Kürzinger G R, Lang G K, Lang G E
Augenklinik, Universitätsklinikum Ulm, Ulm.
Klin Monbl Augenheilkd. 2008 Feb;225(2):159-64. doi: 10.1055/s-2008-1027198.
In age-related macular degeneration (ARMD) angiomatous proliferation can progress from the retina into the subretinal space. Retinal angiomatous proliferation (RAP) can be diagnosed by angiographic findings and optical coherence tomography (OCT). We investigated the outcome of photodynamic therapy in patients with RAP.
14 patients with ARMD and RAP were retrospectively analysed using a standardised protocol. The protocol included best corrected visual acuity (BCVA), ophthalmoscopy, OCT examination, fundus photography and fluorescein angiography (FAG). In a masked fashion the OCT and angiographic findings were independently graded in 3 stages (RAP I: intraretinal neovascularisation, RAP II: subretinal neovascularisation with a retinal-retinal anastomosis or subretinal neovascularisation with a serous pigment epithelial detachment, RAP III: choroidal neovascularisation with vascularised pigment epithelial detachment and retinal-choroidal anastomosis). 15 eyes of these 14 patients were evaluated pre- and post-PDT with the standardised protocol and the data statistically analysed.
The age ranged from 58 to 90 years (median 76 years). In 15 eyes of 14 patients with RAP a PDT was performed. 6 of these 15 PDT cases were successfully treated and gained >or= 2 lines (dry macula), 3 eyes with RAP I and 3 with RAP II. 4 eyes stablilised with +/-1 line (persistent macular oedema) under PDT with 2 RAP I, 1 RAP II and 1 RAP III. 5 eyes showed a deterioration with loss of >or= 2 lines (increasing macula oedema) with 2 RAP I and 3 RAP III. The median BCVA was pre-PDT in the successful cases 0.3, post-PDT 0.6, in the stable cases pre-PDT 0.2, post-PDT 0.2 and in the deterioration group pre-PDT 0.4 and post-PDT 0.01.
According to our study PDT might be helpful in the treatment of RAP stages I and II in selected cases in ARMD patients. Further prospective studies are required to investigate the outcome of PDT in RAP.
在年龄相关性黄斑变性（ARMD）中，血管瘤样增殖可从视网膜发展至视网膜下间隙。视网膜血管瘤样增殖（RAP）可通过血管造影结果和光学相干断层扫描（OCT）进行诊断。我们研究了RAP患者光动力疗法的疗效。
采用标准化方案对14例ARMD合并RAP患者进行回顾性分析。该方案包括最佳矫正视力（BCVA）、检眼镜检查、OCT检查、眼底照相和荧光素血管造影（FAG）。以盲法对OCT和血管造影结果进行独立分级，分为3个阶段（RAP I：视网膜内新生血管形成；RAP II：伴有视网膜-视网膜吻合的视网膜下新生血管形成或伴有浆液性色素上皮脱离的视网膜下新生血管形成；RAP III：伴有血管化色素上皮脱离和视网膜-脉络膜吻合的脉络膜新生血管形成）。对这14例患者的15只眼在光动力疗法（PDT）前后采用标准化方案进行评估，并对数据进行统计学分析。
年龄范围为58至90岁（中位数76岁）。14例RAP患者的15只眼接受了PDT治疗。这15例PDT病例中，6例成功治疗，视力提高≥2行（干性黄斑），其中3只眼为RAP I，3只眼为RAP II。4只眼在PDT治疗下视力稳定在±1行（持续性黄斑水肿），其中2只眼为RAP I，1只眼为RAP II，1只眼为RAP III。5只眼视力下降≥2行（黄斑水肿加重），其中2只眼为RAP I，3只眼为RAP III。成功病例的BCVA中位数在PDT前为0.3，PDT后为0.6；稳定病例在PDT前为0.2，PDT后为0.2；恶化组在PDT前为0.4，PDT后为0.01。
根据我们的研究，PDT可能有助于治疗ARMD患者中选定病例的RAP I和II期。需要进一步的前瞻性研究来调查PDT治疗RAP的疗效。
