三例采用维替泊芬和光动力疗法治疗的视网膜大毛细血管血管瘤病例。

Three cases of large retinal capillary hemangiomas treated with verteporfin and photodynamic therapy.

作者信息

Aaberg Thomas M, Aaberg Thomas M, Martin Daniel F, Gilman James P, Myles Robert

机构信息

Associated Retinal Consultants, Grand Rapids, Mich, 49546, USA.

出版信息

Arch Ophthalmol. 2005 Mar;123(3):328-32. doi: 10.1001/archopht.123.3.328.

DOI:10.1001/archopht.123.3.328

PMID:15767474

Abstract

OBJECTIVE

To investigate the efficacy of verteporfin and photodynamic therapy in the treatment of large retinal capillary hemangiomas.

METHODS

Case reports of 3 patients with large retinal capillary hemangiomas treated with photodynamic therapy using verteporfin. Standard verteporfin dosages (6 mg/m(2) of body surface area) were given. Both standard and modified photodynamic protocols were followed. Modified protocols included shorter verteporfin infusion times and longer light exposure times.

RESULTS

Pretreatment best-corrected Snellen visual acuity of the 3 affected eyes were 20/100, 20/50, and 2/200, respectively. All cases had associated exudative retinal detachments involving the macula. Cases 1 and 2 were classic endophytic retinal capillary hemangiomas. Case 3 was a reactive retinal capillary hemangioma. Case 1 had 2 photodynamic therapy treatments, and after 8 months, visual acuity improved to 20/40. Two years after initiating photodynamic therapy, the visual acuity was 20/30 and there was no reperfusion of the hemangioma. Case 2 had 3 photodynamic therapy treatments. The hemangioma was fibrotic, and 20 months after initiating photodynamic therapy visual acuity improved to 20/30. Case 3 had 1 treatment, 11 weeks later and visual acuity improved to 20/400. Four months after treatment, visual acuity returned to counting fingers because of tractional elevation of the macula as the capillary hemangioma fibrosed. Vitrectomy surgery was performed, and choroidal and retinal neovascularization was discovered. Three months after vitrectomy visual acuity was 20/400. In cases 1 and 2, the capillary hemangioma ultimately regressed, and the exudative detachment resolved.

CONCLUSIONS

Verteporfin and photodynamic therapy were effective in achieving closure of large retinal capillary hemangiomas. In all cases, the hemangioma underwent fibrosis with consequent macular puckering due to retinal traction. In all cases, the visual acuity improved.

摘要

目的

探讨维替泊芬光动力疗法治疗视网膜大毛细血管血管瘤的疗效。

方法

3例视网膜大毛细血管血管瘤患者采用维替泊芬光动力疗法的病例报告。给予标准维替泊芬剂量（6mg/m²体表面积）。遵循标准和改良的光动力方案。改良方案包括缩短维替泊芬输注时间和延长光照时间。

结果

3只患眼治疗前最佳矫正视力分别为20/100、20/50和2/200。所有病例均伴有累及黄斑的渗出性视网膜脱离。病例1和病例2为典型内生性视网膜毛细血管血管瘤。病例3为反应性视网膜毛细血管血管瘤。病例1接受了2次光动力治疗，8个月后视力提高到20/40。开始光动力治疗2年后，视力为20/30，血管瘤无再灌注。病例2接受了3次光动力治疗。血管瘤纤维化，开始光动力治疗20个月后视力提高到20/30。病例3接受了1次治疗，11周后视力提高到20/400。治疗4个月后，由于毛细血管血管瘤纤维化导致黄斑牵拉性抬高，视力恢复到指数。行玻璃体切除术，发现脉络膜和视网膜新生血管。玻璃体切除术后3个月视力为20/400。病例1和病例2中，毛细血管血管瘤最终消退，渗出性脱离消失。