背景 国内外光动力疗法(PDT)治疗中心性渗出性脉络膜视网膜病变(CEC)所使用的维替泊芬剂量是由TAP及VIP小组提出的依据患者体表面积计算得出的,部分临床研究表明该剂量治疗CEC可引起一些局部不良反应或损伤正常组织,因此探索维替泊芬的有效、安全剂量非常重要. 目的 观察并比较标准剂量、半剂量及1/3剂量维替泊芬PDT治疗CEC的临床疗效及安全性. 方法 收集2006年1月至2009年12月经荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)、OCT检查诊断为CEC的患者90例90眼,采用随机数字表法随机分为标准剂量组、半剂量组和1/3剂量组,每组各30例30眼,分别接受6、3、2 mg/m2维替泊芬PDT治疗.治疗后3个月进行复查,如发现脉络膜新生血管(CNV)扩大或复发,给予重复治疗.结果 标准剂量组术后最佳矫正视力(BCVA) (logMAR)为0.44±0.36,视力提高者20例,占66.67％;稳定者8例,占26.67％;下降者2例,占6.67％.治疗后BCVA较治疗前明显提高,差异有统计学意义(t=6.719,P=0.000).治疗后CNV消失者19例,占63.33％,大部分消失者7例,占23.33％;部分消失者3例,占10.00％;未消失或扩大者1例,占3.33％.治疗后黄斑中心凹视网膜厚度(CFT)值为(296.27±81.84) μm,治疗后CFT较治疗前明显变薄,差异有统计学意义(t=5.758,P=0.000).标准剂量组中8例接受了二次PDT治疗,复发率为26.67％.半剂量组术后BCVA为0.36±0.30,术后视力提高者18例,占60.00％;稳定者11者,占36.67％;下降者1例,占3.33％.治疗后BCVA较治疗前明显提高,差异有统计学意义(t=8.294,P=0.000),术后CNV消失或完全消退者16例,占53.33％;大部分消失者8例,占26.67％;部分消失者5例,16.67％;未消失或扩大者1例,占3.33％.治疗后CFT值为(266.17±70.83) μm,治疗后CFT较治疗前明显变薄,差异有统计学意义(t=8.493,P=0.000).半剂量组中10例接受重复治疗,复发率为33.33％.1/3剂量组术后BCVA为0.57±0.30,术后视力提高者8例,占26.67％;稳定者12例,占40.00％;下降者10例,占33.33％.治疗后BCVA与治疗前比较差异无统计学意义(t=0.536,P=0.596).CNV消失或完全消退者8例,占26.67％;大部分消失者8例,占26.67％;部分消失者6例,占20.00％;未消失或扩大者8例,占26.67％.治疗后CFT值为(327.00±78.27) μm,治疗后CFT与治疗前比较差异无统计学意义(t=0.942,P=0.354).1/3剂量组中14例接受2次治疗,8例接受3次治疗,复发率为73.33％. 结论 半剂量与标准剂量维替泊芬PDT治疗CEC的疗效和安全性接近,采用半剂量治疗可以节省患者的治疗费用,但1/3剂量维替泊芬PDT治疗CEC的疗效不明显.
揹景 國內外光動力療法(PDT)治療中心性滲齣性脈絡膜視網膜病變(CEC)所使用的維替泊芬劑量是由TAP及VIP小組提齣的依據患者體錶麵積計算得齣的,部分臨床研究錶明該劑量治療CEC可引起一些跼部不良反應或損傷正常組織,因此探索維替泊芬的有效、安全劑量非常重要. 目的 觀察併比較標準劑量、半劑量及1/3劑量維替泊芬PDT治療CEC的臨床療效及安全性. 方法 收集2006年1月至2009年12月經熒光素眼底血管造影(FFA)、吲哚青綠血管造影(ICGA)、OCT檢查診斷為CEC的患者90例90眼,採用隨機數字錶法隨機分為標準劑量組、半劑量組和1/3劑量組,每組各30例30眼,分彆接受6、3、2 mg/m2維替泊芬PDT治療.治療後3箇月進行複查,如髮現脈絡膜新生血管(CNV)擴大或複髮,給予重複治療.結果 標準劑量組術後最佳矯正視力(BCVA) (logMAR)為0.44±0.36,視力提高者20例,佔66.67％;穩定者8例,佔26.67％;下降者2例,佔6.67％.治療後BCVA較治療前明顯提高,差異有統計學意義(t=6.719,P=0.000).治療後CNV消失者19例,佔63.33％,大部分消失者7例,佔23.33％;部分消失者3例,佔10.00％;未消失或擴大者1例,佔3.33％.治療後黃斑中心凹視網膜厚度(CFT)值為(296.27±81.84) μm,治療後CFT較治療前明顯變薄,差異有統計學意義(t=5.758,P=0.000).標準劑量組中8例接受瞭二次PDT治療,複髮率為26.67％.半劑量組術後BCVA為0.36±0.30,術後視力提高者18例,佔60.00％;穩定者11者,佔36.67％;下降者1例,佔3.33％.治療後BCVA較治療前明顯提高,差異有統計學意義(t=8.294,P=0.000),術後CNV消失或完全消退者16例,佔53.33％;大部分消失者8例,佔26.67％;部分消失者5例,16.67％;未消失或擴大者1例,佔3.33％.治療後CFT值為(266.17±70.83) μm,治療後CFT較治療前明顯變薄,差異有統計學意義(t=8.493,P=0.000).半劑量組中10例接受重複治療,複髮率為33.33％.1/3劑量組術後BCVA為0.57±0.30,術後視力提高者8例,佔26.67％;穩定者12例,佔40.00％;下降者10例,佔33.33％.治療後BCVA與治療前比較差異無統計學意義(t=0.536,P=0.596).CNV消失或完全消退者8例,佔26.67％;大部分消失者8例,佔26.67％;部分消失者6例,佔20.00％;未消失或擴大者8例,佔26.67％.治療後CFT值為(327.00±78.27) μm,治療後CFT與治療前比較差異無統計學意義(t=0.942,P=0.354).1/3劑量組中14例接受2次治療,8例接受3次治療,複髮率為73.33％. 結論 半劑量與標準劑量維替泊芬PDT治療CEC的療效和安全性接近,採用半劑量治療可以節省患者的治療費用,但1/3劑量維替泊芬PDT治療CEC的療效不明顯.
배경 국내외광동력요법(PDT)치료중심성삼출성맥락막시망막병변(CEC)소사용적유체박분제량시유TAP급VIP소조제출적의거환자체표면적계산득출적,부분림상연구표명해제량치료CEC가인기일사국부불량반응혹손상정상조직,인차탐색유체박분적유효、안전제량비상중요. 목적 관찰병비교표준제량、반제량급1/3제량유체박분PDT치료CEC적림상료효급안전성. 방법 수집2006년1월지2009년12월경형광소안저혈관조영(FFA)、신타청록혈관조영(ICGA)、OCT검사진단위CEC적환자90례90안,채용수궤수자표법수궤분위표준제량조、반제량조화1/3제량조,매조각30례30안,분별접수6、3、2 mg/m2유체박분PDT치료.치료후3개월진행복사,여발현맥락막신생혈관(CNV)확대혹복발,급여중복치료.결과 표준제량조술후최가교정시력(BCVA) (logMAR)위0.44±0.36,시력제고자20례,점66.67％;은정자8례,점26.67％;하강자2례,점6.67％.치료후BCVA교치료전명현제고,차이유통계학의의(t=6.719,P=0.000).치료후CNV소실자19례,점63.33％,대부분소실자7례,점23.33％;부분소실자3례,점10.00％;미소실혹확대자1례,점3.33％.치료후황반중심요시망막후도(CFT)치위(296.27±81.84) μm,치료후CFT교치료전명현변박,차이유통계학의의(t=5.758,P=0.000).표준제량조중8례접수료이차PDT치료,복발솔위26.67％.반제량조술후BCVA위0.36±0.30,술후시력제고자18례,점60.00％;은정자11자,점36.67％;하강자1례,점3.33％.치료후BCVA교치료전명현제고,차이유통계학의의(t=8.294,P=0.000),술후CNV소실혹완전소퇴자16례,점53.33％;대부분소실자8례,점26.67％;부분소실자5례,16.67％;미소실혹확대자1례,점3.33％.치료후CFT치위(266.17±70.83) μm,치료후CFT교치료전명현변박,차이유통계학의의(t=8.493,P=0.000).반제량조중10례접수중복치료,복발솔위33.33％.1/3제량조술후BCVA위0.57±0.30,술후시력제고자8례,점26.67％;은정자12례,점40.00％;하강자10례,점33.33％.치료후BCVA여치료전비교차이무통계학의의(t=0.536,P=0.596).CNV소실혹완전소퇴자8례,점26.67％;대부분소실자8례,점26.67％;부분소실자6례,점20.00％;미소실혹확대자8례,점26.67％.치료후CFT치위(327.00±78.27) μm,치료후CFT여치료전비교차이무통계학의의(t=0.942,P=0.354).1/3제량조중14례접수2차치료,8례접수3차치료,복발솔위73.33％. 결론 반제량여표준제량유체박분PDT치료CEC적료효화안전성접근,채용반제량치료가이절성환자적치료비용,단1/3제량유체박분PDT치료CEC적료효불명현.
Background The dosage of verteporfin photodynamic therapy (PDT) for central exudative chorioretinopathy(CEC) depends on the calculation formula of Treatment of Age-related Macular Degeneration with Photodynamic Therapy Study Group(TAP)and Verteporfin in Photodynamic Therapy Study Group(VIP).Some local adverse responses or normal tissue damage have been noted under the standard dose of verteporfin during the treatment of CEC.So it is necessary to explore an appropriate therapeutic dosage of verteporfin.Objective This clinical study aimed to observe and compare the clinical efficacy and safety of different doses of verteporfin PDT for CEC.Methods Ninety eyes of 90 patients with CEC were enrolled in this study with the approval of the Ethic Commission of Affiliated Second Hospital of Nanchang University.Written informed consent was obtained before PDT.The patients were randomly divided into standard dose group,half dose group and 1/3 dose group.All of the patients received PDT.Standard dose(6 mg/m2),3 mg/m2 or 2 mg/m2 of verteporfin was applied in the three groups respectively,with the laser intensity 50 J/cm2.The patients were followed-up for 3 months.Repeat treating regimen was performed in the same way in the patient with fundus fluorescein leakage after initial PDT.Results The BCVA(logMAR) value was 0.44±0.36 after PDT in the standard dose group.Visual acuity improved in 20 patients (66.67％),stabilized in 8 patients(26.67％)and decreased in 2 patients (6.67％).The BCVA showed a significant difference between the preoperative and postoperative BCVA (t =6.719,P =0.000).CNV disappeared in 19 patients (63.33％),obviously improved in 7 patients (23.33％),partially disappeared in 3 patients (10.00％) and unchanged in 1 patient (3.33％).The central fovea thickness (CFT)value was significantly declined in postoperation compared with preoperation (t =5.758,P =0.000).Eight patients received secondary PDT with the recurrence rate 26.67％.In the half dose group,visual acuity improved in 18 patients(60.00％),stabilized in 11 patients(36.67％)and decreased in 1 patient (3.33％).CNV disappeared in 16 patients (53.33％),obviously improved in 8 patients (26.67％),partially disappeared in 5 patients (16.67％) and unchanged in 1 patient (3.33 ％).Significant difference was seen between the preoperative BCVA and postoperative BCVA(t=8.294,P =0.000).The decrease of C FT was significant in postoperation(t =8.493,P =0.000).Ten patients received secondary treatment with the recurrence rate 33.33％.In 1/3 dose group,visual acuity improved in 8 patients (26.67 ％),stabilized in 12 patients (40.00％),decreased in 10 patient (33.3％).CNV disappeared in 8 patients (26.67％),obviously improved in 8 patients (26.67％),partially disappeared in 6 patients (20.00％) and unchanged in 8 patient (26.67％).There was no significant difference between the preoperative BCVA and postoperative BCVA (t =0.536,P =0.596).The difference between preoperative CFT and postoperative CFT was insignificant(t =0.942,P=0.354).Fourteen patients received secondary PDT and 8 patients received three times with the recurrence rate 73.33％.Conclusions 3 mg/m2 verteporfin PDT for CEC shows a similar clinical efficiency and safety to 6 mg/m2 verteporfin.3 mg/m2 verteporfin PDT can decrease cost,but the effect of 2 mg/m2verteporfin PDT is not satisfacted.
