The Study On Treatment Of Choroidal Neovascularization

Objective:Study of choroidal neovascularization (CNV) of treatment in safety and effectiveness. Age-related macular degeneration (AMD), high myopia macular degeneration (PM) and vitelline macular degeneration (VMD) were treated by photodynamic therapy and photodynamic therapy(PDT) combined with anti-angiogenesis growth factor (VEGF), and clinical datas were analyzed.Method:1. The clinical diagnosis was AMD87PDT patients (92eyes), Male51cases (53eyes), female36cases (39eyes), monocular onset in77cases,5cases of eyes. Patients aged49～88years, mean age (63.3±28.4) years old. BCVA:5～68letters. The clinical course were3～37months, the average duration were7.1±9.6months. According to the results of FFA, the largest GLD was5500μm, the minimum was410um, mean GLD was (2802.2±2670.7)μM. Therapy ofanti VEGF for AMD with a total of32cases (40eyes).The patients ranged from54to81years, mean age (69.3±12.9) years old. BCVA:10to71letters, with an average of41.4±16.2letters. The clinical course were3.4to25months, the average duration were6.8±11.7months. Mean GLD WAS(3412.7±1603.8)μM. Anti VEGF combined with PDT for treatment of34cases of wAMD patients (36eyes). Male:20cases, female:14cases. The patients ranged from56to87years, mean age (68.9±15.8) years old. BCVA:8to79letters, with an average of32.5±34letters. The clinical course were2.5to17months, the average duration were5.1±8.8months.. All cases were performed BCVA, direct or indirect ophthalmoscopy, fundus color photography, FFA, ICGA, OCT, intraocular pressure examination. PDT and intravitreal injection were executed according to the conventional operation, observation indexes:BCVA, intraocular pressure, slit lamp microscope, fundus examination, CNV and CRT changes, the side reaction.2. PM treated by PDT were25patients (28eyes), male11cases (12eyes), female14cases (16eyes), patients’age:25～44years, mean age (31.3.3±11.5) years old. BCVA:11～68letters, an average of34.5±12.1letters. The clinical course were1～16months, the average duration were4.15±5.4months. All cases were performed BCVA, direct or indirect ophthalmoscopy, fundus color photography, FFA, ICGA, OCT examination. After diagnosis for AMD and PM, PDT was treated. To the last follow-up, visual acuity, FFA and OCT changes, adverse reaction were analyzed.3. PDT treatment for VMD complicated with CNV in7eyes of7patients included in the study, including2cases of BVMD,5cases of AVMD. Male:4cases, female:3cases; age20～54years, mean age:(34.57±14.03) years old; Follow up: BCVA, slit lamp microscope, indirect ophthalmoscopy, fundus color photography, FFA, both ICGA, frequency domain optical coherence tomography (SD-OCT)(EOG), EOG and ERG (ERG) examination and adverse reaction.Result:1.(1) PDT treatment for AMD at the final follow-up in patients with ETDRS visual acuity increased by5.6±5.1letters; Compared before and after treatment, there was statistically significant difference (P<0.05); to the last follow-up, Visual acuity improved in19eyes (20.5%); stabilization of visual acuity in53eyes (55.4%) decreased in22eyes (24.1%). The average number of repetitions, PDT was (1.3±1.5) time.(2) VEGF inhibitors in the treatment of AMD, patients with BCVA was51.8±21.8letters, as compared with were increased by8.9±3.7letters before treatment; the difference was statistically significant (P<0.05). At the last follow-up,40eyes, visual acuity improved or stabilized in34eyes (85%); visual acuity decreased in6eyes (15.5%)..(3) The average number of treatment of intravitreal injection was4.1. In patients with BCVA was39.2±26.7letters, as compared with before treatment were increased by16.4±7.5letters; the difference was statistically significant (P<0.05). At the last follow-up, visual acuity improved or stabilized in30eyes(88.2%); visual acuity decreased in4eyes(11.7%). At the last follow-up, fluorescent leakage was significantly reduced or dissipated, CNV gradually atrophic, OCT display macular normal form basic recovery.(4) CRT compared with those before treatment reduce by the end of follow up,, the differences were statistically significant (P<0.05). FFA display the CNV fluorescence leakage decrease or leakage.2. Afterl month treaded by PDT,PM’s BCVA has significant difference; after3month,6eyes (21%) deterioration of visual acuity, Visual acuity improved again after PDT treatment. At the last follow-up visual stability. To the last follow-up, the patients ’visual acuity improved in7eyes(25%); stabilization of visual acuity in19eyes(76%); decreased in2eyes(7.1%). The leakage reduced or extincted, OCT display CNV atrophy and smaller.3. VMD complicated with CNV were Treated by PDT, metamorphopsia relieved or disappeared completely; BCVA0.12～1, average BCVA0.53±0.29, visual acuity improved in different degree, of which more than0.5in4eyes, BCVA. FFA and ICGA examination showed no signs of CNV, retina thickness decreased.Conclusion:1. PDT can effectively control CNV lesions, delaying disease. On AMD, PM and other genetic diseases complicated with CNV, PDT can control the progression of the disease, the visual function of patients with stable function.2. VEGF inhibitors in the treatment of CNV can significantly improve visual acuity, but individually using repeated many times,which may increase the potential risk.3. PDT combined intravitreal injection of VEGF inhibitors can more effectively improve vision, loss of retinal edema, reduce the recurrence rate of CNV, reduce the times of treatment and the incidence of complications, reduce patient burden of medical care.