Eandi Chiara M, Ober Michael D, Freund K Bailey, Slakter Jason S, Yannuzzi Lawrence A
The LuEsther T. Mertz Retina Research Center of Manhattan Eye, Ear and Throat Hospital, New York, New York 10021, USA.
Retina. 2007 Sep;27(7):825-31. doi: 10.1097/IAE.0b013e31804b3f70.
To evaluate the efficacy of selective treatment with indocyanine green (ICG) angiography-guided photodynamic therapy (PDT) with verteporfin for polypoidal choroidal vasculopathy (PCV).
In this retrospective consecutive series, 30 eyes of 30 patients with PCV were included. Complete ocular examination, digital fluorescein angiography (FA), ICG angiography, and optical coherence tomography were performed at baseline and at standard intervals thereafter. ICG angiography-guided PDT was performed on all eyes. Only the area of the active PCV or "hot spot" evident on the ICG angiogram was treated. A spot size was chosen to cover the active neovascular lesion with a 200-mum border. Retreatment was performed when angiography revealed a recurrent lesion.
Thirty eyes with PCV were treated and followed for 1 year. Mean age of the patients was 75 years (range, 55-90 years). These patients were all classified as having occult choroidal neovascularization (CNV) with FA and polypoidal CNV with ICG angiography. Improvement of vision (>or=3 lines) was achieved in 15 eyes (50%). Nine eyes had stable vision (30%), and 6 eyes (20%) had a decrease in vision (>or=3 lines). Repeated treatment was required in 15 eyes (50%) for an average of 2.2 treatments in 1 year.
This study indicates that stabilization or improvement of vision is achieved in most eyes (80%) with neovascular AMD from PCV after selected ICG angiography-guided PDT. These outcomes compare very favorably with those in previous reports on the treatment of occult CNV. Reduced collateral damage to the choriocapillaris and reduced upregulation of vascular endothelial growth factor are presumed to be the explanation for this apparently better outcome. Further studies with longer follow-up are warranted to investigate the long-term efficacy in these conditions.
评估吲哚菁绿（ICG）血管造影引导下维替泊芬光动力疗法（PDT）治疗息肉样脉络膜血管病变（PCV）的疗效。
在这个回顾性连续系列研究中，纳入了30例PCV患者的30只眼。在基线期及之后的标准间隔时间进行全面的眼部检查、数字荧光素血管造影（FA）、ICG血管造影和光学相干断层扫描。对所有眼睛进行ICG血管造影引导下的PDT治疗。仅对ICG血管造影上明显的活动性PCV区域或“热点”进行治疗。选择光斑大小以覆盖活动性新生血管病变并留出200μm的边界。当血管造影显示复发病变时进行再次治疗。
30只PCV眼接受治疗并随访1年。患者的平均年龄为75岁（范围55 - 90岁）。这些患者经FA均被分类为隐匿性脉络膜新生血管（CNV），经ICG血管造影为息肉样CNV。15只眼（50%）视力提高（≥3行）。9只眼视力稳定（30%），6只眼（20%）视力下降（≥3行）。15只眼（50%）需要重复治疗，1年内平均治疗2.2次。
本研究表明，在大多数（80%）PCV所致的新生血管性年龄相关性黄斑变性（AMD）眼中，经选择性ICG血管造影引导下的PDT治疗后视力得以稳定或提高。这些结果与以往关于隐匿性CNV治疗的报道相比非常有利。脉络膜毛细血管的附带损伤减少以及血管内皮生长因子的上调减少被认为是这种明显更好结果的原因。有必要进行更长时间随访的进一步研究以探讨这些情况下的长期疗效。
