Spaide Richard F, Sorenson John, Maranan Leandro
Vitreous-Retina-Macula Consultants of New York, New York, New York 10021, USA.
Ophthalmology. 2003 Aug;110(8):1517-25. doi: 10.1016/S0161-6420(03)00544-X.
To examine combined photodynamic therapy (PDT) with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).
Noncomparative case series.
Twenty-six eyes of 26 patients with CNV secondary to AMD. Thirteen with CNV, without restriction to type, were not treated with prior PDT and were called the Newly Treated group. Thirteen patients with prior PDT therapy who experienced visual loss during treatment with PDT alone comprised the remainder and were termed the Prior PDT group.
Patients with CNV were treated with PDT immediately followed by an intravitreal injection of 4 mg of triamcinolone acetonide. Visual acuity was measured by Early Treatment Diabetic Retinopathy Study protocol refraction. Need for retreatment was based on fluorescein angiographic evidence of leakage at 3-month follow-up intervals.
Visual acuity and retreatment rate.
Of the 13 patients in the Newly Treated group the mean visual acuity change at 3 months was an improvement of 1.9 lines, and 4 (30.8%) had an improvement of at least 3 lines. Two patients (15.4%) required retreatment at 3 months. At the 6-month follow-up, available for 12 patients in the Newly Treated group, the mean visual acuity change from baseline was an improvement of 2.4 lines, 4 patients (33%) had an improvement of at least 3 lines and 1 patient required retreatment. At both time points the visual acuity was significantly greater than at baseline (P = 0.023 and P = 0.007, at the 3-month and 6-month time points, Wilcoxon signed ranks test) for patients in the Newly Treated group. Among the 13 patients in the Prior PDT group, the mean change in visual acuity from baseline at the 3-month follow-up was 0.31 lines and 1 patient (7.7%) had an improvement of at least 3 lines. Six-month follow-up was available for 11 patients in the Prior PDT group and the mean change from baseline visual acuity was 0.1 lines and 1 patient (9.1%) experienced an improvement of 3 or more lines. No patient in the Prior PDT group required retreatment at 3 or 6 months. At the 3-month and 6-month time points the visual acuity was not significantly different than the baseline acuity in the Prior PDT group. No patient in either group at any time point experienced a loss of visual acuity of 3 or more lines. Five patients (19.2%), 3 in the Newly Treated group and 2 in the Prior PDT group, required monodrop therapy to control their intraocular pressure. No patient developed endophthalmitis.
Although the number of patients in this pilot study was limited, the improvement of acuity and the lack of fluorescein leakage in these patients suggest combination therapy with PDT and intravitreal triamcinolone acetonide, particularly when used as first-line therapy, merits further investigation.
研究维替泊芬联合玻璃体内注射曲安奈德光动力疗法（PDT）治疗年龄相关性黄斑变性（AMD）继发脉络膜新生血管（CNV）的效果。
非对照病例系列。
26例AMD继发CNV患者的26只眼。其中13例CNV患者，不限类型，未接受过PDT治疗，为新治疗组。其余13例曾接受PDT治疗但在单纯PDT治疗期间出现视力下降的患者为既往PDT组。
CNV患者接受PDT治疗后立即玻璃体内注射4mg曲安奈德。采用早期糖尿病视网膜病变研究方案验光测量视力。再次治疗的必要性基于3个月随访间隔时荧光素血管造影显示的渗漏情况。
视力和再次治疗率。
新治疗组13例患者中，3个月时平均视力改善1.9行，4例（30.8%）至少改善3行。2例患者（15.4%）在3个月时需要再次治疗。在新治疗组12例患者的6个月随访中，平均视力较基线改善2.4行，4例患者（33%）至少改善3行，1例患者需要再次治疗。在新治疗组患者中，两个时间点的视力均显著高于基线（3个月和6个月时间点，Wilcoxon符号秩检验，P = 0.023和P = 0.007）。既往PDT组13例患者中，3个月随访时平均视力较基线变化0.31行，1例患者（7.7%）至少改善3行。既往PDT组11例患者有6个月随访数据，平均视力较基线变化0.1行，1例患者（9.1%）视力改善3行或更多。既往PDT组无患者在3个月或6个月时需要再次治疗。在既往PDT组，3个月和6个月时的视力与基线视力无显著差异。两组均无患者在任何时间点出现3行或更多行的视力下降。5例患者（19.2%），新治疗组3例，既往PDT组2例，需要单滴眼药水治疗来控制眼压。无患者发生眼内炎。
尽管本初步研究的患者数量有限，但这些患者视力的改善和荧光素渗漏的缺乏表明，PDT联合玻璃体内注射曲安奈德的联合治疗，尤其是作为一线治疗时，值得进一步研究。
