Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Eye (Lond). 2013 Feb;27(2):190-8. doi: 10.1038/eye.2012.258. Epub 2012 Dec 14.
Phototherapy can be translated to mean 'light or radiant energy-induced treatment.' Lasers have become the exclusive source of light or radiant energy for all applications of phototherapy. Depending on the wavelength, intensity, and duration of exposure, tissues can either absorb the energy (photocoagulation, thermotherapy, and photodynamic therapy (PDT)) or undergo ionization (photodisruption). For phototherapy to be effective, the energy has to be absorbed by tissues or more specifically by naturally occurring pigment (xanthophyll, haemoglobin, and melanin) within them. In tissues or tumours that lack natural pigment, dyes (verteporphin, Visudyne) with narrow absorption spectrum can be injected intravenously that act as focal absorbent of laser energy after they have preferentially localized within the tumour. Ocular phototherapy has broad applications in treatment of ocular tumours. Laser photocoagulation, thermotherapy, and PDT can be delivered with low rates of complications and with ease in the outpatient setting. Review of the current literature suggests excellent results when these treatments are applied for benign tumours, particularly for vascular tumours such as circumscribed choroidal haemangioma. For primary malignant tumours, such as choroidal melanoma, thermotherapy, and PDT do not offer local tumour control rates that are equivalent or higher than those achieved with plaque or proton radiation therapy. However, for secondary malignant tumours (choroidal metastases), thermotherapy and PDT can be applied as a palliative treatment. Greater experience is necessary to fully comprehend risks, comparative benefits, and complication of ocular phototherapy of ocular tumours.
光疗可以被翻译为“光或辐射能诱导的治疗”。激光已经成为光疗所有应用的光或辐射能的唯一来源。根据波长、强度和暴露时间的不同，组织可以吸收能量（光凝、热疗和光动力疗法（PDT））或发生电离（光破坏）。为了使光疗有效，能量必须被组织吸收，或者更具体地说，被组织中天然存在的色素（叶黄素、血红蛋白和黑色素）吸收。在缺乏天然色素的组织或肿瘤中，可以静脉注射具有窄吸收光谱的染料（verteporfin、Visudyne），这些染料在肿瘤内优先定位后，成为激光能量的局灶性吸收剂。眼部光疗在眼部肿瘤的治疗中有广泛的应用。激光光凝、热疗和 PDT 可以在门诊环境中以低并发症发生率和轻松的方式进行。对当前文献的回顾表明，这些治疗方法对良性肿瘤，特别是局限性脉络膜血管瘤等血管肿瘤，效果极佳。对于原发性恶性肿瘤，如脉络膜黑色素瘤，热疗和 PDT 并不能提供与斑块或质子放射治疗相当或更高的局部肿瘤控制率。然而，对于继发性恶性肿瘤（脉络膜转移瘤），热疗和 PDT 可以作为姑息治疗。需要更多的经验来全面了解眼部肿瘤的眼部光疗的风险、相对益处和并发症。
