Flaxel C J, Owens S L, Mulholland B, Schwartz S D, Gregor Z J
Moorfields Eye Hospital, London, UK.
Eye (Lond). 1998;12 ( Pt 2):266-72. doi: 10.1038/eye.1998.62.
To investigate the role of systemic corticosteroids in the treatment of sight-threatening choroidal neovascularisation (CNV) in patients with punctate inner choroidopathy (PIC) and multifocal inner choroiditis (MIC).
Twelve eyes of 10 patients with evidence of PIC or MIC with recent visual symptoms were identified. All eyes had CNV within the foveal avascular zone on fundus fluorescein angiography (FFA). Systemic oral prednisolone at an initial dose of 1 mg/kg (60-80 mg) was given for 3-5 days and the dose was subsequently tapered. Changes in best corrected visual acuity and leakage on FFA were recorded during follow-up. Systemic side-effects of the corticosteroids were monitored.
In 10 of 12 eyes vision improved or stabilised. Leakage on FFA resolved in 9 eyes and was reduced in 3. Four patients required more than one course of oral corticosteroids. One patient was maintained on low-dose oral corticosteroids for recurrent CNV activity. No systemic complications from the treatment were observed.
A course of oral corticosteroids in healthy young patients with subfoveal CNV in PIC or MIC may reduce subretinal vascular leakage and stabilise vision when no other proven treatment option is available.
探讨全身应用皮质类固醇激素在治疗点状内层脉络膜病变(PIC)和多灶性内层脉络膜炎(MIC)患者中威胁视力的脉络膜新生血管(CNV)的作用。
确定10例有PIC或MIC证据且近期有视觉症状患者的12只眼。所有患眼在眼底荧光血管造影(FFA)检查中,黄斑无血管区内均有CNV。初始给予全身口服泼尼松龙,剂量为1mg/kg(60 - 80mg),持续3 - 5天,随后逐渐减量。随访期间记录最佳矫正视力的变化以及FFA上的渗漏情况。监测皮质类固醇激素的全身副作用。
12只眼中10只眼的视力得到改善或稳定。9只眼FFA上的渗漏消失,3只眼渗漏减少。4例患者需要不止一个疗程的口服皮质类固醇激素治疗。1例患者因复发性CNV活动而维持低剂量口服皮质类固醇激素治疗。未观察到治疗引起的全身并发症。
在没有其他已证实的治疗选择时,对于患有PIC或MIC且黄斑下CNV的健康年轻患者,一个疗程的口服皮质类固醇激素治疗可能会减少视网膜下血管渗漏并稳定视力。