光动力疗法治疗息肉状脉络膜血管病变随访三年效果观察

目的 观察光动力疗法（PDT）治疗息肉状脉络膜血管病变（PCV）随访3年的治疗效果。方法 回顾性、非对照性病例系列研究。临床确诊为PCV的29例患者32只眼纳入研究。所有患者首次均行常规PDT治疗。对治疗后6个月有活动性息肉状病灶、病灶残留及渗出性改变者，行PDT联合玻璃体腔注射抗血管内皮生长因子（VEGF）制剂治疗或单纯玻璃体腔注射抗VEGF制剂治疗。所有患者均随访3年以上，平均随访时间（43.64±10.84）个月。观察统计患者首次PDT治疗后1、3、6、12、24、36个月的最佳矫正视力（BCVA）以及随访期间的PCV复发率和治疗次数。BCVA转换为最小分辨角对数(logMAR)视力记录和分析。结果 首次PDT治疗后1、3、6、12个月，患者平均BCVA均较治疗前明显提高，差异均有统计学意义（t=2.27、4.57、3.77、2.37，P＜0.05）。首次PDT治疗后24、36个月，患者平均logMAR BCVA较治疗前有所下降，但差异无统计学意义（t=-1.29、-0.81，P＞0.05）。首次PDT治疗后36个月，视力提高6只眼，占所有患眼的18.75%；视力稳定14只眼，占所有患眼的43.75%；视力下降12只眼，占所有患眼的37.50%。随访期间，PCV复发24只眼，占所有患眼的75.00%；未复发8只眼，占所有患眼的25.00%。PCV复发的24只眼中，1次复发12只眼，占复发患眼的50.00%；2次复发9只眼，占复发患眼的37.50%；3次复发3只眼，占复发患眼的12.50%。首次PDT治疗后12个月内复发4只眼，占复发患眼的16.67%；治疗后13~24个月复发11只眼，占复发患眼的45.83%；治疗后25~36个月复发9只眼，占复发患眼的37.50%。所有患者PDT治疗、抗VEGF治疗平均次数分别为（1.86±1.04）、（4.95±3.92）次。结论 PDT治疗PCV随访3年的治疗效果较差，其视力提高率较低，PCV复发率较高。

Three-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy

Objective To evaluate the 3 year efficacy of photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV). Methods This is a retrospective, uncontrolled case series study. Thirty-two eyes of 29 patients with PCV were enrolled. All patients were primarily treated with the first conventional PDT. For the eye with active polypoida, residual or exudative lesions in 6 month after PDT, PDT combined with intravitreal anti vascular endothelial growth factor (VEGF）or simple vitreous injection of anti VEGF therapy were used. All the patients were followed up for at least 3 years with the mean follow up duration of 43.64±10.84 months. The best corrected visual acuity (BCVA) in 1, 3, 6, 12, 24 and 36 months after the primary PDT, PCV recurrence rates and number of treatments were followed and analyzed. The BCVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis.Results During the 1, 3, 6, 12 months after the primary PDT, the mean BCVA were all improved with statistically significant difference（t=2.27, 4.57, 3.77, 2.37; P＜0.05）. During the 24 and 36 months after PDT, the mean BCVA was decreased without statistically significant difference（t=-1.29, -0.81;P＞0.05）. On the final evaluation at 36 months, the mean BCVA was improved in 6 eyes（18.75%）, stable in 14 eyes（43.75%）, and decreased in 12 eyes（37.50%）. During the follow-up time, recurrence of PCV in 24 eyes (75.00%), no recurrence in 8 eyes (25.00%). There was 1 recurrence in 12 eyes (50.00%), 2 recurrences in 9 eyes (37.50%), 3 recurrences in 3 eyes (12.50%). Initial recurrences were noted in 4 eyes (16.67%) within 12 months of baseline PDT treatment; in 11 eyes (45.83%) between 13 and 24 months; in 9 eyes (37.50%) between 25 and 36 months. The mean number of PDT and anti-VEGF was 1.86±1.04 and 4.95±3.92 in all patients, respectively. Conclusion The 3-year efficacy of PDT in patients with PCV was poor with low improvement of visual acuity and high recurrence rate of PCV.