Wormald R, Evans J, Smeeth L
'Glaxo' Department of Ophthalmic Epidemiology, Institute of Ophthalmology (UCL) and Moorfields Eye Hospital, City Road, London, UK, EC1V 2PD.
Cochrane Database Syst Rev. 2000(2):CD002030. doi: 10.1002/14651858.CD002030.
In neovascular age-related macular degeneration, new vessels grow under the retina, distorting vision and leading to scarring. This is further exacerbated if the blood vessels leak. Photodynamic therapy, originally used in cancer treatment, has been investigated as a way to treat the neovascular membranes without affecting the retina.
The aim of this review is to examine the evidence for the safety and effectiveness of photodynamic therapy in the treatment of neovascular age-related macular degeneration.
We searched for trials in the Cochrane Eyes and Vision Group trials register (available in the Cochrane Controlled Trials Register), the Cochrane Controlled Trials Register, Medline and Embase. We used the Science Citation Index to search for reports that cited identified relevant study reports. We contacted experts in the field for further trials information, and we searched the reference lists of identified relevant studies for further trial reports. Searches were conducted in December 1999.
We included randomised trials of photodynamic therapy in people with choroidal neovascularisation due to age-related macular degeneration.
Two reviewers extracted the data independently. Meta analysis was not performed.
One published trial was identified. Outcome data were available at 12 months after the first treatment. Patients received an average of 3.7 treatments. The relative risk of losing three or more lines of visual acuity at 12 months comparing the intervention with the control group was 0.72 (95% confidence interval 0.61 to 0.86). The relative risk of losing six or more lines of visual acuity at 12 months comparing the intervention with the control group was 0.62 (95% confidence interval 0.44 to 0.87). Subgroup analyses suggest that the benefits may be confined to people with no occult choroidal neovascularisation.
REVIEWER'S CONCLUSIONS: Photodynamic therapy in people with classic choroidal neovascularisation due to age-related macular degeneration is effective in preventing visual loss. This evidence is drawn from a subgroup analysis of 143 participants in one trial. Outcomes and potential adverse effects of this treatment should be monitored closely. There is no evidence that photodynamic therapy is beneficial for people with evidence of occult choroidal neovascularisation. These people should be offered treatment in the context of a randomised trial.
在新生血管性年龄相关性黄斑变性中，新血管在视网膜下生长，扭曲视力并导致瘢痕形成。如果血管渗漏，情况会进一步恶化。光动力疗法最初用于癌症治疗，已被研究作为一种治疗新生血管膜而不影响视网膜的方法。
本综述的目的是研究光动力疗法治疗新生血管性年龄相关性黄斑变性的安全性和有效性证据。
我们在Cochrane眼科和视力组试验注册库（可在Cochrane对照试验注册库中获取）、Cochrane对照试验注册库、Medline和Embase中检索试验。我们使用科学引文索引搜索引用已识别相关研究报告的文献。我们联系该领域的专家以获取更多试验信息，并检索已识别相关研究的参考文献列表以获取更多试验报告。检索于1999年12月进行。
我们纳入了因年龄相关性黄斑变性导致脉络膜新生血管的患者接受光动力疗法的随机试验。
两名评价员独立提取数据。未进行荟萃分析。
确定了一项已发表的试验。首次治疗后12个月可获得结局数据。患者平均接受3.7次治疗。与对照组相比，干预组在12个月时视力下降3行或更多行的相对风险为0.72（95%置信区间0.61至0.86）。与对照组相比，干预组在12个月时视力下降6行或更多行的相对风险为0.62（95%置信区间0.44至0.87）。亚组分析表明，益处可能仅限于无隐匿性脉络膜新生血管的患者。
对于因年龄相关性黄斑变性导致典型脉络膜新生血管的患者，光动力疗法在预防视力丧失方面是有效的。该证据来自一项试验中143名参与者的亚组分析。应密切监测该治疗的结局和潜在不良反应。没有证据表明光动力疗法对有隐匿性脉络膜新生血管证据的患者有益。这些患者应在随机试验的背景下接受治疗。
