A Long-term Comparative Observation Of Strengthen Photodynamic Therapy For Choroidal Neovascularization

ObjectiveChoroidal neovaseularization(CNV) is a common causes of blindness in ocular fundus diseases. This study comparative observed the long-term effects of strengthen photodynamie therapy(PDT)for in age-related macular degeneration(AMD),Polypoid-al choroidal vasculopathy(PCV),pathologic myopia(PM) and idiopathic choroidal neovascularization (ICNV), and evaluate the long-term clinical curative effect of PDT for CNV,to investigate therapeutic strategies for the individual patient.MethodsTo continuous observing82eyes of78consecutive patients with PDT therapy caused by CNV in Tianjin Eye Hospital from2009-7to2011-4. The patients of2009-7to2010-11received routine PDT protocols, that was spot size was set at0.5mm greater than the greatest linear diameter (GLD) for83secends. The patients of2010-11to2011-4received strengthen PDT,that was plused a strengthen spot light with15secends in addition to the routine protocols.All patients were finished24months follow-up. Best corrected visual acuity(BCVA) and the thickness of CNV were compared among baseline,3-week visit,2-month visit,3-month visit,6-month visit,12-month visit,18-month visit and24-month visit in all groups,as well as the change of BCVA and the CNV thickness at the24-month visit. Besides, The treatment times in24month were analyzed at the24-month visit in two different methods PDT groups. Closely observed the incidence of complications during follow-up, such as retinal hemorrhage, exudation increased, the acute retinal decreased vision and photosensitizer toxicity reaction.Results1.Comparison between the routine group and the strengthen group.AMD group:Between the routine group and the strengthen group, BCVA and CNV thickness did not differ significantly(p>0.05).The change of BCVA and the CNV thickness at the24month did not differ significantly(p=0.45,0.18).The mean times of PDT treatment for the strengthen group and the routine group were1.43and2.14respectively and was statistically significant (p=0.02). PCV group:BCVA and thickness of CNV between the routine group and the strengthen group were different at3-month visit(p=0.04), but did not differ at other visit(p>0.05).The change of BCVA at the24month did not differ between two groups(p=0.43). CNV thickness were reduced or stable in both groups. The mean times of PDT treatment for the strengthen group and the routine group were1.78and1.86respectively and was no differ (p=0.78).PM group:Between the routine group and the strengthen group, BCVA and CNV thickness did not differ significantly(p>0.05,p=0.05at3-month visit). The change of BCVA and the CNV thickness at the24month did not differ (p=0.58,0.06). The mean times of PDT treatment for the strengthen group and the routine group were1.28and1.20respectively and was no differ (p=0.65).ICNV group:The two differernts PDT methods have no significantly differernts in BCVA and CNV thickness(p>0.05). There was no significantly different in change of BCVA and the CNV thickness between two groups(p=0.54,0.57). The mean times of PDT treatment for the strengthen group and the routine group were1.67and1.33respectively and was no differ (p=0.20).2. Observation of PDT for CNV.Patients in the PCV and ICNV group showed a significant improvement in mean BCVA compared to baseline at the24th month(p=0.45,0.18),however, there was no significantly different in AMD and PM group. All patients showed a significant decrease in mean CNV thickness by the end of the24-month observation period compared to baseline(p=0.00,0.00,0.00,0.00).3. Follow-up duration varied from24to29months(mean:25.08months). There were no ocular or systemic adverse events observed,but one injection-related transient back pain.Conclusion1. Strengthen PDT is a safe and effective approach.It could reduce treatment times of CNV due to AMD and benefit over the routine method in improving visual acuity and reducing CNV thickness at early treatment for PCV patients. It is a replicable method in clinical application.2.During the24-month follow-up period, PDT could control and stabilize the progression of AMD,PCV,PM and ICNV.It significantly decreased CNV lesion and improved the visual function of PCV and ICNV patients.