Flaxel C J, Friedrichsen E J, Smith J O, Oeinck S C, Blacharski P A, Garcia C A, Chu H H
Department of Ophthalmology, Loma Linda University Medical Center, California, USA.
Eye (Lond). 2000 Apr;14 ( Pt 2):155-64. doi: 10.1038/eye.2000.46.
To assess the safety and potential toxicity of proton beam radiation in the treatment of subfoveal choroidal neovascular membrane (CNVM) due to age-related manner degeneration (ARMD) in a prospective, non-randomised study.
Forty-eight eyes of 46 consecutive patients with subfoveal CNVM due to ARMD, not amenable to laser photocoagulation, were treated prospectively with a single proton beam exposure. Two dose regimens were evaluated: 8 CGE (Cobalt Gray Equivalent) and 14 CGE. Patients were followed for an average of 22.1 months after proton beam treatment.
At the 12 month follow-up, 44% of eyes in the 8 CGE group and 75% of the eyes in the 14 CGE group had stabilized or improved visual acuity. Complex size in the 8 CGE group as measured on standard fluorescein angiography (FA), decreased or had no change initially but showed less effect over time, while the eyes treated with 14 CGE maintained decreased leakage over the follow-up period of 12 months. However, 11 eyes in the 14 CGE group experienced radiation retinopathy, with the onset between 3 and 30 months. Seven of these 11 eyes have demonstrated some visual loss but only 1 eye developed severe visual loss at 15 months after proton treatment.
To date, 14 CGE has suggested a favourable influence on visual function and growth inhibition of CNVM. Proton beam irradiation appears to inhibit CNVM growth. The 14 CGE dose regimen appears to have a longer effect of CNVM growth than does 8 CGE, with overall stabilisation of visual function and growth inhibition. Radiation retinopathy has developed over time, but severe visual loss has been limited. On the basis of the incidence of radiation retinopathy, adjustments in the total radiation dosage and/or fractionation of the dosage should be considered.
在一项前瞻性、非随机研究中，评估质子束辐射治疗年龄相关性黄斑变性（ARMD）所致黄斑下脉络膜新生血管膜（CNVM）的安全性和潜在毒性。
对46例因ARMD导致黄斑下CNVM且不适合激光光凝治疗的连续患者的48只眼进行前瞻性单剂量质子束照射治疗。评估了两种剂量方案：8 CGE（钴灰当量）和14 CGE。质子束治疗后患者平均随访22.1个月。
在12个月随访时，8 CGE组44%的眼和14 CGE组75%的眼视力稳定或提高。8 CGE组在标准荧光素血管造影（FA）上测量的病灶大小最初减小或无变化，但随时间推移效果减弱，而接受14 CGE治疗的眼在12个月的随访期内渗漏持续减少。然而，14 CGE组有11只眼发生放射性视网膜病变，发病时间在3至30个月之间。这11只眼中有7只出现了一定程度的视力丧失，但只有1只眼在质子治疗后15个月出现严重视力丧失。
迄今为止，14 CGE对CNVM的视觉功能和生长抑制显示出有利影响。质子束照射似乎能抑制CNVM生长。14 CGE剂量方案对CNVM生长的抑制作用似乎比8 CGE更长，能使视觉功能总体稳定并抑制生长。放射性视网膜病变随时间发展，但严重视力丧失有限。基于放射性视网膜病变的发生率，应考虑调整总辐射剂量和/或剂量分割。
