Ruiz-Moreno José M, Montero Javier A, Amat Pedro, Lugo Francisco
Department of Ophthalmology, Albacete Medical School, University of Castilla La Mancha, Spain.
Int J Ophthalmol. 2010;3(2):161-3. doi: 10.3980/j.issn.2222-3959.2010.02.16. Epub 2010 Jun 18.
To report the appearance of choriocapillaris atrophy after combined high dose intravitreal triamcinolone acetonide (TA) and photodynamic therapy (PDT) to treat choroidal neovascularization (CNV) associated with age related macular degeneration (AMD).
The present study was retrospective about non-randomized interventional case series. Fifty-one consecutive eyes with subfoveal (all types) CNV associated with AMD were treated by PDT and intravitreal (19.4±2.1)mg per 0.1mL TA at the Alicante Institute of Ophthalmology. The appearance of macular choriocapillaris and retinal pigment epithelium (RPE) atrophy was considered at two years follow-up. Thirty consecutive eyes treated by PDT alone, matched for age, sex, and type and size of CNV were considered as control group.
Twenty-one of 47 eyes in the study group (45%) and 7 of 30 eyes in the control group (23%) developed macular RPE and choriocapillaris atrophy in the treated area at month 24 (P=0.04, Chi-square test). The greatest diameter of the atrophic areas averaged (5044±1666)µm in the study group vs (4345±1550)µm in the control group. Mean final best corrected visual acuity (logarithm of minimal angle of resolution) was (0.87±0.33) in the cases with RPE atrophy vs (0.66±0.26) in the cases with no RPE atrophy in the study group (P=0.11, Mann-Whitney U test).
The association of high doses of intravitreal TA and PDT may increase the risk for RPE and choriocapillaris atrophy.
报告玻璃体内注射大剂量曲安奈德（TA）联合光动力疗法（PDT）治疗年龄相关性黄斑变性（AMD）相关脉络膜新生血管（CNV）后脉络膜毛细血管萎缩的表现。
本研究为非随机干预病例系列的回顾性研究。阿利坎特眼科研究所对51只连续的伴有AMD的黄斑下（所有类型）CNV眼进行了PDT治疗，并玻璃体内注射每0.1mL含（19.4±2.1）mg的TA。在两年随访时观察黄斑脉络膜毛细血管和视网膜色素上皮（RPE）萎缩的情况。30只连续接受单纯PDT治疗的眼，根据年龄、性别以及CNV的类型和大小进行匹配，作为对照组。
研究组47只眼中有21只（45%），对照组30只眼中有7只（23%）在第24个月时治疗区域出现黄斑RPE和脉络膜毛细血管萎缩（P=0.04，卡方检验）。萎缩区域的最大直径在研究组平均为（5044±1666）μm，对照组为（4345±1550）μm。研究组中出现RPE萎缩的病例最终平均最佳矫正视力（最小分辨角对数）为（0.87±0.33），未出现RPE萎缩的病例为（0.66±0.26）（P=0.11，曼-惠特尼U检验）。
玻璃体内大剂量TA与PDT联合应用可能增加RPE和脉络膜毛细血管萎缩的风险。
