非老年性黄斑变性患者脉络膜新生血管的治疗现状

非老年性黄斑变性(AM D)患者脉络膜新生血管(CNV)的病因复杂,自然预后差异较大,临床上对其治疗方法的选择一直存在较大的争议。当前对其治疗的主要方法包括:观察、激光光凝、局部或全身抗炎药物、黄斑下手术取出CNV、光动力疗法(PDT)治疗等。然而随着治疗理念的更新和新技术的引入,不同方法在不同时期内临床应用的广泛程度存在明显差异。根据CNV的病因、自然预后以及患者自身的特定条件来选择合适的治疗方法是非AM D性CNV患者进行针对性治疗的重要课题。     

脉络膜新生血管的治疗研究进展

脉络膜新生血管(choroid neovascularization,CNV)多见于年龄相关性黄斑变性、病理性近视黄斑变性和中心性渗出性脉络膜视网膜病变等眼底疾病,是导致其视力下降甚至丧失的主要原因。治疗上,激光光凝,经瞳孔温热疗法及光动力学疗法等已在我国广泛开展; 而抗新生血管形成和病变炎性反应过程的药物应用于临床也显著增多; 用基因疗法、靶向治疗CNV等新领域亦取得了成绩,现就近年来国内外关于CNV的治疗研究现状做一综述。     

光动力疗法联合抗血管内皮生长因子药物治疗脉络膜新生血管的进展

脉络膜新生血管( choroidal neovascularization, CNV)是多种眼底病致盲的主要原因,好发于黄斑区,严重影响中心视力。 CNV常用治疗包括相对选择性治疗———光动力疗法( photodynamic therapy, PDT)、选择性治疗———抗血管内皮生长因子( anti-vascular endothelial growth factor, VEGF)药物。但PDT治疗后视力不提高,还可上调VEGF的表达、继发炎症反应;抗VEGF药物需多次注射以维持疗效,进而带来不良反应的风险和经济负担。目前, PDT联合抗VEGF药物治疗CNV在基础与临床研究方面均取得一定进展,使得联合疗法成为 CNV 治疗的选择之一。为了减少治疗后的不良反应,实施联合疗法时是否变更PDT治疗参数需要进一步研究。     

光动力疗法治疗渗出型老年性黄斑变性

光动力疗法(PDT)是目前治疗老年性黄斑变性(AMD)的脉络膜新生血管(CNV)较为安全有效的方法。本文综述了适于PDT治疗的CNV的特点和PDT的并发症。其中CNV的类型、病灶大小、位置及活动性对治疗效果影响较大,而对于AMD特殊类型如息肉状脉络膜血管病变和视网膜血管瘤样增生症的治疗方案尚需进一步探索。     

脉络膜新生血管的光动力疗法研究进展

位于黄斑下的脉络膜新生血管(cgiriudak beivascykaruzatuib，CNV)是严重影响视力的一类病变，光动力疗法(photodynamic therapy，PDT)是CNV的新治疗方法之一，现对光敏剂的研究进展及PDT在CNV的动物实验与临床研究中的应用进展作一综述，指出PDT是CNV的一种安全、有效的治疗方法。     

光动力疗法联合玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab治疗视网膜血管瘤样增生的疗效观察

视网膜血管瘤样增生(RAP)是近年来被认同的一种渗出型老年性黄斑变性( AMD)的特殊类型[1].其表现为深层视网膜内血管异常及视网膜-视网膜或视网膜-脉络膜血管吻合[2-5].RAP自然预后不良,其治疗也尚处于探索阶段.无论是对异常血管团直接激光光凝、激光光凝其滋养血管、光动力疗法(PDT)或经瞳孔温热疗法效果均不理想[6].我们采用PDT联合玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab(商品名Lucentis)对一组RAP患者进行了治疗.现将其结果报道如下.     

光动力疗法治疗脉络膜新生血管性疾病后导致的脉络膜低灌注

脉络膜新生血管(CNV)是引起多种眼底疾病视力障碍的主要原因.目前临床上有多种治疗方法,如光动力疗法(PDT)、抗血管内皮生长因子(VEGF)疗法、经瞳孔温热疗法(TTT)等,但都不能彻底治愈CNV,需要重复多次治疗.其中,PDT能特异性封闭CNV,但可引起脉络膜低灌注.就PDT治疗后产生的脉络膜低灌注及其影响和应对措施进行综述,回顾PDT治疗后发生脉络膜低灌注的证据,与临床效果之间的关系,评估联合治疗的作用,讨论使用低照度光动力激光治疗减少低灌注的潜力.     

脉络膜新生血管的治疗现状与进展

多种病因引起的脉络膜新生血管（CNV）是导致患者中心视力丧失的最常见原因之一。近年来对黄斑中心凹下CNV的治疗主要采用光动力疗法（PDT）,最近也有针对新生血管形成和CNV病变炎性反应过程的药物应用于临床,未来的发展趋势可能是多种治疗机制的方法联合应用,以求获得最大疗效并减少治疗所产生的并发症。     

曲安奈德玻璃体内注射联合PDT治疗AMD患者中心凹下脉络膜新生血管[英]Rechtman E…／／Br J Ophthalmol

目前，对年龄相关性黄斑变性(AMD)患者中心凹下脉络膜新生血管(CNV)的治疗，仅维替泊芬(verteporfin)的光动力学疗法(PDT)和激光凝固治疗有确实效果。曲安奈德作为常用类固醇药物，是已知的最具潜力的抗新生血管药物。目前尚鲜见有关曲安奈德玻璃体内注射(intravitreal triamcinolone acetonide，iTAAC)联合PDT治疗AMD患者CNV的报道。     

光动力疗法在抗血管内皮生长因子时代的存在价值

新生血管类眼底疾病是导致患者中心视力严重丧失的常见原因之一.血管内皮生长因子(VEGF)在病理性新生血管的发病过程中起着非常重要的作用.近年来,抗VEGF药物的研发及广泛的临床应用改变了很多新生血管类疾病的预后,使这类疾病的治疗逐步进入了抗VEGF时代,特别是对以脉络膜新生血管(CNV)为主要病理改变的湿性年龄相关性黄斑变性(wAMD)疾病的治疗取得了突破性的进展,改变了既往以光动力疗法(PDT)为主的wAMD治疗模式.虽然PDT在AMD治疗中退居次要地位,但仍然具有存在的意义,对于特殊情况下的AMD和特殊的CNV病灶,以及一些特定疾病的治疗具有重要价值.     

The development of recurrent choroidal neovascularization in a patient with choroidal coloboma

We report a case of recurrent choroidal neovascularization (CNV) in an eye with chorioretinal coloboma. A 36-year-old woman presented complaining of decreased visual acuity (VA) in her left eye. Best corrected visual acuity (BCVA) was 20/200 and iris coloboma was observed. Funduscopy and fluorescein angiography (FA) showed CNV in the superior extrafoveal region with chorioretinal coloboma reaching just inferior to the optic disc. No other cause for CNV was observed except for the chorioretinal coloboma. BCVA improved to 20/30 after laser photocoagulation. She revisited our clinic for deteriorating VA (20/400) in the same eye 3 years after treatment. Funduscopy and FA demonstrated recurrent CNV with subfoveal hemorrhage. Photodynamic therapy (PDT) was followed by three consecutive intravitreal bevacizumab injections (IVB) for the subfoveally-located CNV. However, the CNV persisted with the appearance of a fresh subretinal hemorrhage. Additional PDT was combined with IVB on the same day 6 months after the initial PDT. The CNV regressed 3 months after treatment and has not recurred as of 8 months after the last treatment. The patient's BCVA improved to 20/60. This case suggests that PDT combined with IVB can be an alternative treatment for the management of recurrent CNV after laser photocoagulation in eyes with chorioretinal coloboma.     

Visudyne photodynamic therapy and feeder vessel occlusion: rationale of a synergistic association and clinical options

PURPOSE: Visudyne photodynamic therapy (PDT) has provided considerable improvement in patient care of subfoveal choroidal neovascularization (CNV). Patients tend to loose vision for a few months after the initial treatment, but the 4-year proven stability in vision most often provides an acceptable quality of life, sometimes with additional low vision rehabilitation. The initial visual acuity loss, borderline cost-effectiveness, and subgroups of patients not responding to PDT warrant improving the symptomatic treatment of subfoveal CNV. Today, the most tempting solution would be to combine PDT with an occlusion of the feeder vessel (FV). METHODS: Two patients are described in whom the feeder vessel was occluded using modifications of the classic PDT treatment method. The FV was identified in both patients using fluorescein and indocyanine green angiographies at a recorded video rate using a modified scanning laser ophthalmoscope (Rodenstock SLO). The feeder vessel of the first patient was occluded by minimal photocoagulation immediately after a Visudyne PDT treatment in order to take advantage of the reduced blood flow within the feeder vessel. The second patient presenting a subfoveal FV was treated using a modified PDT treatment called feeder-vessel PDT. The photosensitizing agent was activated by a first classic spot covering the lesion, followed immediately by a small spot focused on the feeder vessel. RESULTS: Both subfoveal CNVs were successfully and selectively occluded and some visual acuity was gained following the treatment. CONCLUSION: Occlusion of the feeder vessel is an appealing clinical option that is complementary to Visudyne PDT. Both treatment methods presented here could provide additional options to close subfoveal CNV with an optimal efficacy-risk ratio.     

老年性黄斑变性的经瞳孔温热治疗

经瞳孔温热治疗(transpupillary thermotherapy,TTT)作为一种治疗眼底病的新方法已日益发挥出其独特的作用,根据其能使脉络膜新生血管闭塞的作用,近年来用于老年黄斑变性(age—related macular degeneration,AMD)的治疗,并取得可喜进展。现介绍TTT的历史发展、原理以及在AMD治疗中的临床应用现状及前景。     

Photodynamic therapy with verteporfin in treating the choroidal neovascularisation secondary to multifocal choroiditis

Apart from AMD and pathologic myopia the posterior uveitis is the most common pathology being the cause of secondary choroidal neovascularisation (CNV). For many years the method of choice in treating those pathologies was the theramal laser photocoagulation with obvious limitations in the cases of subfoveal CNV. The implementation of PDT modality to every day's clinical practice expanded the range of CNV treatment methods. The following case report shows the results of treating the CNV secondary to multifocal choroiditis with PDT. During the 6 months of follow-up period we consider PDT as an effective, safe modality in treating the CNV secondary to inflammation. In the result of single PDT therapy the VA improvement of 4 ETDRS lines and it's stabilization on the level of 20/25 with the decrease of metamorphopsia was gained.     

Clinical course and treatment outcomes of Sorsby fundus dystrophy

PURPOSE: To analyze the natural history of Sorsby fundus dystrophy and the effect of various treatment methods for choroidal neovascularization (CNV) in this dystrophy. DESIGN: Historical cohort study. METHODS: A cohort of 42 patients with the Ser181 Cys TIMP3 mutation were identified from the electronic database of genetic retinal diseases in Moorfields Eye Hospital. Retrospective analyses of case records were carried out. Serial best-corrected visual acuity, fundus findings, age at onset of CNV, initial location of CNV, time taken for CNV to progress to subfoveal location, and the interval between development of CNV in the first and second eye were recorded. The time taken for CNV to recur to a subfoveal location in patients in whom argon laser photocoagulation was carried out for extrafoveal CNV also was documented. In cases where photodynamic therapy (PDT) was carried out for subfoveal CNV, the visual outcome, number of PDT treatments, and progression of lesion size were noted. RESULTS: The median age at onset of CNV in the first eye was 46.1 years and in the second eye was 50.3 years. The mean interval between the development of CNV in the first and second eye was 4.5 years. The median age at which vision fell to 20/200 or below was 48 years (first eye) and 54 years (second eye). Argon laser therapy and PDT are not effective in treating CNV of patients with this dystrophy. Antiangiogenic agents may be more effective in this condition. CONCLUSIONS: The main cause of blindness resulting from this dystrophy is CNV. Antiangiogenic agents may be useful in preventing visual loss as a result of this condition.     

光动力疗法治疗渗出型老年性黄斑变性四年临床观察总结

目的 总结4年来光动力疗法（PDT）治疗渗出型老年性黄斑变性(AMD)的临床疗效，以评价PDT的长期治疗效果。 方法 回顾73例经双目间接检眼镜、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)检查确诊的渗出型AMD患者的95只患眼行PDT治疗前后的临床资料，对比分析其视力、眼底像、FFA、ICGA和光相干断层扫描(OCT)检查结果的变化。73例患者平均年龄67.8岁，就诊时最佳矫正视力数指/10 cm～1.0。95只眼PDT平均治疗次数为1.5次，治疗后随访时间为3个月～4年。 结果 PDT治疗后末次随访时，39只眼视力提高≥2行，占41.1％；51只眼视力波动在1行以内，占53.7％；5只眼视力下降≥2行，占5.3％ 。所有患眼眼底出血和渗出均减轻。FFA或FFA联合ICGA检查显示：58只眼脉络膜新生血管（CNV）渗漏完全停止，转为瘢痕期，占61.05％；6只眼CNV部分闭合， 占6.32％；22只眼CNV小部分闭合，占23.16％；9只眼CNV复发，占9.47％。早期AMD患者12只眼经过1次PDT治疗后，最佳矫正视力0.6～1.5，CNV完全闭合，OCT检查显示黄斑区水肿及神经上皮脱离消失。随访时间最长达4年，未见有复发，视力保持稳定。 结论 单次和重复PDT治疗渗出型AMD长期疗效较好，安全性较高。对于早期渗出型AMD患者微小典型性CNV，单次PDT治疗可以使其完全封闭，使患者视力保持在较好的水平。 （中华眼底病杂志，2004，20：275-279）     

光动力学治疗脉络膜新生血管的临床观察

目的观察光动力学治疗继发于不同病因的黄斑中心凹下或中心凹旁脉络膜新生血管的疗效和安全性。方法回顾16例16眼经荧光血管造影、吲哚青绿造影证实活动性脉络膜新生血管,继发于老年性黄斑变性4眼,病理性近视6眼和中心性渗出性脉络膜视网膜病变6眼。比较PDT治疗前后最佳矫正视力,散瞳前置镜眼底检查以及荧光血管造影和脉络膜血管造影的资料。典型性为主型CNV14眼,轻微典型性CNV1眼,隐匿性CNV1眼。CNV位于黄斑中心凹下12眼,黄斑中心凹旁4眼。光动力学治疗方案参照TAP制定的标准。结果随访时间:1~14个月,平均(5±4.28)个月。1次治疗14眼,重复治疗2次1眼,3次1眼。最终患眼视力提高8眼,保持不变8眼。FFA检查示CNV渗漏停止1眼,渗漏减少10眼,渗漏无明显减少5眼,渗漏面积较治疗前明显缩小(P<0.05)。CNV复发3眼。仅1例在输液时发生光敏剂渗漏,但未发生光敏反应。治疗后视网膜一过性出血增加3眼。结论光动力学治疗为继发于不同病因的黄斑中心凹下或中心凹旁CNV患者提供一种安全有效的治疗选择。部分患者治疗后短时间内复发,PDT治疗CNV的长期疗效有待进一步观察。     

Photodynamic therapy and indocyanine green guided feeder vessel photocoagulation of choroidal neovascularization secondary to choroid rupture after blunt trauma

Purpose: To describe photodynamic therapy (PDT) and additional indocyanine green (ICG) guided feeder vessel photocoagulation as a treatment of choroidal neovascularization (CNV) secondary to choroidal rupture in case of blunt head trauma. Design: Interventional case report. Methods: A 61-year-old woman developed subfoveal CNV originating from a choroid tear 8 years after blunt head trauma. Four sessions of PDT were applied and an additional two consecutive sessions of selective ICG-guided feeder vessel photocoagulation conducted. Results: Transient reduction of leakage and closure of feeder vessels could not prevent further growth of the CNV. Conclusions: PDT reduced leakage temporarily and additional ICG-guided feeder vessel photocoagulation closed treated feeder vessel and CNV. New feeder vessel formation and growth of CNV in case of traumatic choroid rupture could not be treated effectively by these two laser treatment modalities to prevent severe deterioration of visual acuity.     

黄斑中心凹下脉络膜新生血管光动力疗法治疗后黄斑区对比敏感度变化

目的观察黄斑中心凹下脉络膜新生血管(CNV)光动力疗法(PDT)治疗前后对比敏感度(CS)的变化。方法回顾分析29例PDT治疗的患者32只眼治疗前以及治疗后2周、1、3、6个月、1年时视力、对比度视力、CS检查的临床资料。结果治疗后6个月时,视力稳定者占50%,提高者占40.9%,降低者占9.1%。平均高对比度视力均较治疗前有所提高。治疗后2周、3个月时,低频区CS与治疗前相比均有显著性差异(P=0.043、P=0.037)。6个月时,中频区间频率与治疗前比较有显著性差异(P=0.048),高频区间治疗前后均无改变。年龄以及光斑直径对CS无显著影响。结论PDT治疗黄斑中心凹下CNV短期内可改善患者的视力、对比度视力和CS,但是长期随访仍十分必要。