| Central exudative chorioretinopathy (CEC) is an isolated disease which usually occurs in macula, and causes repeated hemorrhage, exudation, edema, and eventually forms fibrous scar which causes inreversible impairment in macula retinal tissue and permanent impairment of central vision. It is a hang-up in clinical treatment and it is concerned by ophthalmologists for a long time. The current treatment include symptomatic treatment, such as surgery excision, radiotherapy, laser photocoagulation, which are not effective for CEC. In recent years, photodynamic therapy (PDT) is proved a promising treatment for CNV, CNV endothelial cells are selectively combined with photosensitizer (Visudyne) by means of intravenous injection, which has high selectivity and photosensitizer mainly combine with the new blood vessels, while avoided binding with the normal tissues. Laser activates photosensitizer and light oxidation reaction is produced by the specific wavelength of light which kill endothelial cells of new blood vessels. PDT is more effective to close CNV and is almost no damage to neural retina. Present data has shown that photodynamic therapy could reduce the incidence of central vision loss. But its shortcoming is easily recurrent, very expensive, and increase the risk of treatment by PDT. Therefore ophthalmologists are looking for more effective treatment methods to make up the weakness of PDT.Bevacizumab is a kind of newly developed monoclonal antibody which competively binds to vascular endothelial growth factor (VEGF) and reduces vascular permeability and absorb fundus hemorrhage and exudation. After treated with PDT to close CNV, intravitreal injection of Bevacizumab is implemented, which may inhibit the formation of new blood vessels, reduce the number of PDT and adverse drug reactions, promote the absorption of retinal edema, bleeding and exudation, and help restore the structure of retina, stabilize and improve their vision, shorten course, enhance the curative effect, reduce the burden of patients. Comparing the clinic therapeutic effect of PDT associated with intravitreal Bevacizumab injection to solo PDT for central exudative chorioretinopathy to explore the best treatment strategies for central exudative chorioretinopathy.ObjectiveTo compare the clinic therapeutic effect of photodynamic therapy (PDT) versus photodynamic therapy associated with intravitreal Bevacizumab injection for central exudative chorioretinopathy (CEC), and to investigate the safety of treatment.MethodsA retrospective review was performed for 46 patients (46 eyes) diagnosed as CEC.46 patients were assigned to receive either PDT associated with intravitreal Bevacizumab injection (Combined group, n=24) or solo PDT (Control group, n=22). The Control group was treated with solo PDT. The Combined group was treated with an intravitreal injection of Bevacizumab (1.5mg/0.06ml) 1 week after PDT. The best-corrected visual acuity (BCVA), examination of the ocular fundus, FFA, ICGA and OCT were retrospectively performed 1,3,6 and 12 months after treatment. If CNV was partly closed or the leakage went on during follow-up, those patients in Control group were retreated with PDT and patients in Combined group were re-injected with Bevacizumab. The changes of BCVA, ocular fundus, FFA, ICGA and OCT were used to evaluate the clinic therapeutic effect and safety before and after treatment in two groups.Results1. Visual acuity One month later visual acuity of 13 (83.3%) of Combined group,12 (7.2.73%) of Control group improve more than 2 lines, the differences were significant (P<0.05). Three months later visual acuity of 19 (83.3%) of Combined group,18 (72.73%) of Control group improve more than 2 lines, the differences were significant (P<0.05). Twelve months later visual acuity of 20 (83.3%) of Combined group,16(72.73%) of Control group improve more than 2 lines, the differences were significant (P<0.05).2. Examination of the ocular fundus, FFA and ICGAControl group:One months after therapy fundus examination showed fundus bleeding, edema and exudation mostly absorption. FFA/ICGA examination showed fluorescence in 7 (31.82%) eyes CNV partly leakage. Three months after treatment fundus examination showed 8 (36.36%) had new hemorrhage, edema,exudation, FFA/ICGA examination showed 4 (18.18%) eye CNV fluorescence continuously leakage,13 (77.28%) eye CNV appear new fluorescenpe leakage, and 17 (77.28%) eyes were treated with PDT again.12 months later examination of the ocular fundus showed decrease of lesion area and complete absorption of hemorrhage and retinal edema. FFA and ICGA showed completely closed CNV in 15 eyes (68.2%), and almost closed CNV in 7 eyes (31.8%) with obvious reduction of fluorescence leakage. Combined group:One months after therapy fundus examination showed fundus bleeding, edema,exudation amostly absorption. FFA/ICGA examination showed 5(20.83%) eye CNV fluorescence partly leakage. One months later treatment fundus examination showed 7(29.17%) had new hemorrhage, edema, exudation, FFA/ICGA examination showed 2 (8.33%) eyes CNV fluorescence continuously leakage, 11(45.83%) eyes CNV appeared new fluorescence leakage,13(54.17%) eyes were treated with intravitreal Bevacizumab injection again.12 months later examination of the ocular fundus showed decrease of lesion area and complete absorption of hemorrhage and retinal edema. FFA and ICGA showed completely closed CNV in 19 eyes(79.2%), and almost closed CNV in 5 eyes (20.8%) with obvious reduction of fluorescence leakage.3. OCT Control group:One months later OCT. examination showed 19(86.36%) eyes neural retina edema reduced and absorbed, in 5 (22.73%) eyes retinal layers bleeding absorbed,15 (68.18%) eyes RPE and choroidal capillary hyperreflexia layers narrowed.Three months later OCT examination showed 12 (54.55%) eye RPE and choroidal capillary hyperreflexia layers were somewhat enlarged than in one month and retinal neural retinal edema thickened. OCT showed the subretinal fluid absorbed and reduction of CNV.12 months later OCT showed the subretinal fluid absorbed and reduced of CNV.Combined group:One months later OCT examination showed 21(87.50%) eye retina epithelial edema reduced and absorbed,7(29.17%)eye Retinal layers bleeding absorbed 18(75.00%) eye RPE and choroidal capillary layer hyperreflexia narrowed. Three months later OCT examination showed 9(37.50%) eyes RPE and choroidal capillary hyperreflexia layer is somewhat enlarged than in one month, neural retina edema thickened.12 months later OCT showed the subretinal fluid absorbed and reduced of CNV. The average of retina thickness in lesions of Combined group decreased significantly comparing with Control group (P<0.05).4. The treatment frequencyThe average treatment number of intravitreal injection was 1.75 in Combined group and the average treatment number of PDT was 1.86 in control group. There were no ocular or systemic adverse events observed in all patients.ConclusionPDT associated with intravitreal Bevacizumab injection and solo PDT are effective and safe treatment for the patients with CEC. Combined therapy can more effectively close CNV and absorb fundus hemorrhage and exudation, and it decrease the incidence of recurred CNV, cut down the charge of patients, and decrease the incidence of the adverse response. |
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