Eskelin Sebastian, Tommila Petri, Palosaari Tapani, Kivelä Tero
Vitreoretinal Service, Department of Ophthalmology, Helsinki University Central Hospital, Finland.
Acta Ophthalmol. 2008 Nov;86(7):794-9. doi: 10.1111/j.1755-3768.2007.01151.x. Epub 2008 Aug 27.
To evaluate the effect of photodynamic therapy (PDT) with verteporfin on symptomatic, aggressive retinal astrocytomas.
A prospective, interventional study in a tertiary referral centre. Two patients were treated with a single session of PDT using the standard parameters of the Verteporfin in Photodynamic Therapy (VIP) study: a 34-year-old man whose previously stationary juxtapapillary retinal astrocytoma, secondary to tuberous sclerosis, progressed within 7 months to involve the foveola; and a 68-year-old man whose acquired retinal astrocytoma progressed over 18 months in spite of standard photocoagulation. Both tumours were vascularized and had caused secondary lipid exudation and an exudative retinal detachment. Outcome measures were visual acuity, resorption of subretinal fluid, tumour height and fluorescein angiography.
The progressing, vascularized part of both retinal astrocytomas regressed, with little change in the poorly vascularized, stationary part of the congenital hamartoma. Visual acuity improved in the first patient and was unchanged in the second by 3 months, with stable vision in both and no sign of recurrence at 2 years. The exudative retinal detachments resolved completely. Tumour height reduced a median of 30%. Regression was associated with obliteration of tumour vessels within the progressing part of the lesion, with closure of some of the dilated retinal capillaries over the tumour. Intraretinal microvascular abnormalities and scattered haemorrhages appeared outside the treated area in the first patient.
PDT with verteporfin can induce regression of progressive, vascularized, aggressive retinal astrocytomas and may prevent typical progression to total retinal detachment and enucleation, whether the astrocytoma is associated with tuberous sclerosis or not. PDT may be considered a first-line treatment for aggressive retinal astrocytomas.
评估维替泊芬光动力疗法（PDT）对有症状的侵袭性视网膜星形细胞瘤的疗效。
在一家三级转诊中心进行的前瞻性干预研究。两名患者接受了单次PDT治疗，采用光动力疗法中维替泊芬（VIP）研究的标准参数：一名34岁男性，其继发于结节性硬化症的先前静止的视乳头旁视网膜星形细胞瘤在7个月内进展至累及黄斑小凹；另一名68岁男性，其获得性视网膜星形细胞瘤尽管接受了标准光凝治疗，但在18个月内仍有进展。两个肿瘤均有血管化，并导致继发性脂质渗出和渗出性视网膜脱离。观察指标包括视力、视网膜下液吸收情况、肿瘤高度和荧光素血管造影。
两个视网膜星形细胞瘤的进展性、血管化部分均退缩，先天性错构瘤的血管化不良、静止部分变化不大。第一名患者的视力有所改善，第二名患者在3个月时视力未变，两人的视力均保持稳定，2年时均无复发迹象。渗出性视网膜脱离完全消退。肿瘤高度中位数降低了30%。退缩与病变进展部分的肿瘤血管闭塞有关，肿瘤上方一些扩张的视网膜毛细血管关闭。第一名患者在治疗区域外出现视网膜内微血管异常和散在出血。
维替泊芬PDT可诱导进展性、血管化、侵袭性视网膜星形细胞瘤退缩，并可能预防其典型进展至全视网膜脱离和眼球摘除，无论星形细胞瘤是否与结节性硬化症相关。PDT可被视为侵袭性视网膜星形细胞瘤的一线治疗方法。
