Transient visual disturbance after photodynamic therapy.
Transient visual disturbance after photodynamic therapy.
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光动力治疗后短暂的视力障碍。
DOI：
10.1016/j.ajo.2004.08.072
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发表时间：
2005
影响因子：
4.2
通讯作者：
C. Meyer
中科院分区：
文献类型：
--
作者：
S. Mennel;C. Meyer
LAI和相关1例患有各种黄斑疾病的患者在光动力治疗（PDT）前以及治疗后4天、2周和1个月通过多焦视网膜电图（mfERG）进行检查。尽管作者在4天和2周随访访视时通过较低的N1和P1振幅确定了具有统计学意义的视网膜功能降低，但PDT后1个月的值与术前值无差异。作者得出结论，PDT可能导致早期、短暂的视网膜功能受损，尽管文章中4天和2周随访访视时的视力（VA）值仍然缺失。我们感谢作者的发现，并观察到我们的几名患者也抱怨在PDT后的第一周内出现短暂的VA降低。在一项前瞻性研究中，我们评估了24例患者（53次PDT治疗）前以及PDT后2天和1周的A-扫描超声生物测量和光学相干断层扫描（OCT）。2每次随访时均以术前屈光度及术后最佳矫正屈光度进行VA检查。PDT后2天，使用前术前屈光，VA平均下降1.3行。然而，如果进行新的最佳矫正屈光，则下降减小至0.26行。虽然术后平均屈光度为+ 0.35屈光度，但平均角膜视网膜距离减少了0.13 mm，相当于OCT上视网膜厚度连续增加至680 μm。黄斑区的横截面OCT扫描显示视网膜脱离，而神经感觉视网膜的解剖结构保持完整，显示无相关增厚或分裂样变化。PDT后1周，使用初始术前屈光时的平均VA与术前值无差异;然而，使用新评价的最佳矫正屈光时，平均VA增加了0.23行。此时的平均远视移位为+0.07屈光度。OCT检查，视网膜厚度降至315 μm。我们的研究结果表明，主观短暂的视觉障碍，在术后第一周，这可以通过使用适当的屈光补偿。Costa和同事先前的检查确定PDT后几小时，吲哚菁绿色血管造影（ICG）显示视网膜下渗漏增加，OCT显示连续视网膜抬高，证实了我们的功能和OCT结果。3 Michels和Schmidt-Erfurth观察到PDT后1天荧光素血管造影（FA）和ICG渗漏增加，随后PDT后1周ICG显示明显的脉络膜低灌注。他们的结论是，血视网膜屏障的早期破坏可能伴随着缺氧。4这些影响可能反映了Rogers及其同事的OCT结果，他们报告了PDT后3个月持续视网膜变薄的结构改变。5相应的功能改变可以解释所报告的从正图像（白色背景上的黑色字母）到倒置负图像的变化。Meyer及其同事观察到PDT后1周从阳性图像永久转变为阴性图像，即使在重复治疗后仍然保持不变。6 Lai及其同事使用mfERG报告的一过性视网膜功能降低可能反映了Mennel及其同事和Costa及其同事使用OCT描述的视网膜下液的解剖学积聚。2，3虽然视网膜下液主要在1周后被重吸收，但PDT后2周N1和P1值降低可能反映了光感受器的恢复过程或脉络膜灌注不足。4虽然Lai and Associates 1.
LAI AND ASSOCIATES 1 EVALUATED PATIENTS WITH VARI-ous macular disease prior to as well as 4 days, 2 weeks, and 1 month after photodynamic therapy (PDT) by multifocal electroretinogram (mfERG). Although the authors determined a statistically significant reduced retinal function by a lower N1 and P1 amplitude at the 4-day and 2-week follow-up visit, the values at 1 month after PDT did not differ from the preoperative values. The authors concluded that PDT might cause an early, transient impaired retinal function, although visual acuity (VA) values at the 4-day and 2-week follow-up visit remained missing in the article. We appreciate the authors’ findings and observed that several of our patients also complained about a transient reduced VA during the first week after PDT. In a prospective study, we evaluated 24 patients (53 PDT sessions) before PDT as well as 2 days and 1 week after PDT by A-scan ultrasound biometry and optical coherence tomography (OCT). 2 VA was tested with the preoperative refraction as well as the best-corrected postoperative refraction at each follow-up visit. Two days after PDT, VA declined by a mean of 1.3 lines using the former preoperative refraction. However, the decline diminished to 0.26 lines if a new best-corrected refraction was made. Although the postoperative average refractive shift was+ 0.35 diopters, the mean corneoretinal distance was reduced by 0.13 mm, corresponding to a consecutive increased retinal thickness up to 680 μm on OCT. The cross-sectional OCT-scan in the macular area revealed a retinal detachment, whereas the anatomy of the neurosensory retina maintained intact, demonstrating no relevant thickening or schisis-like changes. One week after PDT, the average VA did not differ from the preoperative values using the initial preoperative refraction; however, an increase of 0.23 lines was achieved using a new evaluated best-corrected refraction. The average hyperopic shift at this time was+ 0.07 diopters. On OCT, the retinal thickness decreased to 315 μm. Our results demonstrated subjective transient visual disturbances during the first postoperative week, which could be compensated by using adequate refraction. Previous examinations by Costa and associates determined that a few hours after PDT an increased subretinal leakage on indocyanine green angiography (ICG) and consecutive retinal elevation on OCT, confirming our functional and OCT findings. 3 Michels and Schmidt-Erfurth observed an increased leakage 1 day after PDT in fluorescein angiography (FA) and ICG, followed by a marked choroidal hypoperfusion on ICG 1 week after PDT. They concluded that an early breakdown at the blood-retina-barrier may be followed by hypoxia. 4 These effects may reflect OCT findings by Rogers and associates, who reported structural alterations in terms of persistent retinal thinning 3 months after PDT. 5 Corresponding functional alterations may explain a reported change from positive images (black letters on white background) to inverted negative images. Meyer and associates observed a permanent shift from positive to negative images 1 week after PDT, which remained and did not change even after repeated treatment sessions. 6 The reported transient reduced retinal function using mfERG by Lai and associates may reflect an anatomical accumulation of subretinal fluid as described by Mennel and associates and Costa and associates using OCT. 2, 3 Whereas subretinal fluid is mainly reabsorbed after 1 week, reduced N1 and P1 values 2 weeks after PDT may possibly reflect a recovery process of the photoreceptors or choroidal hypoperfusion. 4 Although Lai and associates 1 …