|
Also known as choroidal neovascularization (CNV) subretinal neovascularization, is a variety of causes of choroidal neovascular through the Brush membrane and retinal pigment subcutaneous fibrovascular tissue proliferation and the formation of retinal nerve sensory layer, which caused retinal hemorrhage, exudation, edema as well as the machine of scar will seriously affect the patient's central vision and the quality of everyday life. Retinal disease caused by choroidal neovascularization many, the most common age-related macular degeneration (AMD) and pathological myopia (PM), other central exudative retinal choroiditis, the choroiditis traumatic choroidal rupture histoplasmosis. The choroidal neovascularization reason there are a lot of questions, compare two factors recognized by hypoxia and inflammation. Neovascularization of the basic process of vascular endothelial cells (EC) activation, degradation of the extracellular matrix (ECM), the proliferation of EC, the lumen structure is formed, and the formation of vascular adventitia. Therefore, in the process of neovascularization, with the participation of many cytokines, and extracellular matrix. Radiation therapy, surgery, and laser therapy for the treatment of choroidal neovascularization. Previous two treatments, radiation therapy because there are more complications as well as security issues, is still in the exploratory stage, clinical rarely used. The surgical treatment of macular translocation surgery and neovascular membrane removal surgery. These two ways are built in mature vitreoretinal microsurgery based on, through microsurgery operation fovea from abnormal retinal pigment cortex transfer to the normal position or remove the abnormal choroidal neovascularization two kinds of treatments are surgical trauma, postoperative complications, and visual prognosis is not ideal, still the long-term observation is needed to clarify its efficacy and value. For the treatment of choroidal neovascularization laser photocoagulation treatment, mainly including the following three: krypton laser photocoagulation, transpupillary thermotherapy (TTT, photodynamic therapy (PDT). Krypton laser photocoagulation for distance macular 500μm outside the fovea, the early clear boundary CNV, the main principle is the high temperature generated by photocoagulation instant, closed the neovascular tissue for therapeutic purposes. drawback of limited treatment position and normal tissue damage, and the treatment of recurrence The rate is also higher. 810nm near-infrared light, low energy, large spot, improve the partial retinal tissue temperature, prompting the formation of new blood vessels thrombosis, for therapeutic purposes, can be relatively preserved lesions transpupillary thermotherapy (TTT) recurrence the surface retinal function, theoretically, can be closed all types of CNV is the disadvantage that may not be fully closed CNV or closed, and some damage exists for normal retinal tissue by photodynamic therapy (PDT) is recognized with good treatment for CNV The effect of the method is mainly the specific binding of the photosensitizer by intravenous injection with CNV (Visudyne, 689nm semiconductor laser irradiation and activation, resulting in the photooxidation of anti-endothelial cell, closed CNV is clear its therapeutic effect on the normal retinal tissue injury, and the treatment can be repeated, but the high cost of treatment, and some recurrence rate. According to the above description, we can know different laser indications and therapeutic effect for the treatment of choroidal neovascularization, and each laser there are advantages and disadvantages, whether through joint treatment of the several laser treatment advantages together, and use of cheap and of the CNV good treatment effect is a problem worthy of study in this line of thinking. under the guidance for the currently most commonly used for choroidal neovascularization treated two laser transpupillary thermotherapy (TTT) and the combination of photodynamic therapy (PDT). research purposes: 1. evaluation of TTT United PDT for CNV the effect repeat the efficacy of PDT group compared by TTT Joint PDT group to explore the feasibility of the combination therapy and research methods: 1. analysis in our hospital from September 2006 - January clinically diagnosed CNV and patients receiving treatment, a total of two groups were age-related macular degeneration and pathologic myopia patients, FFA ICGA are subfoveal or next subfoveal CNV group to accept repeated PDT treatment patients, a total of 55 cases of 87, including age-related macular degeneration with choroidal neovascularization 61 pathologic myopia with choroidal neovascularization 16 PDT treatment, the average age of 61 years for all patients a month, 3 months accept the distance and near vision inspection (snell eye chart), FFA ICGA, OCT examination, the review found that there is still the CNV leakage or CNV recurrence patients for three months, give again PDT treatment, patients with an average follow-up time of 6.8 months; another group after three months of treatment to accept TTT, FFA ICGA examination found that there are still CNV, PDT treatment of patients, 24 age-related macular degeneration with choroidal neovascularization, pathologic myopia with choroidal neovascularization 10 of 25 Example 34, with an average age of 59 years, all patients were also in the treatment of one month, three months to accept the distance and near vision check, FFA ICGA examination, OCT examination, mean follow-up time of 5.2 months. 3.PDT treatment methods: the photosensitizer benzoporphyrin derivative monoacid (BPD) (the trade name visudyne, Novartis Pharma Co., Ltd.). 6mg / m ~ 2 body surface area to calculate the required total, and diluted to 30ml alternate using semiconductor laser (French light too), laser wavelength cm ^ 2, with BPD maximum absorption peak phase agreement. cubital vein 10min uniform pushing Note darkroom. treatment according to lesion size adjustment irradiation diameter, irradiation diameter should exceed CNV range of maximum diameter (in both sides plus 1000μm). power density 600mw/cm ~ 2, the laser lesion time for 83s; the total score Luminous Flux from as 50J/cm to 2 after treatment the dark for 48 h. repeated PDT treatment indications: previous PDT 3 months after treatment, fundus examination, FFA ICGA examination, OCT examination confirmed affected eyes residual or recurrent CNV leakage area of ??more than 50% of the original area, or the emergence of new CNV leakage points; does not appear after the last treatment significant adverse reactions and complications; family members of patients said the understanding and support. TTT treatment: TTT treatment using semiconductor laser (French light too), the laser emission wavelength of 810nm. different spot diameter and energy according to the size of the CNV spot is slightly larger than the lesions, if necessary when more than one spot. using the spot diameter 3mm, spot number 1-2, 180-300mJ energy. treatment omentum no color change, appear to change the immediate termination of the laser treatment. 4 groups last follow-up visual acuity, fluorescein angiography and indocyanine green angiography (FFA ICGA), optical coherence tomography (OCT) examination results and treatment before contrast, evaluation of treatment effect of the two methods, and to compare the efficacy of the two methods compare the difference not statistically significant. 5. efficacy evaluation criteria: vision changes using the international standard eye chart (snellen) check from a change in vision and imaging. prevail, patients with corrected visual acuity improved 2 or two rows of the above vision improve; vision correction changes in a row within the scope of the vision and stability; corrected visual acuity 2 lines or more than 2 lines, and decreased vision. imaging tests for the FFA joint ICGA comparison before and after treatment changes come, the lesion the CNV is no longer leakage inspection showed only staining leak stopped; leakage inadequate treatment of CNV leakage before 50% of range, significantly reduce the leak; CNV is leakage accounted for more than 50% of the pre-treatment CNV leakage range for continuous leaking; leakage exceeded pre-treatment CNV lesions range increase; leakage after laser treatment, the leak has completely stopped, after the emergence of CNV leakage or typicality and (or) occult CNV lesions for CNV recurrence of. OCT examination bleeding edema significantly reduced, no significant change for the better for heavier vision deteriorate. stability in more than one line, fluorescein angiography leakage narrow OCT shows hemorrhagic edema of stability for the sector, divided into a treatment effective and ineffective treatment effect analysis of the effect of treatment were compared using the chi-square test, statistical analysis software SPSS11.5. findings: 1.PDT treatment group: 32 (36.78%) PDT repeated treatments, visual acuity improved gt; 2 line 35 (40.23%) fluctuations in vision in a row, 20 (22.99%), visual acuity decreased gt; 2 line. FFA ICGA angiography, leakage stop by 23, accounting for 26.44%, leakage range reduced by 51, accounting for 58.62%, no significant change in 13, accounting for 14.94%. to check bleeding edema significantly absorb 35 stable 36 increased 16 optical coherence tomography (OCT). 2. TTT combined with PDT treatment group: 12 (35.29%) visual acuity improved after receiving treatment gt; 2 line, 18 (52.94%) fluctuations in vision in a row, 4 (11.76%), decreased vision gt ; 2 lines. FFA ICGA angiography examination leakage stop 14, accounting for 41.18%, leakage to reduce the scope of 17, accounting for 50.00%, no significant changes in two, accounting for 5.88%, eye new CNV bleeding of 2.94% optical coherence tomography (OCT) examination, bleeding, edema significantly absorb 15 stable 18, aggravated a vision stability in line 1, fluorescein angiography leakage narrow, and The OCT shows hemorrhagic edema of stability for the sector, divided into the treatment of valid and invalid analysis of the treatment effect, the therapeutic effect of the two groups for the vision was no significant difference was not statistically significant (Z = -1.386 P = 0.166), FFA ICGA two groups for CNV closure effect, there was no significant difference was not statistically significant (Z = -0.899, P = 0.374), OCT examination showed two groups of treatment for the CNV bleeding edema The effect of the presence of a significant difference statistically significant (Z = 2.189 P = 0.029) the TTT the United PDT group is superior to repeat the PDT group and the therapeutic effect of the two groups of patients with AMD vision was no significant difference was not statistically significant (Z = -1.221 P = 0.222), FFA ICGA two groups for the closure of the effect of the CNV no significant differences, not statistically significant (Z = -0.612 P = 0.540), OCT examination two groups for treatment of CNV hemorrhagic edema effect does not exist significant differences were not statistically significant (Z = -1.643 P = 0.100). therapeutic effect of the two groups of patients with PM eyesight was no significant difference not statistically significance (Z = -0.656 P = 0.512), FFA ICGA two groups for the closure of the effect of the CNV no significant differences, not statistically significant (Z = -0.656 P = 0.512), OCT examination showed two groups for the CNV bleeding edema effect does not exist significant differences were not statistically significant (Z = -1.474 P = 0.141). conclusion 1.TTT combined with PDT for CNV effective in the short term; a certain extent, the of TTT United PDT treatment can reduce the number of repeat PDT treatment; 3. scarring after treatment because of TTT PDT treatment is still the first choice, so in the case of a conditional.
|