Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, France.
Laboratoire UMR-CNRS 5510 Matéis, Villeurbane, France.
Retina. 2021 Feb 1;41(2):277-286. doi: 10.1097/IAE.0000000000002843.
The aim of this study was to compare the functional and anatomical effectiveness of photodynamic therapy (PDT) versus proton beam therapy (PBT) in a real-life setting for the treatment of circumscribed choroidal hemangioma.
A total of 191 patients with a diagnosis of circumscribed choroidal hemangioma and treated by PBT or PDT were included for analyses.
The 119 patients (62.3%) treated by PDT were compared with the 72 patients treated by PBT. The final best-corrected visual acuity did not differ significantly between the two groups (P = 0.932) and final thickness was lower in the PBT compared with the PDT group (P = 0.001). None of the patients treated by PBT needed second-line therapy. In comparison, 53 patients (44.5%) initially treated by PDT required at least one other therapy and were associated with worse final best-corrected visual acuity (P = 0.037). In multivariate analysis, only an initial thickness greater than 3 mm remained significant (P = 0.01) to predict PDT failure with an estimated odds ratio of 2.72, 95% confidence interval (1.25-5.89).
Photodynamic therapy and PBT provide similar anatomical and functional outcomes for circumscribed choroidal hemangioma ≤3 mm, although multiple sessions are sometimes required for PDT. For tumors >3 mm, PBT seems preferable because it can treat the tumor in only 1 session with better functional and anatomical outcomes.
本研究旨在比较光动力疗法（PDT）与质子束疗法（PBT）在治疗局限性脉络膜血管瘤的实际情况下的功能和解剖效果。
共纳入 191 例经 PBT 或 PDT 治疗的局限性脉络膜血管瘤患者进行分析。
119 例（62.3%）接受 PDT 治疗的患者与 72 例接受 PBT 治疗的患者进行比较。两组最终最佳矫正视力无显著差异（P = 0.932），PBT 组最终厚度低于 PDT 组（P = 0.001）。无 PBT 治疗的患者需要二线治疗。相比之下，53 例（44.5%）最初接受 PDT 治疗的患者至少需要另一种治疗，且与最终最佳矫正视力较差相关（P = 0.037）。多变量分析显示，仅初始厚度大于 3mm 仍与 PDT 失败显著相关（P = 0.01），估计优势比为 2.72，95%置信区间（1.25-5.89）。
对于厚度≤3mm 的局限性脉络膜血管瘤，PDT 和 PBT 提供相似的解剖和功能结果，尽管 PDT 有时需要多次治疗。对于厚度＞3mm 的肿瘤，PBT 似乎更可取，因为它可以仅用 1 次治疗即可治疗肿瘤，且具有更好的功能和解剖结果。
