Wormald R, Evans J, Smeeth L, Henshaw K
London School of Hygiene & Tropical Medicine, International Centre for Eye Health, Keppel Street, London, UK, WC1E 7HT.
Cochrane Database Syst Rev. 2007 Jul 18(3):CD002030. doi: 10.1002/14651858.CD002030.pub3.
In neovascular age-related macular degeneration (AMD) new vessels grow under the retina distorting vision and leading to scarring. This is exacerbated if the blood vessels leak. Photodynamic therapy (PDT) has been investigated as a way to treat the neovascular membranes without affecting the retina.
The aim of this review was to examine the effects of PDT in the treatment of neovascular AMD.
We searched CENTRAL (Issue 1, 2007), MEDLINE (1966 to March 2007), EMBASE (1980 to March 2007). We contacted experts in the field and searched the reference lists of relevant studies.
We included randomised trials of PDT in people with choroidal neovascularisation due to AMD.
Two authors independently extracted the data. Risk ratios were combined using a fixed-effect model after testing for heterogeneity.
Three published trials were identified that randomised 1022 participants to verteporfin therapy compared to 5% dextrose in water. The TAP and VIP trials were performed by the same investigators using largely the same clinical centres and funded by manufacturers of verteporfin. Outcome data were available at 12 and 24 months after the first treatment. Participants received on average five treatments over two years. The risk ratio of losing three or more lines of visual acuity at 24 months comparing the intervention with the control group was 0.77 (95% confidence interval 0.69 to 0.87). The risk ratio of losing six or more lines of visual acuity at 24 months comparing the intervention with the control group was 0.62 (95% confidence interval 0.50 to 0.76). The results at 12 months were similar to those at 24 months. The most serious adverse outcome, acute (within seven days of treatment) severe visual acuity decrease, occurs in about one in 50 patients. Some outcomes from the more recent VIM trial could be included in the meta-analysis but have not greatly altered the findings.
AUTHORS' CONCLUSIONS: Photodynamic therapy in people with choroidal neovascularisation due to AMD is probably effective in preventing visual loss though there is doubt about the size of the effect. Outcomes and potential adverse effects of this treatment should be monitored closely. Further independent trials of verteporfin are required to establish that the effects seen in this study are consistent and to examine important issues not yet addressed, particularly relating to quality of life and cost. However, the advent of new interventions for AMD make this unlikely.
在新生血管性年龄相关性黄斑变性（AMD）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，情况会更加恶化。光动力疗法（PDT）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PDT治疗新生血管性AMD的效果。
我们检索了Cochrane系统评价数据库（2007年第1期）、MEDLINE（1966年至2007年3月）、EMBASE（1980年至2007年3月）。我们联系了该领域的专家并检索了相关研究的参考文献列表。
我们纳入了因AMD导致脉络膜新生血管的患者接受PDT的随机试验。
两位作者独立提取数据。在检验异质性后，使用固定效应模型合并风险比。
共识别出三项已发表的试验，将1022名参与者随机分为维替泊芬治疗组和5%葡萄糖水溶液对照组。TAP和VIP试验由相同的研究人员进行，使用的临床中心基本相同，并由维替泊芬制造商资助。首次治疗后12个月和24个月可获得结局数据。参与者在两年内平均接受五次治疗。在24个月时，与对照组相比，干预组视力下降3行或更多行的风险比为0.77（95%置信区间0.69至0.87）。在24个月时，与对照组相比，干预组视力下降6行或更多行的风险比为0.62（95%置信区间0.50至0.76）。12个月时的结果与24个月时相似。最严重的不良结局，即急性（治疗后7天内）严重视力下降，约每50名患者中就有1例发生。较新的VIM试验的一些结果可纳入荟萃分析，但并未显著改变研究结果。
对于因AMD导致脉络膜新生血管的患者，光动力疗法可能有效预防视力丧失，尽管效果大小存在疑问。应密切监测该治疗的结局和潜在不良反应。需要进一步开展维替泊芬的独立试验，以确定本研究中观察到的效果是否一致，并研究尚未解决的重要问题，特别是与生活质量和成本相关的问题。然而，AMD新干预措施的出现使得这种情况不太可能发生。
