光动力疗法治疗息肉样脉络膜血管病变的三年结果：回顾性研究与系统评价
THREE-YEAR RESULTS OF POLYPOIDAL CHOROIDAL VASCULOPATHY TREATED WITH PHOTODYNAMIC THERAPY: Retrospective Study and Systematic Review.
作者信息
Wong Chee Wai, Cheung Chui Ming Gemmy, Mathur Ranjana, Li Xiang, Chan Choi Mun, Yeo Ian, Wong Edmund, Lee Shu Yen, Wong Doric, Wong Tien Yin
机构信息
*Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore; †Academic Clinical Program in Ophthalmology and Visual Sciences, Duke-NUS Graduate Medical School, Singapore; ‡Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and §Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore.
出版信息
Retina. 2015 Aug;35(8):1577-93. doi: 10.1097/IAE.0000000000000499.
PURPOSE
To evaluate the 3-year outcome in eyes with polypoidal choroidal vasculopathy (PCV) treated with photodynamic therapy with verteporfin.
METHODS
Retrospective study and review of the literature. We performed a retrospective study of patients with PCV who were treated with photodynamic therapy between January 2007 and December 2008. Patients were excluded if they had received photodynamic therapy before the study period, but those who received previous treatment with other modalities (thermal laser or intravitreal therapies) were allowed. The main outcome measures were best-corrected visual acuity, repeat photodynamic therapy, and recurrence of PCV at the end of Years 1, 2, and 3. We further conducted a systematic review of the literature using the terms "polypoidal choroidal vasculopathy" and "photodynamic therapy" and compared the visual outcome of studies over 3 years using meta-analytical methods.
RESULTS
The retrospective study included 68 eyes. The mean best-corrected visual acuity was 0.73 ± 0.56 logMAR (20/107, Snellen equivalent) at baseline, 0.73 ± 0.70 logMAR (20/107, Snellen equivalent) at 1 year, 0.96 ± 0.76 logMAR (20/182, Snellen equivalent) at 2 years, and 1.07 ± 0.81 logMAR (20/235, Snellen equivalent) at 3 years. The cumulative recurrence rates of PCV were 16.1% (1 year), 34.9% (2 years), and 52.7% (3 years) and eyes with recurrence were more likely to suffer ≥3 lines loss compared with eyes without recurrence (63.2 vs. 17.6%, P = 0.006). The systematic review summarized results from 48 published studies and our retrospective study. The pooled analysis from 29 studies (316 eyes reporting the 3-year visual outcome) reported mean best-corrected visual acuity improvement of 0.115 logMAR at 1 year (n = 1,669), 0.066 logMAR at 2 years (n = 701), and 0.027 logMAR at 3 years (n = 316). Reported recurrence rates were 5.9% to 50.0% after 1 year, 9.1% to 83.3% after 2 years, and 40.0% to 78.6% after 3 years or longer of follow-up.
CONCLUSION
The visual outcome in eyes with PCV was stable until 2 years, but the outcome at 3 years worsened, particularly in eyes that experienced recurrence.
目的
评估接受维替泊芬光动力疗法治疗的息肉状脉络膜血管病变（PCV）患眼的3年预后。
方法
回顾性研究及文献综述。我们对2007年1月至2008年12月期间接受光动力疗法治疗的PCV患者进行了回顾性研究。若患者在研究期间之前接受过光动力疗法，则将其排除，但接受过其他治疗方式（热激光或玻璃体内注射疗法）的患者可纳入。主要观察指标为最佳矫正视力、重复光动力疗法以及在第1、2和3年末PCV的复发情况。我们进一步使用“息肉状脉络膜血管病变”和“光动力疗法”等术语对文献进行系统综述，并采用荟萃分析方法比较3年研究的视力结果。
结果
回顾性研究纳入68只患眼。基线时平均最佳矫正视力为0.73±0.56 logMAR（20/107，Snellen等效值），1年时为0.73±0.70 logMAR（20/107，Snellen等效值），2年时为0.9±0.76 logMAR（20/182，Snellen等效值），3年时为1.07±0.81 logMAR（20/235，Snellen等效值）。PCV的累积复发率分别为16.1%（1年）、34.9%（2年）和52.7%（3年），与未复发的患眼相比，复发患眼更有可能视力下降≥3行（63.2%对1±6%，P = 0.006）。系统综述总结了48项已发表研究及我们的回顾性研究结果。29项研究（316只患眼报告了3年视力结果）的汇总分析显示，1年时平均最佳矫正视力改善0.115 logMAR（n = 1,669），2年时改善0.066 logMAR（n = 701），3年时改善0.027 logMAR（n = 316）。报告的随访1年后复发率为5.9%至50.0%，2年后为9.1%至83.3%，3年及更长时间后为40.0%至78.6%。
结论
PCV患眼的视力结果在2年内保持稳定，但3年时恶化，尤其是复发的患眼。
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