Department of Ophthalmology, University of Gunma School of Medicine, Maebashi, Japan.
Ophthalmologica. 2010;224(5):267-73. doi: 10.1159/000287348. Epub 2010 Feb 25.
To evaluate the protective effect of intravitreal bevacizumab (IVB) and sub-Tenon triamcinolone acetonide (TA) against choriocapillaris occlusion induced by photodynamic therapy (PDT).
This prospective, nonrandomized, consecutive study included 80 eyes of 80 patients with polypoidal choroidal vasculopathy who underwent an initial PDT. The posttherapeutic follow-up periods were more than 3 months (mean, 9.3 months). Patients were divided into three groups consecutively: the PDT group included 21 eyes of 21 patients treated with only PDT, the TA group included 32 eyes of 32 patients treated with PDT and a sub-Tenon injection of 20 mg TA, and the IVB group included 27 eyes of 27 patients treated with PDT and an intravitreal injection of 1.25 mg bevacizumab. Indocyanine green angiography (ICGA) was performed before and 3 months after PDT. The degree of choriocapillaris occlusion was assessed in the marginal zone of the PDT area based on the background hypofluorescence seen on ICGA quantified by densitometry (Imagenet).
ICGA at 1 and 5 min showed hypofluorescence in the marginal zone in all eyes 3 months after PDT. The hypofluorescence became indistinguishable from the background fluorescence 15 min after treatment in some eyes; however, the relative hypofluorescence persisted in some cases. The rates of fluorescence intensity in the marginal zone compared to those in the untreated area, i.e. the percentage of baseline fluorescence, were 0.60, 0.65 and 0.73 at 1, 5 and 15 min after dye injection in the PDT group, respectively, 0.64, 0.68 and 0.82 in the TA group, and 0.64, 0.73 and 0.90 in the IVB group. The intensity of the fluorescence was significantly (p < 0.05) higher in the TA group at 15 min and in the IVB group at 1, 5 and 15 min compared with the PDT group.
IVB and TA reduced choriocapillaris occlusion after PDT. IVB appeared to have a stronger protective effect than TA in this therapeutic regimen.
评估玻璃体内注射贝伐单抗（IVB）和经Tenon 下曲安奈德（TA）对光动力疗法（PDT）诱导的脉络膜毛细血管闭塞的保护作用。
这是一项前瞻性、非随机、连续研究，纳入了 80 例 80 只眼患有息肉状脉络膜血管病变的患者，这些患者均接受了初始 PDT 治疗。治疗后的随访期超过 3 个月（平均 9.3 个月）。患者连续分为三组：PDT 组包括 21 只眼 21 例患者，仅接受 PDT 治疗；TA 组包括 32 只眼 32 例患者，接受 PDT 和 20mg TA 经 Tenon 下注射治疗；IVB 组包括 27 只眼 27 例患者，接受 PDT 和 1.25mg 贝伐单抗玻璃体内注射治疗。治疗前和 PDT 后 3 个月均进行吲哚青绿血管造影（ICGA）。根据 ICGA 定量密度测定法（Imagenet）显示的背景荧光下 PDT 区域边缘的脉络膜毛细血管闭塞程度进行评估。
所有患者在 PDT 后 3 个月的 ICGA 第 1 和 5 分钟时均显示出边缘区的荧光减弱。在治疗后 15 分钟时，一些患者的荧光减弱与背景荧光无法区分；然而，在一些情况下，相对荧光减弱仍然存在。与未经治疗区域相比，即基线荧光的百分比，在 PDT 组中，在染料注射后 1、5 和 15 分钟时，边缘区的荧光强度分别为 0.60、0.65 和 0.73，在 TA 组中，分别为 0.64、0.68 和 0.82，在 IVB 组中，分别为 0.64、0.73 和 0.90。在 15 分钟时，TA 组和在 1、5 和 15 分钟时 IVB 组的荧光强度显著（p<0.05）高于 PDT 组。
IVB 和 TA 降低了 PDT 后的脉络膜毛细血管闭塞。在这种治疗方案中，IVB 似乎比 TA 具有更强的保护作用。
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