中华眼科医学杂志(电子版)
中華眼科醫學雜誌(電子版)
중화안과의학잡지(전자판)
CHINESE JOURNAL OF OPHTHALMOLOGIC MEDICINE(ELECTRONIC EDITION)
2013年
2期
79-83
,共5页
孤立性脉络膜血管瘤%光动力疗法%经瞳孔温热疗法
孤立性脈絡膜血管瘤%光動力療法%經瞳孔溫熱療法
고립성맥락막혈관류%광동력요법%경동공온열요법
Circumscribed choroidal hemangioma%Photodynamic therapy%Transpupillary thermotherapy
目的:评估光动力疗法( PDT)对国人限局性脉络膜血管瘤( CCH)的疗效。方法回顾性系列病例研究。收集2004年1月至2010年12月首都医科大学附属北京同仁医院眼科门诊23例(23只眼) CCH患者临床资料进行回顾性分析。其中男性15例,女性8例;年龄16~68岁,平均45岁。采用眼底镜、荧光素眼底血管造影( FFA)及B超检查。光动力疗法为TAP标准疗法,采用光敏剂为维替泊芬。肿瘤厚度≤3 mm采用50 J/cm2,83 s,≥4 mm采用75 J/cm2,125 s。治疗后每3个月复查一次,治疗前后各项检测指标比较采用配对t检验。结果视力≤0.05者6只眼,0.06~0.2者6只眼,0.3~0.5者6只眼,0.6~1.0者5只眼。瘤体位于黄斑及其周围者13只眼(56.5%),位于视盘及其周围者9只眼(39.1%),位于血管弓者1只眼(4.4%)。全部病例瘤体表面及黄斑部均有视网膜脱离,脱离扩展至眼底下半部者4只眼。全部病例只作1次PDT 治疗,未见并发症。治疗有效14只眼(60.8%)。其中,渗液吸收,维持原视力者9只眼(39.1%),视力增进≥2行者5只眼(21.7%)。在治疗有效的病例中,渗出性视网膜脱离较浅,基线(即原始)视力平均为0.43±0.43。视力增进者由治疗前视力平均0.09±0.07,增进至术后平均为0.64±0.23,差异有统计学意义(t=4.98,P<0.05)。 FFA检查,治疗前早期有瘤体血管显现荧光,荧光渗漏至瘤体内和视网膜下方。晚期瘤体呈高荧光团或排空,视网膜囊样变处呈高荧光点。治疗有效者瘤体荧光渗漏减轻或停止。 B超检查,治疗前瘤体厚度1.3~3.3 mm,平均厚度为(2.08±0.75)mm;治疗后瘤体平均厚度有所减小为(1.70±0.71) mm,但差异无统计学意义(t=2.10,P>0.05)。治疗无效(指渗液不吸收和(或)视力下降≤2行)者共9例。与治疗有效的病例相比,无效病例渗出性视网膜脱离较重,基线视力较差,平均为0.14±0.13,差异有统计学意义(t=2.27,P<0.05);瘤体较厚,厚度2.9~7.0 mm,平均厚度为(4.63±1.55) mm。治疗有效与无效的瘤体厚度相比差异有统计学意义(t=4.81,P<0.05)。结论1次性PDT治疗CCH安全有效。应首选瘤体厚度≤4 mm且视网膜脱离较浅的病例为宜。否则可考虑增加PDT治疗次数或选用其他疗法如经瞳孔温热疗法或放射疗法等。
目的:評估光動力療法( PDT)對國人限跼性脈絡膜血管瘤( CCH)的療效。方法迴顧性繫列病例研究。收集2004年1月至2010年12月首都醫科大學附屬北京同仁醫院眼科門診23例(23隻眼) CCH患者臨床資料進行迴顧性分析。其中男性15例,女性8例;年齡16~68歲,平均45歲。採用眼底鏡、熒光素眼底血管造影( FFA)及B超檢查。光動力療法為TAP標準療法,採用光敏劑為維替泊芬。腫瘤厚度≤3 mm採用50 J/cm2,83 s,≥4 mm採用75 J/cm2,125 s。治療後每3箇月複查一次,治療前後各項檢測指標比較採用配對t檢驗。結果視力≤0.05者6隻眼,0.06~0.2者6隻眼,0.3~0.5者6隻眼,0.6~1.0者5隻眼。瘤體位于黃斑及其週圍者13隻眼(56.5%),位于視盤及其週圍者9隻眼(39.1%),位于血管弓者1隻眼(4.4%)。全部病例瘤體錶麵及黃斑部均有視網膜脫離,脫離擴展至眼底下半部者4隻眼。全部病例隻作1次PDT 治療,未見併髮癥。治療有效14隻眼(60.8%)。其中,滲液吸收,維持原視力者9隻眼(39.1%),視力增進≥2行者5隻眼(21.7%)。在治療有效的病例中,滲齣性視網膜脫離較淺,基線(即原始)視力平均為0.43±0.43。視力增進者由治療前視力平均0.09±0.07,增進至術後平均為0.64±0.23,差異有統計學意義(t=4.98,P<0.05)。 FFA檢查,治療前早期有瘤體血管顯現熒光,熒光滲漏至瘤體內和視網膜下方。晚期瘤體呈高熒光糰或排空,視網膜囊樣變處呈高熒光點。治療有效者瘤體熒光滲漏減輕或停止。 B超檢查,治療前瘤體厚度1.3~3.3 mm,平均厚度為(2.08±0.75)mm;治療後瘤體平均厚度有所減小為(1.70±0.71) mm,但差異無統計學意義(t=2.10,P>0.05)。治療無效(指滲液不吸收和(或)視力下降≤2行)者共9例。與治療有效的病例相比,無效病例滲齣性視網膜脫離較重,基線視力較差,平均為0.14±0.13,差異有統計學意義(t=2.27,P<0.05);瘤體較厚,厚度2.9~7.0 mm,平均厚度為(4.63±1.55) mm。治療有效與無效的瘤體厚度相比差異有統計學意義(t=4.81,P<0.05)。結論1次性PDT治療CCH安全有效。應首選瘤體厚度≤4 mm且視網膜脫離較淺的病例為宜。否則可攷慮增加PDT治療次數或選用其他療法如經瞳孔溫熱療法或放射療法等。
목적:평고광동력요법( PDT)대국인한국성맥락막혈관류( CCH)적료효。방법회고성계렬병례연구。수집2004년1월지2010년12월수도의과대학부속북경동인의원안과문진23례(23지안) CCH환자림상자료진행회고성분석。기중남성15례,녀성8례;년령16~68세,평균45세。채용안저경、형광소안저혈관조영( FFA)급B초검사。광동력요법위TAP표준요법,채용광민제위유체박분。종류후도≤3 mm채용50 J/cm2,83 s,≥4 mm채용75 J/cm2,125 s。치료후매3개월복사일차,치료전후각항검측지표비교채용배대t검험。결과시력≤0.05자6지안,0.06~0.2자6지안,0.3~0.5자6지안,0.6~1.0자5지안。류체위우황반급기주위자13지안(56.5%),위우시반급기주위자9지안(39.1%),위우혈관궁자1지안(4.4%)。전부병례류체표면급황반부균유시망막탈리,탈리확전지안저하반부자4지안。전부병례지작1차PDT 치료,미견병발증。치료유효14지안(60.8%)。기중,삼액흡수,유지원시력자9지안(39.1%),시력증진≥2행자5지안(21.7%)。재치료유효적병례중,삼출성시망막탈리교천,기선(즉원시)시력평균위0.43±0.43。시력증진자유치료전시력평균0.09±0.07,증진지술후평균위0.64±0.23,차이유통계학의의(t=4.98,P<0.05)。 FFA검사,치료전조기유류체혈관현현형광,형광삼루지류체내화시망막하방。만기류체정고형광단혹배공,시망막낭양변처정고형광점。치료유효자류체형광삼루감경혹정지。 B초검사,치료전류체후도1.3~3.3 mm,평균후도위(2.08±0.75)mm;치료후류체평균후도유소감소위(1.70±0.71) mm,단차이무통계학의의(t=2.10,P>0.05)。치료무효(지삼액불흡수화(혹)시력하강≤2행)자공9례。여치료유효적병례상비,무효병례삼출성시망막탈리교중,기선시력교차,평균위0.14±0.13,차이유통계학의의(t=2.27,P<0.05);류체교후,후도2.9~7.0 mm,평균후도위(4.63±1.55) mm。치료유효여무효적류체후도상비차이유통계학의의(t=4.81,P<0.05)。결론1차성PDT치료CCH안전유효。응수선류체후도≤4 mm차시망막탈리교천적병례위의。부칙가고필증가PDT치료차수혹선용기타요법여경동공온열요법혹방사요법등。
Objective To study the effect of photodynamic therapy ( PDT ) on circumscribed choroidal hemangiomas(CCH).Methods It was a retrospective case series study.A total of 23 cases (23 eyes) with CCH in Tongren hospital from 2004 to 2010 were retrospectively enrolled in the study with men 15 cases, female 8 cases.The age of cases was 16-68 years with average 45 years.Ophthalmoscope、fundus fluorescein angiography ( FFA ) and ultrasonography were used for exam.Verteporfin photodynamic therapy(TAP protocol) were performed with 50 J/cm2,83 s in the tumors height≤3 mm,with 75 J/cm2, 125 s in the tumors height≥4 mm.The follow-up interval was 3 months.Paired t test was used to analyze the data.Difference was statistically significant when P<0.05.Results The visual acuity was ≤0.05 in 6 eyes, 0.06-0.2 in 6 eyes, 0.3-0.5 in 6 eyes, 0.6-1.0 in 5 eyes.The tumor was located at macular area in 13 cases(56.5%),around the disc in 9 cases(39.1%), at the temporal arcuate in 1 case(4.4%). Retinal detachment appeared on the tumor surface and macular area in all cases, extended in the inferior half part of the fundus in 4 cases.One session of PDT was performed in all cases.No complication was found. The effective cases included subretinal fluid absorption with VA maintained in 9 cases(39.1%), the fluid absorption with improved VA≥2 lines in 5 cases(21.7%).The effective rate was 14/23 cases(60.8%).In effective cases, the retinal detachment was more shallow, baseline ie primary VA was average 0.43±0.43, the VA was improved significantly from average 0.09±0.07 before treatment to average 0.64±0.23(t=4.98,P<0.05) after treatment in 5 cases.The height of tumor was(1.3-3.3) mm with average( 2.08±0.75) mm before treatment by ultrasonography,and was decreased to average (1.70±0.71) mm(t=2.10,P>0.05) after treatment.The subretinal fluid not absorbed and/or VA decreased≤2 lines compared to baseline VA were regarded as unsuccessful in 9 cases, which showed clinically significant retinal detachment, baseline VA average 0.14 ±0.13 ( t=2.27, P<0.05 ) and the tumor thickness ( 2.9-7.0 ) mm with average ( 4.63 ± 1.55) mm.Compared to successful cases, unsuccessful cases had lower VA(t=4.81,P<0.05),thicker tumor thickness and more significant retinal detachment.Conclusions One session of PDT for CCH was effective and safe.It was suitable for cases with tumor thickness≤4 mm and shallow retinal detachment to perform PDT.