摘要
目的探讨孤立性脉络膜血管瘤根据位置采用PDT与TTT联合治疗方法及效果。方法经散瞳后90D全视网膜镜检查、眼底荧光素血管造影(FFA)、吲哚青绿血管造影(ICGA)、B超确诊为孤立性脉络膜血管瘤。位置:视盘周围6例(单独位于黄斑部瘤体不在此统计范围内),OCT提示瘤体表面神经上皮脱离波及黄斑区。发病最短1周,最长2个月。术前矫正视力:0.05～0.4,B超检查厚度2.2～4mm,直径6.6～11.2mm,OCT提示黄斑部神经上皮脱离高度156～486mm,发病2个月病例下方的视网膜脱离。采用IRIS Medical OculightSLX半导体激光器(810nm),对黄斑部以外瘤体部分采用TTT治疗,能量:每个光斑照射直径1mm,功率设置为150～250mW,时间60s,每次不超过3个光斑。治疗终末视网膜表面变淡白为标准。2周复查,TTT治疗区脉络膜萎缩,视网膜色素上皮增生。FFA示未治疗黄斑活动病变,进行PDT治疗,静脉注射维速达尔(6mg/mm^2)15min后,689nm激光照射,时间83～126s,厚度3mm以下瘤体照射83s 1个光斑,厚度3mm以上瘤体照射126s双光斑,2周复查黄斑部视网膜少量色素沉着。均随访3～12个月。结果最终视力达0.1～1.0,OCT提示最早1例治疗第3周黄斑部脱离的神经上皮完全恢复正常,另3例均于第4周恢复正常。1例伴有视网膜脱离于治疗后3个月视力部分恢复。OCT提示黄斑部脱离及囊变的神经上皮基本恢复正常。B超于治疗第3个月,复查2例瘤体难以测出,4例厚度0.8～2.2mm,6个月复查,6例完全正常。6例PDT均治疗1次。结论经瞳孔温热疗法与光动力治疗联合针对孤立性脉络膜血管瘤在眼底特殊部位安全有效。各发挥其优点,同时降低单一使用PDT多次治疗费用,可使瘤体萎缩并保存或提高视力。
Objective To investigate the approach and effect of PDT and TTT therapeutic alliance for isolated choroidal angioma according to the lication. Methods After mydriasis, through 90D retinal mirror examination,fluorescein fundus angiography （FFA）, Indocyanine green angiography （ICGA） and ultrasound,the diagnosis of angiography choroidsal hemangioma was made. Position：peripapillary , six cases（tumors locating only in macula fovea were not included in this statistical area）. OCT suggested that epithetlial tumors from the surface of nerve macular were affected. Period of the disease was between one week and two months . Preoperative best corrected vision acuity range was 0.05-0.4. By ultrasonography, tumors thickenss was from 2.2mm to 4mm, and diameter was from 6.6mm to 11.2mm. OCT indicated that the height of neural epithetlium breaking away from macular area was between 156mm and 486mm. inferior retinas separated two months after morbidity. TTT was partly applied to cure tumor body ortside macdular area with IRIS Medical OculightSLX gallium arsenicde laser（810nm）. Energy：per light spot shining diameter was 1mm, and the power was between 150mw to 250mW, and time was 60s. Therapeutic standard was retinal surface changing to pale. Choroids shrunk back and retinal ptgment epithetlium prolixferated in TTT therapy area;recheck 2 weeks later. If FFA showed that active macula fovea pathological changes were not cured, PDT was performed as following：689nm laser was used , and veteporfin（ comm. ercial name：Visudyne）was injected by intravenous at a speed of 6mg/mm^2, and 15 minutes later,the laser was irradiated for a period of 83 - 126s. For tumors with thicdness under 3mm, one light spot was irradiated for 83s; for rumors with thicdness above 3mm, acouple light apot was irradiated for 125s. A small quantity of hyperpigmintation occurred in the limbus,luteus retinae at the second week of follow up. All the cases were followed up for 3 months to 12 months. Results The final vision reached 0.1 -1.0. OCT showed that the earliest complete recovery of limbus luteus retinae neural epithetlium was at the third week,and for another 3 cases,the recovery was at the 4th week. One case with detachment of retina partial recovered 3 months after treatment. OCT suggested that most of the macular detachment and epithetlial cystic degenerateion of neurons recovered to normal, type - B ultrasound was performed in the first three months of treatment. The tumors were difficult to be detected in two cases, and four cases had a thickness of 0.8- 2.2mm. At the 6th month,the detection of tumors for the six cases showed normal results. PDT was used only once in the included six cases. Conclusion PDT and TTT therapeutic alliance for isolated choroidsal angioma is safe and effective at special position of eye ground. Each treatment showed its unlque adventages in this combination with a reduction of frequentcy and cost of expensive cost of PDT, and satisfying results of the shrink of the rumors and improvement or preservation of vision.
出处
《医学研究杂志》
2009年第12期57-60,共4页
Journal of Medical Research
