Photodynamic therapy for choroidal neovascularisation due to choroidal coloboma in a 5 1/2-year-old child long-term results after 5 1/2 years
Photodynamic therapy for choroidal neovascularisation due to choroidal coloboma in a 5 1/2-year-old child long-term results after 5 1/2 years
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DOI：
10.1055/s-2006-927389
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发表时间：
2007-02-01
影响因子：
0.8
通讯作者：
Rehfeldt, K.
中科院分区：
文献类型：
--
作者：
von Eicken, J.;Hoeh, H.;Rehfeldt, K.
背景资料：关于维替泊芬光动力疗法（PDT）在继发性新生血管形成中的安全性的报道很少，关于PDT在儿童中的报道也很少，其中只有一例在学龄前儿童中。我们增加的情况下，5岁半的儿童与脉络膜新生血管由于脉络膜缺损。我们用PDT治疗这种情况。病人：一个5岁半的儿童，双眼脉络膜缺损，表现出从右眼到左眼的注视转换，发散性斜视转换为会聚性斜视，此外还记录到视力从0.4下降到0.04。这是由临床上可见的中央凹下脉络膜新生血管从上边缘的缺损。由于没有标准的治疗方法是可用于这种特殊的条件，我们决定治疗的孩子与PDT.Results：PDT与维替泊芬进行后，没有问题的动机和支持的孩子的父母（2.46毫升维替泊芬，4500点大小，83秒的治疗时间），并导致了一个完整的疤痕的CNV后14天。在治疗后3个月和6个月的随访中，我们仅记录到中度染色，但CNV无荧光素渗漏，也无黄斑水肿。在24个月内，遮盖治疗后视力提高至0.2，治疗后右眼的固定恢复，并导致间歇性固定。同时，德国"联邦法院"已经决定了这种标签外使用在极少数疾病中的报销规则。随访5年半未见CNV复发。结论：本病例证明PDT治疗包括学龄前儿童在内的合作儿童是可行和安全的。PDT不仅诱导继发于脉络膜缺损的CNV瘢痕形成，而且还恢复了失去的视力。
Background: There are only few reports about the safety of photodynamic therapy (PDT) with verteporfin in secondary neovascularisations and only scarce reports about the PDT in children, only one of them in preschool-age children. We add the case of a 5 and a half-year-old child with choroidal neovascularisation due to choroidal coloboma. We treated this condition with PDT.Patient: A 5 and a half-year-old-child with choroidal coloboma in both eyes showed a switch of fixation from the right to the left eye and divergent strabismus switched to convergent strabismus, in addition a decrease in visual acuity from 0.4 to 0.04 was recorded. This was caused by a clinically visible subfoveal choroidal neovascularisation from the upper edge of the coloboma. Because no standard therapy is available for this special condition, we decided to treat the child with PDT.Results: PDT with verteporfin was performed without problems after motivation and support of the child by the parents (2.46 mL verteporfin, 4500 pm spot size, 83 seconds treatment time) and led to a complete scaring of the CNV after 14 days. At follow-up 3 and 6 months after therapy we documented only a moderate staining but no fluorescein leakage from the CNV and no macular oedema. Visual acuity increased after occlusion therapy Within 24 months to 0.2 and fixation of the treated right eye was restored and resulted in intermittent fixation. Mean while the German "Bundessozialgericht" has decided on the reimbursement rules for this off-label use in very seldom diseases. No recurrence of the CNV was observed within the follow-up time of 5 and a half years.Conclusion: This case proves that PDT is possible and safe in cooperative children including those in preschool age. PDT not only induced scaring of a CNV secondary to choroidal coloboma but also a return of the lost visual acuity.