显增加13眼;1个月后黄斑区出血较1周时明显减少31眼,无明显变化4眼,出血范围增加3眼。治疗后1周黄斑中心凹区视网膜厚度或渗漏明显减少、CNV病灶复合体变小36眼,无明显变化2眼。1个月时黄斑中心凹区视网膜厚度或CNV病灶复合体较1周时有所增加11眼,其余眼保持1周时的状态或继续好转。治疗后1个月FFA显示原CNV渗漏明显减轻27眼,无明显变化5眼,渗漏增加6眼。所有病例治疗时及治疗后均无并发症发生。结论 PDT作为治疗黄斑区脉络膜新生血管的一种技术能起到稳定视功能的作用,治疗后的CNV病灶短期内明显萎缩,但1个月时有部分可能会重新开放,此时可辅以抗新生血管生长因子等药物的治疗。OCT检查对于早期评判病灶的变化及对病变的预后有重要意义。部分病例治疗后短期内可引起出血的增加,但此类出血多不影响视力,且可逐渐吸收。
Objective To observe and analyze the focal features of macular choroidal neovascularization (CNV) after photodynamic therapy (PDT). Methods Thirty-four patients (38 eyes) with macular choroidal neovascularization diagnosed by indirect ophthalmoscope, fluorescein angiography (FFA), indocyanine green choroidal angiography (ICGA) and optical coherence tomography (OCT) Motility therapy, intravenous injection of Velocity 15min according to the size of the lesion with 689nm laser irradiation 83s. After treatment, patients with dark 5d. Visual acuity, ocular fundus changes, OCT findings and FFA changes at 1 month were observed at 1 week and 1 month after treatment. Results 34 cases of follow-up patients with no improvement in visual acuity before treatment. One week after treatment, the visual acuity increased (2 lines or more than 2 lines), 18 eyes, unchanged 20 eyes; 1 month after eyesight increased by 12 eyes, unchanged 25 eyes, decreased (2 lines or more) 1 case. One week after treatment, the macular hemorrhage (based on funduscopy and fundus photography) was significantly reduced by 13 eyes, with no significant change in the bleeding range in 12 eyes, and the bleeding range was significantly increased by 13 eyes. The macular hemorrhage was significantly reduced by 1 month compared with that at 1 week Eyes, no significant change in 4 eyes, increased bleeding 3 eyes. At 1 week after treatment, the retinal thickness or leakage in the foveal area was significantly reduced, CNV lesion complex decreased 36 eyes, no significant change in 2 eyes. At 1 month, the retinal thickness or CNV lesion complex in the foveal area increased by 11 eyes compared with that at 1 week, and the rest of the eyes maintained the state at 1 week or continued to improve. One month after treatment, FFA showed that the original CNV leakage was significantly reduced in 27 eyes, no significant change in 5 eyes, and increased leakage in 6 eyes. No complications occurred during and after treatment in all cases. Conclusion PDT as a treatment of macular choroidal neovascularization can play a role in stabilizing visual function, after treatment of CNV lesions significantly shortened, but some may be reopened at 1 month, this time can be supplemented with anti- Neovascular growth factor and other drugs. OCT examination for the early assessment of changes in lesions and the prognosis of lesions of great significance. Some cases of short-term treatment may cause increased bleeding, but more such bleeding does not affect the vision, and gradually absorbed.