Donati G, Soubrane D, Quaranta M, Coscas G, Soubrane G
Eye Clinic, Department of Clinical Neurosciences, University Hospitals of Geneva.
Br J Ophthalmol. 1999 Jun;83(6):646-51. doi: 10.1136/bjo.83.6.646.
BACKGROUND/AIMS: Teletherapy has been proposed as a possible treatment for choroidal neovascular membranes (CNV), secondary to age related macular degeneration (AMD) not amenable to laser photocoagulation. The aim of this prospective study has been to investigate the effect of teletherapy on isolated occult choroidal neovascular membranes of subfoveal location.
28 AMD patients presenting with retrofoveal isolated occult CNV demonstrated by fluorescein angiography were treated by external beam radiation. A complete ophthalmological examination, fluorescein angiography, and indocyanine green angiography (ICG) were performed within 15 days before treatment and repeated at follow up. A total dose of 16 Gy was applied in four sessions of 4 Gy using a 4 MeV photon beam. Follow up ranged from 6 to 9 months (mean follow up 6.4 months).
Visual acuity was found to be stable in 68% of the cases. The decrease in visual acuity was of 3-6 lines in 18% and of more than 6 lines in 10% of the eyes at last examination. On fluorescein angiography the size of the lesion area was found to be stable in 67%, decreased in 13%, and increased in 20% of the cases. On ICG angiography the size of the CNV was stable in 93% and increased in 7% of the cases. All the eyes experiencing a visual acuity decrease showed either no change or an increase in size of the membrane on fluorescein angiography and/or on ICG.
According to this study with strict inclusion criteria, external beam radiotherapy seems to have a beneficial effect on the evolution of isolated occult subfoveal CNV.
背景/目的：对于年龄相关性黄斑变性（AMD）继发的脉络膜新生血管膜（CNV），若无法采用激光光凝治疗，远距离治疗被认为是一种可能的治疗方法。本前瞻性研究旨在探讨远距离治疗对孤立性黄斑中心凹下隐匿性脉络膜新生血管膜的疗效。
28例经荧光素血管造影证实存在黄斑中心凹后孤立性隐匿性CNV的AMD患者接受了外照射放疗。在治疗前15天内进行了全面的眼科检查、荧光素血管造影和吲哚菁绿血管造影（ICG），并在随访时重复检查。使用4 MeV光子束，分4次给予总剂量16 Gy，每次4 Gy。随访时间为6至9个月（平均随访6.4个月）。
68%的病例视力保持稳定。在最后一次检查时，18%的患眼视力下降了3 - 6行，10%的患眼视力下降超过6行。荧光素血管造影显示，67%的病例病变区域大小稳定，13%减小，20%增大。ICG血管造影显示，93%的病例CNV大小稳定，7%增大。所有视力下降的患眼在荧光素血管造影和/或ICG上均显示膜大小无变化或增大。
根据本纳入标准严格的研究，外照射放疗似乎对孤立性黄斑中心凹下隐匿性CNV的病情发展具有有益作用。
