Choroidal vascular remodelling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level
Choroidal vascular remodelling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level
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DOI：
10.1136/bjo.87.12.1453
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发表时间：
2003-12-01
影响因子：
4.1
通讯作者：
Chan, CKM
中科院分区：
文献类型：
--
作者：
Chan, WM;Lam, DSC;Chan, CKM
目的：评价维替泊芬光动力疗法(PDT)治疗中心性浆液性脉络膜视网膜病变(CSC)后脉络膜血管的变化，探讨其作为治疗方案的可能性。方法：对持续性CSC和中心凹荧光素渗漏的慢性CSC进行前瞻性、非对照、干预性研究。所有患者均接受单次PDT+维替泊芬(6 mg/m(2)体表面积)，然后用50J/cm(2)波长689 nm激光照射。激光光斑大小以ICG-A检查结果为依据。结果：分析了6例6只眼的平均随访时间为12.7个月。所有(100%)接受PDT治疗的眼均可显示原扩张的脉络膜血管变窄，血管外渗漏减少。术后3个月，扩张的脉络膜血管直径由546um降至371um(p=0.028)。5例(83%)患者的视觉症状和最佳矫正视力得到改善。5只眼(83%)在随访1个月时停止荧光渗漏，6只眼(100%)在3个月时停止荧光渗漏。术后3个月随访1只眼发生脉络膜新生血管。结论：PDT成功地阻止了6例CSC患者的荧光素渗漏，且无复发。ICG-A发现PDT后脉络膜血管重塑和脉络膜通透性降低是令人鼓舞的。由于样本量小，平均随访期短，需要对联合应用维替泊芬的PDT治疗CSC进行进一步试验，以确定确保长期安全性和有效性结果的最佳参数。
Aims: To evaluate the changes in the choroidal vasculature in central serous chorioretinopathy (CSC) after photodynamic therapy (PDT) with verteporfin and to assess its potential role as a treatment option.Methods: A prospective, non-comparative, interventional study was performed in eyes with persistent CSC or chronic CSC that had fluorescein leakage at the fovea. All eyes received one single session of PDT with verteporfin (6 mg/m(2) body surface area) followed by application of 50 J/cm(2) laser at 689 nm. The laser spot size was guided by findings in ICG-A.Results: Six eyes from six patients with a mean follow up of 12.7 months were analysed. Narrowing of the original dilated choroidal vessels and decrease in extravascular leakage could be demonstrated in all (100%) PDT treated eyes. 3 months after PDT, the mean diameter of the dilated choroidal vessel reduced from 546 mum to 371 mum (p = 0.028). Five (83%) patients had improvement in visual symptoms and best corrected visual acuity. Fluorescence leakage stopped at the 1 month follow up in five eyes ( 83%) and at 3 months in all six eyes ( 100%). One eye developed choroidal neovascularisation at 3 month follow up. There was no other serious ocular or systemic complication.Conclusions: PDT is successful in stopping the fluorescein leakage in all six patients without recurrence of CSC. The ICG-A findings of choroidal vascular remodelling and decreased choroidal permeability after PDT are encouraging. As the sample size is small and the mean follow up period is short, further trials of PDT with verteporfin for CSC are required to address the optimal parameters in ensuring longer term safety and efficacy outcome.