中华眼外伤职业眼病杂志
中華眼外傷職業眼病雜誌
중화안외상직업안병잡지
CHINESE JOURNAL OF OCULAR TRAUMA AND OCCUPATIONAL EYE DISEASE
2014年
4期
255-258
,共4页
血管瘤,脉络膜%疗法,光动力%疗法,温热,经瞳孔%效果
血管瘤,脈絡膜%療法,光動力%療法,溫熱,經瞳孔%效果
혈관류,맥락막%요법,광동력%요법,온열,경동공%효과
Hemangioma,choroidal,circumscribed%Therapy,photodynamic%Thermotherapy,transpupillary%Effect
目的 比较光动力疗法(PDT)和经瞳孔温热疗法(TTT)对局限性脉络膜血管瘤的治疗效果.方法 任选进入经瞳孔温热疗法组114例(114只眼)和光动力疗法组20例(20只眼).采用荧光素眼底血管造影及眼B型超声波检查.经瞳孔温热疗法治疗时光斑覆盖整个瘤体呈灰白色反应.如瘤体较大则多个光斑组合.每次所作光斑点数1～6个.治疗次数1～5次.治疗间隔时间1～3个月.光动力疗法治疗采用维替泊芬(vertepoffin)静脉注射15 min后,用689 nm激光照射.肿物厚度≤3 mm者采用83 s,＞3 mm采用166 s.光斑点数1～4个.治疗间隔时间≥3个月.结果 从5个方面对两种疗法进行对比.(1)瘤体部位.经瞳孔温热疗法治疗黄斑区肿物有效率达91.0％(61/67),视盘旁肿物有效率为94.3％ (33/35),二者差异无统计学意义(P =0.563).(2)视网膜脱离.该因素对PDT治疗的影响比TTT大.(3)瘤体厚度≥4 mm者,TTT所用激光穿透力强,比PDT优越.(4)激光对瘤体和组织的反应.PDT治疗后有轻微色素变动,也可引起迟发性脉络膜视网膜的萎缩.TTT治疗所形成色素瘢痕增生比PDT明显(5)有效率及视力.两组进行有效率及视力对比,P =0.40,0.28,均无统计学意义.结论 两种疗法均有治疗效果.位于黄斑中心区的渗液较少且不厚的肿物,可优先考虑作PDT治疗.如需再作,应慎重考虑PDT对组织的损伤.国人PDT治疗参数及对组织的损伤仍有观察探讨的必要.瘤体较厚渗液较多者可优先考虑TTT治疗.
目的 比較光動力療法(PDT)和經瞳孔溫熱療法(TTT)對跼限性脈絡膜血管瘤的治療效果.方法 任選進入經瞳孔溫熱療法組114例(114隻眼)和光動力療法組20例(20隻眼).採用熒光素眼底血管造影及眼B型超聲波檢查.經瞳孔溫熱療法治療時光斑覆蓋整箇瘤體呈灰白色反應.如瘤體較大則多箇光斑組閤.每次所作光斑點數1～6箇.治療次數1～5次.治療間隔時間1～3箇月.光動力療法治療採用維替泊芬(vertepoffin)靜脈註射15 min後,用689 nm激光照射.腫物厚度≤3 mm者採用83 s,＞3 mm採用166 s.光斑點數1～4箇.治療間隔時間≥3箇月.結果 從5箇方麵對兩種療法進行對比.(1)瘤體部位.經瞳孔溫熱療法治療黃斑區腫物有效率達91.0％(61/67),視盤徬腫物有效率為94.3％ (33/35),二者差異無統計學意義(P =0.563).(2)視網膜脫離.該因素對PDT治療的影響比TTT大.(3)瘤體厚度≥4 mm者,TTT所用激光穿透力彊,比PDT優越.(4)激光對瘤體和組織的反應.PDT治療後有輕微色素變動,也可引起遲髮性脈絡膜視網膜的萎縮.TTT治療所形成色素瘢痕增生比PDT明顯(5)有效率及視力.兩組進行有效率及視力對比,P =0.40,0.28,均無統計學意義.結論 兩種療法均有治療效果.位于黃斑中心區的滲液較少且不厚的腫物,可優先攷慮作PDT治療.如需再作,應慎重攷慮PDT對組織的損傷.國人PDT治療參數及對組織的損傷仍有觀察探討的必要.瘤體較厚滲液較多者可優先攷慮TTT治療.
목적 비교광동력요법(PDT)화경동공온열요법(TTT)대국한성맥락막혈관류적치료효과.방법 임선진입경동공온열요법조114례(114지안)화광동력요법조20례(20지안).채용형광소안저혈관조영급안B형초성파검사.경동공온열요법치료시광반복개정개류체정회백색반응.여류체교대칙다개광반조합.매차소작광반점수1～6개.치료차수1～5차.치료간격시간1～3개월.광동력요법치료채용유체박분(vertepoffin)정맥주사15 min후,용689 nm격광조사.종물후도≤3 mm자채용83 s,＞3 mm채용166 s.광반점수1～4개.치료간격시간≥3개월.결과 종5개방면대량충요법진행대비.(1)류체부위.경동공온열요법치료황반구종물유효솔체91.0％(61/67),시반방종물유효솔위94.3％ (33/35),이자차이무통계학의의(P =0.563).(2)시망막탈리.해인소대PDT치료적영향비TTT대.(3)류체후도≥4 mm자,TTT소용격광천투력강,비PDT우월.(4)격광대류체화조직적반응.PDT치료후유경미색소변동,야가인기지발성맥락막시망막적위축.TTT치료소형성색소반흔증생비PDT명현(5)유효솔급시력.량조진행유효솔급시력대비,P =0.40,0.28,균무통계학의의.결론 량충요법균유치료효과.위우황반중심구적삼액교소차불후적종물,가우선고필작PDT치료.여수재작,응신중고필PDT대조직적손상.국인PDT치료삼수급대조직적손상잉유관찰탐토적필요.류체교후삼액교다자가우선고필TTT치료.
Objective To compare the therapeutic effects between transpupillary thermotherapy (TTT) and photodynamic therapy (PDT) for circumscribed choroidal hemangioma(CCH).Methods One hundred and fourteen eyes of 114 cases treated by TTT and twenty eyes of 20 cases treated by PDT were enrolled in the study.Fundus fluorescein angiography(FFA) and ultrasonography(B-scan) were used for examination.In TTT,the entire tumor surface was covered by the laser spots resulting in a gray-white reaction and overlapping laser spots were placed for larger tumors.There were 1 ～ 6 laser spots in each treatment.The session for management was 1 ～ 5 times with 1 ～ 3 months interval.The standard photodynamic therapy with the photosensitizer verteporfin was carried out.The intravenous verteporfin was administered 15 minutes before laser irradiation at 689 nm.Tumors less than 3 mm thick were irradiated for 83 seconds; tumors thicker than 3 mm were irradiated for 166 seconds.The interval time was ≥3 months.Results The five factors were compared.(1) The location of tumor.The rate of efficiency of TTT in foveal and para-foveal cases was 91％ (61/67) and 94.3％ (33/35) in around disk.There was no significant difference in effective rate between the two locations (P =0.563).(2) Retinal detachment.The incidence of retinal detachment over the tumor surface was higher in PDT group than TTT group.(3)Tumor thickness.For tumor with thickness≥4 mm,the effect of TTT was better than PDT penetrate tissue.(4) The response of body tissues and tumor to laser power.There were higher degrees of scarring,pigment,proliferation in TTT cases than PDT cases which only had slight pigment changes and sometimes with delayed chorioretinal atrophy.(5)The efficiency and visual aeuity(VA).There was no significant difference in the rate of efficiency and VA improvement between TTT and PDT groups (P =0.40,0.28).Conclusion The two laser are effective for CCH.The CCH in foveal and para-foveal with less exudation should be treated by PDT.The side effects are needed to be concerned in subsequent treatment.TTT is preferred for thicker tumors with much exudation.
