原田病药物治疗后吲哚青绿眼底血管造影观察

目的 探讨利用吲哚青绿血管造影检查作为原田(Harada)病临床观察指标的意义.方法 对经药物治疗后19例(38只眼)原田病患者同时行荧光素眼底血管造影(fundus fluorescein angiography,FFA)及吲哚青绿血管造影(indocyanine green angiography,ICGA)检查资料进行分析.结果 FFA检查发现有4例(8只眼)视盘轻度染色,视网膜未发现异常改变;ICGA早期及中期无异常表现,但后期8只眼(包括FFA中视盘染色的4只眼)在中周及后极部出现了点状或斑片状弱荧光;3例6只眼FFA及眼底正常,在ICGA后期后极部出现了斑点状弱荧光;24只眼脉络膜大、中血管影像减少,其中12只眼dalen-fuchs结节着色.结论 ICGA可较好提供原田病的脉络膜循环损害的信息,并在评价疗效上有意义.

Abstract：

Objective To investigate the clinical value of indocyanine green angiography(ICGA)in patients with Harada disease.Methods Fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA)were used for comparative analyses in 26 cases(52 eyes)of Harada disease after treatment.Results Mild dyeing in disk was found only in 4 cases(8 eyes),and the others were not found any abnormal in FFA.There were no any abnormal found in early period and middle period of ICGA,but of 8 eyes(include 4 eyes of dyeing in disk in FFA)multifocal lower fluorescence were found in the mid-periphery and posterior pole of the fundus in the late phase.Of 3 cases(6 eyes)were normal in FFA,however multifocal lower fluorescence were found in the posterior pole of the fundus in the late phase of ICGA.Of 24 eyes were found decreased fluorescence in large and middle choroidal vessel,and 12 eyes of Dalen-Fuchs were colored.Conclusions ICGA may assist in providing valuable information on choroidal circulation of Harada disease and be useful in evaluating the curative effects.     

息肉状脉络膜血管病变在眼底FFA 与ICGA中特征分析

目的 探讨息肉状脉络膜血管病变(PCV)眼底荧光素血管造影(FFA)和吲哚青绿血管造影(ICGA)同步检查的影像学特征及其临床意义.方法 选取62例患者(75只眼)进行眼底彩色照相、FFA 和ICGA同步检查,对黄斑部视网膜下出血病灶其形态及特征做以对比分析.结果 FFA图像显示:PCV75只眼中斑块样视网膜下出血48只眼,占64.0%;伴浆液性视网膜色素上皮(RPED)脱离12只眼,占16.0%;出血性RPED8只眼,占10.7%;脉络膜血管网及息肉样结节7只眼,占9.4%,早期即出现荧光素渗漏并逐渐增强,CNV末端膨大处出现点状高荧光.ICGA图像显示:75只患眼中72只眼呈"蘑菇"状或"树枝"状异常扩张,其血管网末端多个息肉样膨大与彩色照相所见的结节样病变部位吻合.结论 FFA和ICGA同步检查,不但对PCV患者病灶其形态及特征作出对比分析,ICGA检查还能提高PCV视网膜下脉络膜新生血管膜(CNV)的检出率,同时提高PCV患者激光光凝的可能性,而FFA对评估PCV 视网膜下出血及出血性或浆液性视网膜色素上皮脱离、脉络膜血管网及息肉状结节则均有较好的效果.

Abstract：

Objective To observe on fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) in polypoidal choroidal vasculopathy (PCV), and sync examine of its image features and clinical meaning. Methods Sixty-two patients (75 eyes) applied fundus camera, FFA and ICGA synchronous examination, do comparison analysis in macular sub-retinal hemorrhage shape and area. Results FFA image in 75 PCV patients showed 48 eyes (64.0%) with plaque sub-retinal hemorrhage, 12 eyes (16.0%) accompanied with retinal pigment epithelial detachments (RPED), 8 eyes (10.7%) with bleeding RPED, 7 eyes (9.4%) with choroid blood vessel net and polypoidal node of early stage flouresence leakage. ICGA showed that 75 eyes had abnormal choroid blood vessel net extension, 72 with "mushroom" shape or "tree-branch" shape with more polypoidal enlarge in the end which was the same as seen under ophthalmoscope. Conclusions It proves that FFA and ICGA synchronous examination, not only can be used for PCV patients' tissue shape and area comparison analysis, but also improves the finding rate of the choroidal neovascularization (CNV) in PCV, increases the feasibility of photocoagulation to PCV. FFA gives good result to evaluate PCV sub-retinal hemorrhage.     

息肉状脉络膜血管病变的随访观察

目的 观察息肉状脉络膜血管病变(PCV)患者的临床特征及其视力预后情况.方法 回顾性病例系列研究.对经眼底彩色照相、荧光素眼底血管造影及吲哚氰绿血管造影等确诊的45例(51只眼)PCV患者的临床资料进行回顾性分析,包括患者年龄、随访前视力、有无脉络膜视网膜病变、病灶面积、病灶是否累及黄斑中心凹、随访期间病灶消退且无新病灶出现等6项因素.对患者随访期间视力变化情况进行多因素相关回归分析.结果 45例(51只眼)PCV患者随访时间6～18个月,平均随访(11.1±2.0)个月.随访期间病变区出血、渗出增多者15只眼(29.4%),出血、渗出减少者25只眼(49.0%),盘状瘢痕与萎缩改变者分别为5只眼(9.8%)和6只眼(11.8%).视力增加、稳定及下降者分别为11(21.6%)、21(41.2%)及19(37.2%)只眼.息肉状病灶累及黄斑中心凹者25只眼(49.0%),未累及者26只眼(51.0%).在病程进展过程中,息肉状病灶部分消退18只眼(35.3%),稳定不变13只眼(25.5%),扩大和新生13只眼(25.5%),消退和新生并存7只眼(13.7%).患者视力变化与年龄、随访前视力、息肉状病灶累及黄斑中心凹诸因素相关(b=-0.005,0.382,-0.430;P=0.034,0.000,0.000),视力提高与息肉状病灶累及黄斑中心凹(b=-2.957,P=0.013,OR=0.052)、息肉状病灶消退且无新病灶出现相关(b=2.259,P=0.019,OR=9.578).结论 PCV患者视力预后情况不同,年龄小者随访前视力较好;息肉状病灶未累及黄斑中心凹者随访视力相对较好,其中无新病灶出现者,随访期间视力提高的可能性较大.脉络膜视网膜病变情况和病灶面积不能作为判断预后的敏感指标.

Abstract：

Objective To observe the natural course and evaluate the prognostic factors influencing the follow-up visual acuity of polypoidal choroidal vasculopathy (PCV). Methods It was a retrospective case series. Forty-five consecutive patients (51 eyes) who were diagnosed with PCV by fundus photography,fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were followed up with (11.1 ± 2. 0 )months (mean ± SD ). Age, baseline visual acuity, the presence of pigment epithelium detachment (PED), lesion size, the polypoidal lesions involving the fovea and the regression of polypoidal lesions were recorded. Multi-factor regression analysis of visual acuity at follow up was applied with SPSS 16. 0 statistics software. Results Among the 45 patients (51 eyes), the hemorrhage or exudation were increased in 15 eyes (29. 4% ), decreased in 25 eyes (49. 0% ), 5 eyes (9. 8% ) developed macula scar and 6 eyes (11.8%) macula atrophy . During the follow-up period, the visual acuity was improved in 11 eyes (21.6%), stable in 21 (41.2%) and regressed in 19 (37. 2% ). Twenty-five eyes (49.0%)demonstrated polypoidal lesions involving the fovea and 26 eyes (51.0%) did not. ICGA revealed that the polypoidal lesions were unchanged in 18 eyes ( 35. 3% ), regressed in 13 ( 25.5% ), grew in 13 (25.5%), and mixed in 7 eyes ( 13.7% ). The changes of visual acuity at follow up were related to the age, baseline visual acuity, and polypoidal lesions involving in the fovea ( b = - 0. 005, 0. 382 and - 0. 430 ;P = 0. 034, 0. 000 and 0. 000). Improvement of visual acuity at follow up was related to the regression of polypoidal lesions ( b = 2. 259, P = 0. 019, OR = 9. 578). Conclusions There is a large variation in the visual prognosis in Chinese patients with PCV. The presence of PED and the lesion size had no effect on the visual prognosis of PCV. Better visual acuity during follow-up period is correlated with younger age, better baseline visual acuity, polypoidal lesions not involving the fovea and a regression of polypoidal lesions.     

光学相干断层扫描在光动力疗法治疗中心性渗出性脉络膜视网膜病变的应用

目的 探讨光学相干断层扫描(optical coherence tomography,OCT)对光动力疗法(photodynamic terapy PDT)治疗中心性渗出性脉络膜视网膜病变(central exudative chorioretinopathy,CEC)脉络膜新生血管(choroidal neovascularization,CNV)的临床应用价值.方法 对CEC患者45例(46只眼)进行光学相干断层扫描,荧光素眼底血管造影(fundus fluorescein angiography,FFA),吲哚青绿脉络膜血管造影(indocyanine green angiography,ICGA)检查.根据FFA,ICGA和OCT检查结果,明确CNV位置、范围和大小.PDT治疗按维替泊芬PDT治疗(VIP)研究组的方法 进行.并对其疗效进行评价.结果 光动力疗法(PDT)治疗后视力提高者13只眼,占28.26%;视力稳定不变者22只眼,占47.82%;视力下降者11只眼,占23.92%.OCT复查结果 为14只眼(3044%)黄斑水肿消失;18只眼(39.13%)黄斑水肿减轻;10只眼(21.73%)无变化;4只眼(8.7%)黄斑冰肿加重.CNV消失15只眼(32.61%),CNV缩小24只眼(52.17%),CNV无变化4只眼(8.7%),CNV增大3只眼(6.52%).治疗后视网膜厚度明显变薄(P<0.01).黄斑中心凹视网膜神经上皮层厚度与视力呈负相关(r=0.4963,P<0.01).结论 OCT可客观、精确地显示CNV的位置、大小、范围及视网膜水肿的变化程度,对指导光动力疗法(PDT)治疗中心性渗出性脉络膜视网膜病变(CEC)脉络膜新生血管(CNV)的疗效评价有着重要价值.

Abstract：

Objective To verify the applicable significance of optical coherence tomography (OCT)photodynamic therapy (PDT) for central exudative chorioretinopathy (CEC) choroidal neovascularization (CNV). Methods Forty-five cases (46 eyes) of central exudative chorioretinopathy (CEC) were managed with PDT. Before and post-treatment, all cases underwent OCT, fiuorescein angiography (FFA) and indocyanine green angiography (ICGA). PDT treatment was in accordance with the PDT verteporfin therapy (VIP) Study Group methods. Results The visual acuities of last visit were compared with those before the treatment. The visual acuity was improved in 13eyes (28.26%), unchanged in 22 eyes (47.82%), and declined in 11 eyes (23.92%). OCT was re-done and compared with OCT images before PDT treatment. The macular edema was disappeared in 14 eyes (30.44%), decreased in 18 eyes (39.13%), unchanged in 10 eyes (21.73%), and increased in 4 eyes (8.7%). CNV was disappeared or decreased in 39 eyes (84.78%), unchanged in 4 eyes (8.7%),and progressed in 3 eyes (6.52%). The retinal thickness was decreased obviously (P ＜0.001). The statistical analysis showed there was a negative correlation between the thickness of fovea and visual acuity (r =0.4963, P =0.001). Conclusions OCT can precisely show the location, size and changes of retinal thickness and has an important significance in PDT treatment for CEC.     

玻璃体黄斑牵引综合征的手术疗效观察

目的 探讨玻璃体手术治疗玻璃体黄斑牵引综合征的临床效果及光相干断层扫描、荧光素眼底造影对手术疗效的评价.方法 经裂隙灯前置镜、间接眼底镜检查、B超、光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)等检查确诊为玻璃体黄斑牵引综合征行玻璃体手术的患者30例(30只眼)的临床资料进行回顾性分析.结果 30只眼经手术解除玻璃体对黄斑部的牵引.术后20只眼视力提高.术后黄斑区牵引处OCT测量高度平均减小267μm,有明显改善.术前荧光素眼底血管造影检查存在黄斑囊样水肿伴渗漏,术后明显减轻.术前合并高度近视眼者视力预后不佳.结论 玻璃体手术能够有效解除玻璃体对黄斑部的牵引,阻止患者视力进一步下降,减轻黄斑水肿及渗漏,是治疗玻璃体黄斑牵引综合征的有效方法.光相干断层扫描及荧光素眼底造影检查可以对手术疗效进行评价,有利于术后随访.

Abstract：

Objective To evaluate the efficacy of vitreous surgery for patients with vitreomacular traction syndrome. Methods Of 30 patients (30 eyes) who underwent vitrectomy for vitreomacular traction syndrome were retrospectively analyzed. Results Vitreomacular traction was released successfully, and a better visual acuity was obtained in 20 eyes. Mean macular thickness decreased by 267μ m postoperatively. The eyes showed statistically significant improvement in visual acuity and central macular thickness (P <0.05). Optical coherence tomography (OCT) and fluorescein fundus angiography (FFA) showed macular edema gradually alleviated after vitreous surgery. Preoperative high myopia was associated with prognosis of postoperative visual acuity (P<0.05). Conclusions Vitrectomy can relieve macular traction, and is effective for decreasing macular thickness and improvement of vision in vitreomacular traction syndrome. OCT and FFA are useful for evaluation and follow-up for vitreomacular traction syndrome.     

光动力疗法治疗渗出型老年性黄斑变性的初步报告

目的 观察单次光动力治疗(photodynamic therapy,PDT)对渗出型老年性黄斑变性(age-related macular degeneration,AMD)脉络膜新生血管(choroidal neovascularization,CNV)的近期治疗效果。 方法 回顾分析经荧光素眼底血管造影(fundus fluorescein angiography, FFA)、吲哚青绿脉络膜血管造影(indocyanine green angiography, ICGA)以及光学相干断层扫描(optic coherence tomography,OCT)检查确诊的5例渗出型AMD患者的7只患眼行PDT治疗前及治疗后随访观察1周和1个月时的临床资料,主要以视力、FFA及(或)ICGA、OCT的改变为观察指标,评价PDT对渗出型AMD的治疗效果。 结果 7只患眼在治疗后1个月视力均无下降。治疗后1周时除1只眼在ICGA后期仍可观察到CNV有轻微渗漏外,其余6只眼FFA及(或)ICGA均显示CNV渗漏停止;OCT检查显示CNV有不同程度缩小,CNV周围视网膜脉络膜水肿及神经上皮脱离明显好转。但在治疗后1个月时观察到有2只眼在原渗漏病灶处又有渗漏灶出现。 结论PDT 治疗可以在短期内封闭AMD的CNV,使其停止渗漏,且不影响视力。(中华眼底病杂志,2000,16:213-216)     

光动力疗法治疗中心性渗出性脉络膜视网膜病变疗效观察

目的 评价光动力疗法(photodynamictherapy,PDT)治疗中心性渗出性脉络膜视网膜病变(centralexudativehorioretinopathy,CEC)的临床疗效.方法 对比分析中心性渗出性脉络膜视网膜病变所致黄斑部脉络膜新生血管(choroidaineovascularization,CNV)患眼21例,治疗前与单次PDT治疗后3个月的视力、眼底、固视性质、光学相干断层扫描(optic coherence tomograph,OCT)图像及荧光素钠血管造影(fundus fluoresein angiography,FFA)、吲哚菁绿血管造影(indocyanine greenan giography,ICGA)的变化.结果 PDT治疗后3个月11只眼视力提高(52.38%),10只眼视力稳定(47.62%),其中5例由偏心固视恢复为中心固视.眼底检查可见出血渗出明显减少,部分患者完全吸收.FFA联合ICGA检查显示CNV病灶渗漏停止10只眼(47.62%),渗漏减少10只眼(47.62%);OCT检查表现为CNV缩小.组织水肿减轻.结论 PDT治疗可以部分或完全封闭中心性渗出性脉络膜视网膜病变所致的CNV,减少CNV引起的视力下降的危险性.     

眼底血管样条纹临床及荧光造影表现

目的 分析眼底血管样条纹(angioidstreaks,AS)的临床特征与眼底荧光血管造影(fundus fluorescein angiography,FFA)及吲哚青绿血管造影(fundus indocyanine green Angiography,ICG)表现.方法 对7例(14只眼)血管样条纹患者行眼科常规检查,眼底照相.其中6例(12只眼)患者行FFA及ICG检查.结果 眼底表现:14只眼眼底见视盘周围血管样放射状条纹,7只眼黄斑区视网膜下出血,黄白色硬性渗出,大小不一的灰黄色病灶(50.00%),3只眼见黄斑区萎缩瘢痕灶(21.43%);FFA表现:血管样条纹10眼表现为透见荧光(83.33%),2只眼表现为中央低荧光,两侧高荧光(16.67%),7只眼在黄斑区出现脉络膜新生血管(choroidalneovascularization,CNV)的强荧光(58.33%),3只眼黄斑区萎缩瘢痕灶晚期荧光着染(25.00%);ICG表现:12只眼血管样条纹表现为早期不显影,中期呈强荧光,7只眼CNV表现为强荧光,3只眼黄斑区萎缩瘢痕灶中2只眼见边界不清斑状CNV.结论 眼底血管样条纹患者的眼底较典型,FFA及ICG能进一步明确诊断,对疾病治疗有指导意义.

Abstract：

Objective To investigate the clinical manifestations, features of fundus fluorescein angiography(FFA)and fundus indocyanine green angiography(ICG)with angioid streaks. Methods Seven patients(14 eyes)with bilateral angioid streaks were examined by the routine ophthalmological examination, FFA and ICG. Colorfundus photographs were also taken. Results Fundus findings: angioid streaks were visualized in the posterior pole of 14 eyes and the macular areas of 7 eyes,(50.00%)had subretinal hemorrhages with neovascularization. FFA: streaks were hyperfluorescent in 10 eyes(83.33%), hypofluorescentareas between hyperfluorescent edges in 2 of the 12 eyes(16.67%), hyperfluorescent were seen in choroidal neovascularization (CNV)of macular in 7 eyes(58.33%). ICG: the result of streaks in 12 eyes showed hypofluorescence at the early phase and hyperfluorescence at the late phase, hyperfluorescent were seen in CNV of macular in 7 eyes, 2 eyes presented occult CNV. Conclusion In all eyes, angioid streaks are well visualized. FFA and ICG results may contribute to the diagnosis and treatment for patients with angioid streaks.     

Fundus Analysis and Visual Prognosis of Macular Hemorrhage in Pathological Myopia without Choroidal Neovasculopathy

Purpose:To analysis and evaluate the fundus characteristics and visual prognosis of macular hemorrhage in pathological myopia without choroidal neovasculopathy.Methods:Thirty-seven patients (38 eyes) of pathological myopia with macular hemorrhage and without choroidal neovascularization (CNV) underwent color photograph and fundus fluorescein angiography (FFA) examinations. Indocyanine green angiography (ICGA) was also performed on 11 patients (11 eyes). Follow-up ranged from 3 to 21 months.Results :The macular hemorrhage in pathological myopia without CNV demonstrated oval, less than 1PD, without edema and exudation. Lacquer cracks appeared at the site of previous subretinal bleeding in 84.2% of the eyes. The visual acuities were improved in 81.6% of eyes during the follow-up period. ICGA revealed linear hypofluorescence in 7 of 11 eyes (63.6%), indicating a ruptured Bruch‘s membrance at the onset of subretinal bleeding.Conclusion : A rupture of choriocapillaris complex and Bruch‘s membrane causes macular hemorrhage of pathological myopia without CNV,leading to the formation of a new lacquer crack.Its prognosis is favorable.     

Changes of Indocyanine Green and Fluorescein Angiography in Multiple Evanescent White-dot Syndrome： A Case Report

Purpose:To study the clinicopathological change on "Multiple Evanescent White-dot Syndrome (MEWDS)" through fundus angiogrphy analyses.Methods:Examing the case with fluorescein angiography (FFA) and indocyanine green angiography(ICGA), visual field and following up for 15 months.Results:There exist multiple white dots in the fundus photo and angiography. The changes on ICGA maintain longer than fundus photo and FFA. Papille may be edematous and macula could present with special hypofluorescent flecks.Conclusions:MEWDS has specific angiographic features. Its pathological changes involve deep retinal pigment epithelium(RPE) as well as choroidal capillaries. The prognosis of the visual acuity for MEWDS is very good. Eye Science 2003;19:171-173.     

光动力疗法治疗息肉状脉络膜血管病变

目的 探讨光动力疗法（PDT）治疗息肉状脉络膜血管病变（PCV）的疗效。方法经荧光素眼底血管造影（FFA）、吲哚氰绿眼底血管造影（ICGA）及相干光断层扫描（OCT）结合临床体征及病史确诊的10例（10只眼）PCV患者,应用维替泊芬进行PDT治疗。其中男性8例（8只眼）,女性2例（2只眼）;年龄50～77岁,平均59岁;治疗前最佳矫正视力为0．1～0．5。治疗后随访时间最短6个月,最长36个月,平均24个月。随访期间复查患者视力、眼底,进行FFA及ICGA检测。结果PDT治疗后1个月,患者最佳矫正视力：4只眼与术前一致,3只眼提高1行,2只眼提高2行,1只眼下降3行。FFA和ICGA检测,显示4只眼的血管荧光素渗漏停止,3只眼渗漏减轻,2只眼有微小渗漏。末次随访时,患者最佳矫正视力：4只眼保持不变,2只眼提高1行,2只眼提高2行,1只眼行3次PDT治疗后提高3行,1只眼下降2行。FFA和ICGA检测,显示7只眼的血管荧光素渗漏停止,2只眼仍有轻微渗漏。术后1个月,有1只眼并发玻璃体出血（术前合并广泛视网膜下出血）,未见其他全身及局部不良反应。结论PDT能够阻止或减轻PCV所致的黄斑区血管荧光素渗漏,促进出血、渗出及水肿吸收,稳定或改善患者视力,可作为PCV治疗的首选方法之一。但确切疗效尚待多中心、随机对照的临床研究结果进一步证实。（中华跟群杂志,2007,43：642-645）     

光动力疗法联合玻璃体腔注射雷珠单抗治疗息肉样脉络膜血管病变疗效观察

目的 观察光动力疗法（PDT）联合玻璃体腔注射雷珠单抗治疗息肉样脉络膜血管病变（PCV）的安全性和有效性。方法 回顾性系列病例研究。临床确诊为PCV的患者24例24只眼纳入研究。所有患者均行视力、眼底彩色照相、荧光素眼底血管造影（FFA）、吲哚青绿血管造影(ICGA)和光相干断层扫描（OCT）检查。视力检查采用糖尿病视网膜病变早期治疗研究组视力表进行。患者治疗前平均视力为（33.41±19.43）个字母,平均黄斑视网膜厚度（CRT）为（343.63±88.60） μm。所有患者先行常规PDT治疗,72 h后玻璃体腔注射10 mg/ml的雷珠单抗0.05 ml（含雷珠单抗0.5 mg）。根据检查情况确定是否需要重复行单独玻璃体腔注射雷珠单抗或PDT联合玻璃体腔注射雷珠单抗治疗。治疗后平均随访时间为13.1个月。观察统计每只眼的平均治疗次数、患者并发症及全身不良反应的发生情况。对比分析治疗前后患者视力和CRT的变化,以及黄斑区出血及渗出、PCV病灶的渗漏情况。结果 每只眼平均重复玻璃体腔注射雷珠单抗治疗次数为(2.8±1.6)次,平均重复联合治疗次数为(0.4±0.5)次。所有患眼均未出现与治疗相关的并发症和全身不良反应。末次随访时,患眼视力为（44.21±17.24）个字母,较治疗前平均提高10.8个字母。治疗前后视力比较,差异有统计学意义（t=-4.77,P＜0.01）。24只眼中,视力提高11只眼,占45.8%;视力稳定13只眼,占54.2%。眼底检查发现,黄斑区出血、渗出完全吸收7只眼,占29.2%;黄斑区出血、渗出明显减轻17只眼,占70.8%。FFA及ICGA检查发现,荧光渗漏停止17只眼,占70.8%;仍有轻微荧光渗漏7只眼,占29.2%。OCT检查发现,视网膜下积液消退19只眼,占79.2%;视网膜下积液减轻5只眼,占20.8%。患者平均CRT为（171.33±38.06） μm,较治疗前平均降低172.30 μm。治疗前后平均CRT比较,差异有统计学意义（t=11.96,P＜0.05）。结论 PDT联合玻璃体腔注射雷珠单抗治疗PCV安全有效,可提高患者视力,减轻视网膜水肿,停止或减少PCV病灶渗漏。     

玻璃体腔注射雷珠单抗联合光动力疗法治疗息肉状脉络膜血管病变的临床观察

目的观察玻璃体腔注射雷珠单抗联合光动力疗法（PDT）治疗息肉状脉络膜血管病变（PCV）的临床疗效和安全性。方法回顾分析临床确诊为PCV的患者19例（19只眼）,所有患者行ETDRS视力表检查、前置镜下眼底检查、荧光素眼底血管造影（ FFA）、吲哚菁绿血管造影（ ICGA）、相干光断层扫描（ OCT）检查。所有患者按照常规内眼手术操作要求玻璃体腔内注射10 mg／ml雷珠单抗0．05 ml,注射后3～7 d联合PDT治疗,随访12个月。以末次随访时间为观察比较点,比较分析治疗前后视力、黄斑中心凹视网膜厚度（ CRT ）、黄斑出血和渗出情况。结果所有患者均未出现与治疗相关的局部和全身并发症。重复联合治疗1次者6只眼,2次者1只眼,平均联合治疗次数为（1．42±0．6）次。治疗前最佳矫正视力（BCVA）平均（19．95±11．36）个字母,末次随访BCVA平均（31．63±11．75）个字母,较治疗前提高11．68个字母,治疗前后平均视力比较,差异有统计学意义（ t ＝－3．27, P＜0．01）。治疗前患眼平均CRT为（383．67±90．42）μm,治疗后平均CRT为（192．75±42．36）μm,较治疗前下降190．92μm,治疗前后平均CRT比较,差异有统计学意义（ t ＝8．09, P ＜0．01）。 FFA和ICGA检查13只眼荧光渗漏停止（占68．4％）,6只眼仍有轻度渗漏（占31．6％）。结论玻璃体腔注射雷珠单抗联合PDT治疗PCV是安全有效的,有利于提高患者视力,减轻视网膜水肿,停止或减少息肉病灶的渗漏。     

光动力疗法治疗病理性近视所致黄斑部CNV的临床疗效观察

目的:评价光动力疗法(photodynamic therapy,PDT)治疗病理性近视所致黄斑部脉络膜新生血管(choroidal neovascularization,CNV)的临床疗效。方法:回顾性分析20例21眼临床确诊为病理性近视合并CNV患者的临床资料,对比分析PDT治疗前后患者最佳矫正视力(BCVA)、固视性质,FFA/ICGA和OCT等检查结果的变化。结果:PDT治疗后随访6mo,1例患者PDT治疗后3mo因玻璃体积血行玻璃体切除手术,未继续随访。其余患者BCVA与治疗前相比明显提高,差异具有统计学意义(P<0.05)。PDT治疗前中心固视3眼,中心外固视18眼,随访期间固视性质未发生改变。FFA/ICGA检查显示,PDT治疗后3mo,CNV病灶渗漏停止或渗漏减少者18眼(86%),持续渗漏2眼(10%),1眼出现玻璃体积血。PDT治疗后6mo,CNV病灶渗漏停止或渗漏减少者19眼(90%),持续渗漏1眼(5%),OCT显示CNV缩小,组织水肿减轻。结论:PDT治疗可以部分或完全封闭病理性近视所致脉络膜CNV,减少CNV引起的视力下降危险性。     

光动力疗法治疗渗出性年龄相关性黄斑变性

目的观察光动力疗法(photodynamic therapy,PDT)治疗渗出性年龄相关性黄斑变性(age-related macular degeneration,AMD)的疗效。方法回顾分析经荧光素眼底血管造影(fundus fluorescein angiography,FFA)、吲哚菁绿血管造影(indocyanine green angiography,ICGA)以及光学相干断层扫描(optical coherence tomography,OCT)检查确诊的21例(31眼)渗出性AMD患者PDT治疗前及治疗后的临床资料,主要以视力、FFA及(或)ICGA、OCT的改变为观察指标,评价PDT对渗出性AMD的治疗效果。结果治疗后13眼视力明显改善(视力提高≥2行),占41.9%;14眼视力稳定不变(视力波动在1行以内),占45.2%;4眼视力下降2行,占12.9%。大部分患眼于PDT治疗后眼底出血和渗出减轻;ICGA检查显示:PDT治疗后1周,16眼CNV的渗漏明显减少或完全停止,8眼渗漏完全停止。OCT检查显示:CNV周围视网膜脉络膜水肿以及神经上皮脱离好转。5例6眼患者在PDT治疗过程中及治疗后发生视网膜神经上皮脱离范围变大,1例1眼发生黄斑部再次大面积出血,所有病例均未发生任何全身不良反应。结论单次和重复PDT治疗可以部分或完全封闭渗出性AMD的CNV,PDT治疗对病灶周围的正常视网膜和脉络膜组织短期内有轻度影响,对视力无损害。     

眼底血管样条纹并发脉络膜新生血管的临床特征及联合治疗

目的 分析眼底血管样条纹（AS）并发CNV的临床特征,探讨光动力疗法（PDT）联合玻璃体腔注射雷珠单抗治疗AS合并黄斑病变的临床疗效及安全性。方法 回顾性系列病例研究。分析21例（42眼）AS的临床资料,包括BCVA、眼底表现、FFA、ICGA以及OCT。其中18例（22眼）合并黄斑CNV,先采用PDT治疗,3 d内玻璃体腔注射雷珠单抗,治疗后定期随访,至少随访12个月。随访时如发现视力下降、黄斑区出现新病灶、视网膜下或层间积液、CNV活动性病变,则重复玻璃体腔注射。数据采用独立样本t检验或配对样本t检验进行分析。结果 本组21例患者均双眼发病,仅5例（24%）合并全身病变,男性为主（76%）,其中18例（86%）继发黄斑CNV,BCVA显著低于病变未侵及黄斑者。联合治疗的22眼末次随访时BCVA较治疗前提高10.4个字母;OCT示治疗后黄斑区视网膜厚度从基线的（338.4±55.2）μm降至（212.6±36.2）μm;FFA（ICGA）显示15眼（68%）CNV完全闭合,渗漏消失,5眼呈瘢痕染色。所有患者接受1次PDT,平均玻璃体腔注射次数3.2次。1例PDT后出现黄斑区视网膜下出血,行玻璃体腔注射雷珠单抗后出血吸收,5例发生一过性眼压升高,4例出现结膜下出血,均完全恢复,无其他明显眼部及全身不良反应。结论 眼底AS具有特殊的眼底表现,FFA（ICGA）有助于明确诊断,相当比例的患者可继发黄斑部CNV。PDT联合玻璃体腔注射雷珠单抗能有效控制AS合并黄斑病变的病情进展,显著改善患者视功能,减少CNV渗漏,且不良反应少。     

Long-term follow-up of polypoidal choroidal vasculopathy after photodynamic therapy with verteporfin

Purpose To report on the clinical features of three cases of polypoidal choroidal vasculopathy (PCV) during long-term follow-up after photodynamic therapy (PDT). Design Interventional case reports. Methods Among the participants in the Japanese Age-Related Macular Degeneration Trial (JAT) at our hospital, a PCV was seen in three eyes at baseline on retrospective analysis of indocyanine green angiography (ICGA) using fundus camera. We report the clinical features of these cases during more than 4 years follow-up. Results The mean number of PDT treatments was 5.7. Improved visual acuity (VA) and cessation of fluorescein leakage was achieved within 18 months in all eyes; however, subretinal hemorrhage and subfoveal fluid recurred due to new or recurrent PCV. The final VA decreased markedly in two eyes. Conclusions The eyes with PCV, which had been treated successfully with PDT, may have developed new or recurrent PCV during long-term follow-up. Periodical ICGA would be needed to detect abnormal choroidal vascular changes. The authors have no proprietary interest in any aspect of this report.     

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。     

息肉状脉络膜血管病变的眼底血管造影表现

目的 观察息肉状脉络膜血管病变(PCV )的临床特征及眼底血管造影表现。 方法 回顾分析12例PCV患者12只眼的眼底检查、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)及其5例5只眼的光相干断层扫描(OCT)检查资料。 结果 12只眼均可见深层和(或)浅层出血，黄色脂质渗出。其中6只眼病变处见橘红色病灶，2只眼伴视网膜前出血。FFA检查，静脉期6只眼橘红色病灶内点状荧光，4只眼病变处可见脉络膜血管网。晚期均见息肉状强荧光点荧光素渗漏，2只视网膜前出血眼晚期未见荧光素渗漏。ICGA检查，12只眼晚期见强度不等、簇状或孤立的息肉状扩张灶，4只眼显示明显的脉络膜血管网。OCT检查，4只眼视网膜色素上皮（RPE）和脉络膜毛细血管高反射层呈穹窿状隆起，1只眼无改变。 结论 PCV眼底多见黄斑区出血性和(或)浆液性视网膜色素上皮脱离(RPED)和(或)神经上皮脱离，黄色脂质渗出。FFA及ICGA检查可见分支状脉络膜血管网及末梢膨大息肉状扩张灶。 （中华眼底病杂志，2004，20：310-312）