光动力疗法联合玻璃体腔曲安奈德注射治疗脉络膜新生血管

目的观察光动力疗法(PDT)联合玻璃体腔曲安奈德(TA)注射治疗老年黄斑变性和病理性近视引起的脉络膜新生血管(CNV)的近期疗效和安全性。方法16例经过视力、眼压、荧光素眼底血管造影(FFA)以及光相干断层扫描(OCT)等检查确诊的CNV患者的16只患眼进行PDT联合玻璃体腔TA注射治疗。其中,渗出型老年黄斑变性14例14只眼,病理性近视2例2只眼。16只眼中,12只眼在PDT治疗后72 h行玻璃体腔TA注射,4只眼在PDT 3个月~1年(平均9个月)后行玻璃体腔TA注射。第1年的平均治疗次数为1.1次。联合治疗后,采用与治疗前相同的条件和检查方法进行随访观察,随访时间3~18个月,平均随访时间18.6个月。对比观察治疗前后患者的最佳矫正视力、眼压、CNV病灶渗漏情况以及黄斑区视网膜厚度变化。结果16只眼中,7只眼视力提高,占43.8%;9只眼视力稳定,占56.2%。FFA显示CNV病灶在联合治疗后渗漏停止或减轻,OCT显示黄斑区视网膜水肿消退或减轻。1只眼暂时性眼压升高,占6.3%。经药物短期治疗后恢复正常。结论PDT联合玻璃体腔TA注射可以安全有效地治疗CNV,延缓视力下降,并且可以减少重复治疗的次数。

Photodynamic therapy combined with intravitreous injection with triamcinoione acetonide for choroidal neovascularization

Objective To evaluate the efficacy and safety of photodynamic therapy(PDT) combined with intravitreous injection with triamcinolone acetonide(TA) for choroidal neovascularization(CNV) caused by age-related macular degeneration(AMD) and pathological myopia.Methods A total of 16 eyes of 16 patients with CNV,which was diagnosed by examination of visual acuity,ocular pressure,fundus fluorescein angiography(FFA),and optic coherence tomography(OCT),were underwent PDT combined with intravitreous injection with TA.Exudative AMD was in 14 patients(14 eyes),and pathological myopia was in 2 patients(2 eyes).In the 16 patients(16 eyes),intravitreal injection with TA was performed 72 hours after PDT on 12 patients(12 eyes),and 3 months to 1 year after PDT on 4 patients(4 eyes).The average therapeutic times in the first year were 1.1.After the treatments,the patients were examined and observed in the same way before the treatment during the follow-up period ranging from 3 to 18 months(mean 18.6 months).Best-corrected visual acuity,intraocular pressure,leakage of CNV,and retinal thickness before and after the treatments were observed and analyzed.Results In the 16 eyes,visual acuity was improved in 7(43.8%) and was stable in 9(56.2%).The result of FFA showed that the leakage of CNV was alleviated or stopped after the treatments,and the result of OCT revealed that the macular edema was alleviated or disappeared.Transient elevation of intraocular pressure occurred in 1 eye(6.3%) which was recuperated after short-term medication.Conclusion PDT combined with intravitreal injection with TA for CNV is safe and effective.It may reduce the risk of visual loss and reduce the treatment frequency.