Singh Christopher N, Saperstein David A
Department of Ophthalmology, University of Washington, Seattle, WA, USA.
Retina. 2008 Jun;28(6):789-93. doi: 10.1097/IAE.0b013e31817082d7.
To evaluate combination treatment with reduced-fluence photodynamic therapy (PDT) and intravitreal triamcinolone acetonide (IVT) injection for choroidal neovascularization (CNV) in age-related macular degeneration (AMD).
This is a retrospective consecutive case series of 23 previously untreated eyes of 22 patients with subfoveal CNV secondary to AMD. Six eyes were treated with 50 J/cm; 8, with 40 J/cm; and 9, with 25 J/cm. PDT was immediately followed by a 4-mg IVT injection. Patients were observed for 6 months at 6-week intervals.
: The 50 J/cm subset lost a mean of 2.2 lines of Snellen visual acuity at the 6-month follow-up compared with a 1-line lost in the 40 J/cm subset and a 0.9-line gain in the 25 J/cm subset. In the 50 J/cm subset, 60% lost < or =3 lines of Snellen visual acuity, 33% gained > or =0 line, and 33% gained > or =3 lines. In the 40 J/cm subset, 75% lost < or =3 lines of Snellen visual acuity, 50% gained > or =0 line, and 25% gained > or =3 lines. In the 25 J/cm subset, 89% lost < or =3 lines of Snellen visual acuity, 56% gained > or =0 line, and 33% gained > or =3 lines. Fifty percent of the 50 J/cm subset, 50% of the 40 J/cm subset, and 33% of the 25 J/cm subset required retreatment by 6 months.
Although the sample in this study was small, there was a dose-response trend toward better visual outcomes and fewer treatments in the group treated with IVT injection and reduced-fluence PDT. This study along with other previously reported work suggests that studies using PDT in combination treatment for CNV should consider adding a reduced-fluence PDT arm.
评估低能量光动力疗法（PDT）联合玻璃体内注射曲安奈德（IVT）治疗年龄相关性黄斑变性（AMD）所致脉络膜新生血管（CNV）的效果。
这是一项回顾性连续病例系列研究，纳入22例继发于AMD的黄斑中心凹下CNV患者的23只未经治疗的眼睛。6只眼睛接受50 J/cm²的治疗；8只接受40 J/cm²的治疗；9只接受25 J/cm²的治疗。PDT治疗后立即进行4 mg的IVT注射。患者每隔6周观察6个月。
在6个月的随访中，接受50 J/cm²治疗的亚组平均视力下降2.2行Snellen视力表，而接受40 J/cm²治疗的亚组视力下降1行，接受25 J/cm²治疗的亚组视力提高0.9行。在接受50 J/cm²治疗的亚组中，60%的患者视力下降≤3行Snellen视力表，33%的患者视力提高≥0行，33%的患者视力提高≥3行。在接受40 J/cm²治疗的亚组中，75%的患者视力下降≤3行Snellen视力表，50%的患者视力提高≥0行，25%的患者视力提高≥3行。在接受25 J/cm²治疗的亚组中，89%的患者视力下降≤3行Snellen视力表，56%的患者视力提高≥0行，33%的患者视力提高≥3行。接受50 J/cm²治疗的亚组中有50%、接受40 J/cm²治疗的亚组中有50%以及接受25 J/cm²治疗的亚组中有33%的患者在6个月时需要再次治疗。
尽管本研究样本量较小，但在接受IVT注射和低能量PDT治疗的组中，存在剂量反应趋势，即视力结果更好且治疗次数更少。本研究以及其他先前报道的工作表明，使用PDT联合治疗CNV的研究应考虑增加低能量PDT组。
