Department of Ophthalmology, HK Sanatorium Hospital, Happy Valley, Hong Kong.
Graefes Arch Clin Exp Ophthalmol. 2010 May;248(5):613-26. doi: 10.1007/s00417-010-1307-z. Epub 2010 Feb 17.
BACKGROUND: Verteporfin photodynamic therapy (PDT) is approved for the treatment of predominantly classic subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD), as well as for subfoveal CNV due to pathologic myopia and ocular histoplasmosis syndrome. Verteporfin PDT addresses the underlying pathology of ocular vascular disorders through its angio-occlusive mechanism of action, which reduces both visual acuity loss and the underlying leakage associated with lesions. Verteporfin PDT has also been associated with encouraging treatment outcomes in case studies involving patients with choroidal vascular disorders such as polypoidal choroidal vasculopathy, central serous chorioretinopathy, choroidal haemangioma, angioid streaks, and inflammatory CNV, i.e. conditions currently considered as non-standard indications of verteporfin PDT. In many studies, outcomes were better than expected based on the natural courses of each of these conditions. Although the anti-vascular endothelial growth factor (VEGF) therapies, ranibizumab and pegaptanib, have been approved for CNV due to AMD, their role in these other choroidal vascular disorders remains to be established. We summarize current literature that has documented the use of verteporfin PDT in these conditions. CONCLUSIONS: The complex pathogenesis of CNV provides a rationale for investigating combination approaches comprising verteporfin PDT and anti-VEGF therapies. Randomized controlled studies are warranted to confirm the preliminary results of verteporfin PDT as a monotherapy or in combination with anti-VEGF therapies in the treatment of a variety of choroidal vascular conditions.
背景:维替泊芬光动力疗法(PDT)已被批准用于治疗主要为典型性黄斑下脉络膜新生血管(CNV)的年龄相关性黄斑变性(AMD),也可治疗病理性近视和眼组织胞浆菌病综合征所致的黄斑下 CNV。维替泊芬 PDT 通过其血管闭塞作用机制治疗眼部血管疾病,可减少视力丧失和与病变相关的潜在渗漏。维替泊芬 PDT 还与涉及脉络膜血管疾病患者的病例研究中令人鼓舞的治疗结果相关,例如息肉样脉络膜血管病变、中心性浆液性脉络膜视网膜病变、脉络膜血管瘤、脉络膜血管样条纹和炎症性 CNV,这些情况目前被认为是非维替泊芬 PDT 的标准适应证。在许多研究中,根据这些疾病的自然病程,其结果均好于预期。尽管抗血管内皮生长因子(VEGF)治疗药物雷珠单抗和贝伐珠单抗已被批准用于 AMD 所致的 CNV,但它们在这些其他脉络膜血管疾病中的作用仍有待确定。我们总结了目前记录维替泊芬 PDT 用于这些疾病的文献。
结论:CNV 的复杂发病机制为研究包括维替泊芬 PDT 和抗 VEGF 治疗的联合治疗方法提供了依据。需要进行随机对照研究以证实维替泊芬 PDT 作为单一疗法或联合抗 VEGF 治疗在治疗各种脉络膜血管疾病中的初步结果。
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