One-year outcomes of photodynamic therapy in age-related macular degeneration and polypoidal choroidal vasculopathy in Japanese patients
One-year outcomes of photodynamic therapy in age-related macular degeneration and polypoidal choroidal vasculopathy in Japanese patients
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DOI：
10.1016/j.ophtha.2007.02.031
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发表时间：
2008-01-01
期刊：
影响因子：
13.7
通讯作者：
Tano, Yasuo
中科院分区：
文献类型：
--
作者：
Gomi, Fumi;Ohji, Masahito;Tano, Yasuo
目的：为了确定息肉状脉络膜血管病变（PCV）在日本患者中的患病率，推测这些患者患有年龄相关性黄斑变性（AMD），并比较PCV和继发于AMD的脉络膜新生血管在光动力治疗后1年的结果。设计：前瞻性干预研究。参与者：93名连续患者（93只眼）符合纳入标准：至少50岁，早期治疗糖尿病视网膜病变研究（ETDRS）字母表上的最佳矫正视力（VA）为34至73，荧光素血管造影（FA）上的最大线性尺寸（GILD）为5400 Am或更小的中心凹下病变，并符合光动力治疗的条件。所有受试者均行吲哚菁绿色血管造影，鉴别PCV和AMD，给予光动力学治疗，观察1年。通过FA测定AMD的GLD，通过吲哚菁绿色血管造影测定PCV的GLD，并选择激光光斑尺寸的直径，将额外的1000 μ m添加到GILD。重复光动力治疗，如果泄漏发生在FA在3个月的随访visits.Main结果措施：PCV的基线和视觉和血管造影的变化，1年后的PCV和AMD的患病率。结果：使用吲哚菁绿色血管造影，36只眼（39%）被诊断为PCV和54只眼（58%）继发于AMD的脉络膜新生血管。从基线到1年，使用ETDRS字母评分的VA中位变化在AMD眼中为-7.0，在PCV眼中为+8.0（Mann-Whitney秩和检验; P= 15字母），AMD和PCV分别下降6%和25%，分别下降（>= 15字母）31%和8%。PCV组和AMD组中分别有86%和61%的患者在术后1年内停止了视网膜色素渗漏（P = 0.031）。息肉状脉络膜血管病变复发2 PCV眼（5.6%），和一个新的PCV病变发展在1 PCV眼（2.8%）和2 AMD眼（3.7%）的吲哚菁绿色angiography在1 year.Conclusion：PCV的患病率符合治疗标准的光动力治疗假定的AMD在日本患者是很高的。光动力疗法对PCV比对AMD更有效，这可以解释日本患者的良好结果。进一步研究应评估长期临床结果。Ophthalmology 2008; 115：141-146（c）2008，美国眼科学会。
Purpose: To determine the prevalence of polypoidal choroidal vasculopathy (PCV) in Japanese patients presumed to have age-related macular degeneration (AMD) and compare 1-year outcomes after photodynamic therapy between PCV and choroidal neovascularization secondary to AMD.Design: Prospective interventional study.Participants: Ninety-three consecutive patients (93 eyes) met the inclusion criteria: at least 50 years old, best-corrected visual acuity (VA) of 34 to 73 on the Early Treatment Diabetic Retinopathy Study (ETDRS) letter chart, a subfoveal lesion 5400 Am or smaller in greatest linear dimension (GILD) on fluorescein angiography (FA), and eligibility for photodynamic therapy.Methods: Indocyanine green angiography was performed in all participants, and PCV and AMD were differentiated, treated with photodynamic therapy, and the patients observed for 1 year. The GLD was determined by FA for AMD and by indocyanine green angiography for PCV, and the diameter of the laser spot size was chosen, with an extra 1000 mu m added to the GILD. Photodynamic therapy was repeated if leakage occurred on FA at 3-month follow-up visits.Main Outcome Measures: Prevalence of PCV at baseline and visual and angiographic changes 1 year after photodynamic therapy in PCV and AMD.Results: Using indocyanine green angiography, 36 eyes (39%) were diagnosed with PCV and 54 eyes (58%) with choroidal neovascularization secondary to AMD. The median change in VA using the ETDRS letter score from baseline to 1 year was -7.0 in AMD eyes and +8.0 in PCV eyes (Mann-Whitney rank sum test; P= 15 letters) in AMD and PCV by 6% and 25%, respectively, and decreased ( >= 15 letters) by 31% and 8%, respectively. Fluorescein leakage stopped at 1 year in 86% of PCV and 61% of AMD eyes (P = 0.031). Polypoidal choroidal vasculopathy recurred in 2 PCV eyes (5.6%), and a new PCV lesion developed in 1 PCV eye (2.8%) and 2 AMD eyes (3.7%) on indocyanine green angiography at 1 year.Conclusion: The prevalence of PCV meeting the treatment criteria for photodynamic therapy for presumed AMD is high in Japanese patients. Photodynamic therapy is more efficacious for PCV than for AMD, which may explain the good results in Japanese patients. Further study should assess the long-term clinical results. Ophthalmology 2008; 115:141-146 (c) 2008 by the American Academy of Ophthalmology.