The Changes Of Macular Structure And Function After The Treatment Of Macular Degeneration

Objective:To evaluate the recovery of macular structure and function of central serous choroidal vasculopathy (Central serous chorioretinopathy, CSC) after photodynamic therapy (PDT).Research Object:18cases of patients26eyes, who were diagnosis of central serous chorioretinopathy (CSC) in the First Affiliated Hospital of Kunming Medical University from April2011to December2012.Methods:A non-randomized single-center clinical research methods. For patients with pure PDT treatment, who were diagnosed with CSC admission line. At the same time, the examinations of BCVA (Best Corrected Visual Acuity)、OCT (Optical Coherence Tomography), observed mean foveal thickness (Central Fovea Thickness, CFT) changes and FFA (Fundus Fluorescein Angiography, FFA)+ICGA angiography (Indocyanine Green Angiography, ICGA) joint imaging lesions change of the situation, respectively, before the treatment and after the treatment at1month,3months,6months. Humphrey perimetry in the standard static perimetry, calculate its visual field of mean defect (MD), pattern standard deviation (PSD),10degrees average light sensitivity (10°MS),4degrees mean sensitivity (4°MS) combined. First, for each variable within the group comparison before and after treatment, again make analysis within each group of variables correlation. Measurement data normality test and found that data were normally distributed. The group analyzed data can be x±s description of central tendency, meanwhile using Pearson linear correlation. Observation the index of BCVA, CFT, MD, PSD,10°MS,4°MS. The four index of BCVA,10°MS, MD, CFT were carried correlation analysis.Results After treatment with a half-dose PDT,18patients26eyes1.3times within6months follow-up compared with the preoperative BCVA were significantly increased (F=11.53, P=0.00), the difference was statistically significant (P<0.05).2. The OCT result showed the CFT significantly reduced of18patients26eyes after6months treatment, CFT (F=27.227, P=0.000)(P<0.05), there are statistically significant.3. FFA and ICGA angiography performance, after six months treatment26-eyes, FFA and ICGA angiography,24(92.3%) leak stopped completely, one (3.84%) to reduce leakage eye, one (3.84%) eyes did not change significantly.4. The results of Visual field can be seen the values of each variable of BCVA, CFT, MD, PSD,10°MS,4°MS compared with preoperative were to change significantly after6months. BCVA (F=11.53, P=0.00), MD (F=4.74, P=0.004),10°MS (F=7.108, P=0.000),4°MS (F=17.830, P=0.000), PSD (F=6.329, P=0.001), the differences were statistically significant,(P<0.05).5. The preoperative and postoperative of1,3,6months’ BCVA, CFT, MD, MS and PSD were done with comparative analysis of pair wise, the differences were statistically significant,(P<0.05).6. CFT and BCVA,10°MS and MD were correlated and showed a negative correlation. CFT and BCVA (r=-0.295, P=0.002), CFT and10°MS (r=-0.314, P=0.000) CFT and MD (r=-0.198, P=0.038), the differences were statistically significant (P<0.05).Conclusion1. The short-term effect is remarkable after the treatment of Half-dose verteporfin combined photodynamic therapy in CSC patients in1month,3months,6months, no significant recurrence;2.10-2program perimetry of Humphrey Ⅱ-750automatic perimetry has a good guiding significance to evaluate visual function for CSC.3. The changes of visual function are consistent with the morphological of macular in CSC patients.4. The short-term effect is remarkable after treatment. Withing the centers visual acuity, retinal light sensitivity has significantly improved after treatment with half-dose verteporfin combined photodynamic on CSC patients in6months, the fovea thickness and visual field defectsdecreased significantly, meanwhile central scotoma reduced or even disappear. Objective:To evaluate the recovery of visual function of two kinds of domestic common diseases of choroidalneovascularization after intravitreal Anti-VEGF agents combination photodynamic therapy (PDT) or intravitreal Anti-VEGF alone therapy, which contains exudative age-related macular degeneration (W-AMD) and high myopia macular degeneration (HMMD).Research Object:34patients, who were diagnosis macular choroidal neovascularization (26patients were exudative age-related macular degeneration;8patients were high myopia macular degeneration) in the First Affiliated Hospital of Kunming Medical University from April2011to December2012.Methods:A non-randomized single-center clinical research methods. Patients who were diagnosis W-AMD and HMMD on admission respectively grouped into typical predominant W-AMD-based (group A) and micro classic W-AMD and HMMD patient (group B) groups. Group A and group B, with PDT combination intravitreal Anti-VEGF therapy or intravitreal Anti-VEGF therapy, respectively. It though observe best corrected visual acuity (BCVA), OCT result that is to observe the mean foveal thickness (central fovea thickness, CFT) changes and fundus fluorescein angiography (FFA)+Indocyanine green angiography (ICGA) joint imaging lesions change of the situation, respectively, before and after the treatment at1month,3months,6months. Humphrey perimetry in the standard static perimetry, calculate its visual field mean defect (MD), pattern standard deviation (PSD),10degrees average light sensitivity (10°MS),4degrees mean sensitivity (4°MS) combined. First, for each variable within the group comparison before and after treatment, again make analysis within each group of variables correlation. Measurement data normality test and found that data were normally distributed; the group analyzed data can be x±s description of central tendency, using Pearson linear correlation. Observation the index of BCVA, CFT, MD, PSD,10°MS,4°MS, The four indexes of BCVA,10°MS,4°MS, CFT were carried correlation analysis.Results:34(40) patients after treatment of patients with macular degeneration 1. Group A of patients in the postoperative BCVA after1month,3month,6-month follow-up were increased significantly, compared to the preoperative, BCVA (F=3.45, P=0.020). Group B after1month,3months,6months follow-up BCVA also seen significant changes. Comparison of preoperative BCVA (F=3.79, P=0.014). Differences were statistically significant (P<0.05).2. OCT of macular showed, group A of patients after1month,3month,6-month followed CFT were changed significantly, compared to the preoperative, CFT (F=12.59, P=0.00). Group B after1month,3months,6months follow-up CFT changed significantly. Comparison of preoperative CFT (F=4.35, P=0.007), the differences were statistically significant (P<0.05).3. FFA and ICGA angiography performance of all34cases (40) W-AMD and HMMD patients after PDT+ball anti-VEGF combination therapy and simple ball anti-VEGF therapy,35(87.5%) after treatment, infiltration leakage and bleeding was significantly reduced, suggesting that her condition improved.1(2.50%) continued leakage, bleeding prompted CNV lesions larger range of activities and to continue to intensify.4(10%) leakage stops bleeding absorbed, but not high fluorescence, suggesting that CNV lesions quiescent.4. Humphrey perimetry standard static perimetry showed, A group of patients in January, March,6-month follow-up MD, PSD,10°MS,4°MS each variable were changed significantly, compared to the preoperative MD (F=4.661,P=0.005),10°MS (F=5.70, P=0.001),4°MS (F=4.359, P=0.007), PSD (F=6.44, P=0.001), the differences were statistically significant (P<0.05). Group B after1month,3months,6months follow-up MD,10°MS,4°MS has changed significantly the value of the variable. Comparison of preoperative MD (F=4.96, P=0.004)10°MS (F=4.54, P=0.006),4°MS (F=4.93, P=0.004), the differences were statistically significant (P<0.05)5. Group A and B:The preoperative and postoperative of lmonth,3months,6months’ BCVA, CFT, MD, MS and PSD were done with comparative analysis of pair wise, the differences were statistically significant,(P<0.05). But after three follow-up were not statistically significant contrast (P>0.05).6. Group A and B’BCVA and CFT, CFT and10°MS, CFT was negatively correlated with MD, A group within the BCVA and CFT, CFT and10°MS, CFT was negatively correlated with MD, BCVA and CFT (r=-0.297, p=0.005), CFT and10°MS (r=-0.385, p=0.000), CFT and MD (r=-0.193, p=0.033), were statistically significant (P<0.05). B group BCVA and CFT (r=-0.174, p=0.024) CFT and10°MS (r=-0.349, p=0.003), CFT and MD (r=-0.280, p=0.017), were statistically significance (P<0.05).Conclusion1. Typical predominant W-AMD patients after PDT combined with anti-VEGF therapy (A group) and to small and HMMD typical W-AMD patients (B group) inside the ball by simply anti-VEGF therapy to get macular structural abnormalities recovery of visual function in June has significantly improved, but the follow-up late (after June) compared early (after1month,3months) has decreased again, require long-term observation2.10-2program perimetry of Humphrey Ⅱ-750automatic perimetry has a good guiding significance to evaluate visual function for macular degenerative disease.3. The central vision improved after treatment of patients with macular degeneration, FFA showed macular fluorescein leakage and bleeding in some patients reduces or evens no leakage, bleeding absorption. Withing all patients’ retinal light sensitivity improved significantly, the fovel thickness、visual field defect and central scotoma has also reduced.4. It is worth to further discuss which one changes more earlier between morphological and physiological functions of the macular degeneration disease.