Objective To observe the therapeutic effect of photodynamic therapy (PDT) and transpupillary thermotherapy (TTT) on circumscribed choroid hemangioma (CCH).Methods Clinical data of 32 patients (33 eyes) with CCH diagnosed by ocular fundus examination, fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA),optical coherence tomography (OCT) and Bultrasound examination were retrospectively analyzed.Before the therapy the selected cases had best corrected visual acuity (BCVA) of fingercounting/15 cm-0.2,the sizes of 2-10 disc diameter (DD) and serous retinal detachment.Twentyone patients (22 eyes) whose tumor located at the posterior pole except for the papillomacular bundle and arch ring area underwent TTT.The parameters of TTT included: Iris 810 nm infra red diode laser，7001200 mW,60 s,and 1-3 spots. Eleven patients (11 eyes) with tumor located at the posterior pole except for the papillomacular bundle and arch ring area underwent. After 15 minutes of intravenous injection with Visudyne, laser irradiation with the wavelength of 689 nm was performed with the time of 83-123 s. The followup period was 12-48 months with the mean of 25.6 months.BCVA and results of indirect ophthalmoscopy,fundus photogrphy,FFA,ICGA,OCT and B ultrasound examination were exanmined and anlyzed.Results In the 22 eyes in TTT group, the BCVA improved in 15 and kept unchanged in 7;the results of fundus examinations showed healed retina and atrophy tumor with greywhite organized scar;the results of FFA revealed no fluorescence leakage and scar fluorescence dyeing of the lesion in later period；the results of OCT indicated disappeared retinal detachment, completely absorbed subretinal liquid and increased reflection of choroid tumor with scar；the results of Bultrasound examination showed no retinal detachment and atrophy tumor.In 11 eyes in PDT group,the BCVA improved in 9, unchanged in 2;the results of fundus examinations showed atrophy tumor with pigmentation；the results of FFA revealed disappeared fluorescence leakage；the results of OCT indicated completely absorbed subretinal liquid；the results of B-ultrasound examination showed atrophy tumor.Conclusions Both TTT and PDT can make the tumor atrophy,improve BCVA or keep it still;but apply to different area.
Up-regulation of vascular endothelial growth factor (VEGF) is demonstrated to be a key role in formation process of intraocular neovascularization. Anti-VEGF treatment is the breakthrough of intraocular neovascular diseases therapy. Intrav itreal injection of antineovascularization drug looks to be an effective method on ocular neovascular diseases which with the advantages of good biocompatibility, low prices and longer intravitreal half-time etc. However, at present, it lack of multi-center study; the long-term efficacy and the systematic safety needs the further clinical verification. Various types of CNV showed the different therapeutic reactions to either PDT or Anti-VEGF agent, the treatment methods for exudative AMD include laser, PDT, and drug like Triamcinolone Acetonide，several anti-VEGF preparations. Therefore, understanding the pathogenesis of neovascular AMD and choosing a reasonable therapeutic methods are necessary. We should try to explore a safe, effective, economic, new approach. （Chin J Ocul Fundus Dis，2008，24：157-159）
Objective To evaluate the efficacy and safety of photodynamic therapy (PDT) combined with intravitreal injection of bevacizumab for choroidal neovas cularization (CNV) caused by age-related macular degeneration (AMD). Methods A total of 21 eyes of 21 patients with AMD, which was diagnosed by examination of visual acuity, intraocular pressure, ocular fundus, fundus color photography, fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA)and optic coherence tomography(OCT), were underwent PDT combined with intravitreal injection of Bevacizumab. The patients, 15 males (15 eyes) and 6 females (6 eyes), aged from 56 to 78 years, with the average of 68.6 years. The best corrected visual acuity：counting fingers/10cm0.9, logMAR was 1.04 plusmn; 0.41.CNV located in below or side central fovea of macula. There was obvious leakage of fluorescein which examined by FFA and ICGA. The average of retinal thickness of macular foveal was （258.91 plusmn; 78.66）mu;m. The treatment method of PDT has to according to the way of PDT for TAP and Verteporfin PDT for VIP. Intravitreal infection with 1.5mg bevacizumab was performed after three days under surface anesthesia. Follow-up time was 1, 3, 6, 12 months after the treatment. Results At last visit, the best-corrected visual acuity：counting fingers/10 cm 1.5, logMAR was 1.04plusmn;0.41, and the differences are statistically significant compared with before. The BCVA improved four or more lines in 6 eyes (28.57%), improved two to four lines in 9 eyes (42.86%), stabilized (plusmn;1 line or no change) in 6 eyes (28.57%) and decreased in none. The average intraocular pressure was （15.20plusmn;2.41）mmHg after surgery, and the differences was not statistically significant compared with before（P＞0.05）. FFA and ICGA showed CNV complete closure in 13 eyes (61.90 %), partial closure in 8 eyes (38.10%). The average of retinal thickness of mac ular foveal was（127.38plusmn;20.14） mu;m (P＜0.01). Conclusion Combining treatment with PDT and intravitreal injection of Bevacizumab is safe and effective for CNV which caused by AMD. It has significant improvement in BCVA, leakage of CNV and retinal edema. (Chin J Ocul Fundus Dis,2008,24:164-167)