应用维替泊芬光动力治疗后后部巩膜旁注射曲安奈德对脉络膜新生血管生长的影响

来源 :世界核心医学期刊文摘.眼科学分册 | 被引量 : 0次 | 上传用户:bigjohn6120
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Objective: To assess if posterior juxtascleral application of 40 mg triamcinolone acetonide (TA), given at the same time as initial photodynamic therapy (PDT) for predominantly classic choroidal neovascularization (CNV) related to age-related macular degeneration affects lesion growth at 3 and 6 months. Design: Comparative (nonrandomized) interventional study. Participants: The study group consists of 38 eyes of 38 patients. The control group consists of 73 eyes of 73 patients. Methods: Comparison of 2 consecutive case series collected at different times. The study group had a posterior juxtascleral TA with their initial PDT treatment. The controls were treated with PDT alone. All patients were reviewed at 1, 3, and 6 months. Main Outcome Measures: Change in total lesion size; secondary outcomes: area of leak, best-corrected visual acuity, number of treatments, an d intraocular pressure. Results: There was significantly less growth of total lesion at 3 months (mean difference=2.47 mm2; 95%confidence interval (CI): +1.22 to +3.72 mm2; P=0.0002) and 6 months (mean difference=2.88 mm2; 95%CI: +0.61 to +5.15 mm2; P=0.0134) in patients given TA with PDT compared with PDT alone. There was also a significantly smaller residual area of leak at 3 months in the study group (mean difference=1.07 mm2; 95%CI: +0.16 to +1.97 mm2; P=0.02). At 6 months, the residual area of leak between the 2 groups became comparable (mean difference=0.13 mm2; 95%CI=-1.59 to +1.33 mm2; P=0.86). Mean number of let ters lost on the logarithm of the minimum angle of resolution chart at 6 months was 9.1 letters (standard error of the mean SEM=2.21) in the study group compared with 12.4 letters (SEM=1.91) in the control group (P=0.30). At 6 months, 10 of 36 eyes (27.8%) in the study group showed <15 letters loss, compared with 29 of 73 eyes (39.7%) in the control group. Intraocular pressure was raised in 4 of 38 eyes (10.5%). Fewer retreatments were required in the TA with PDT group (2.03 compared with 2.47 P=0.006). Conclusions: Posterior juxtascleral placemen t of TA with PDT at baseline significantly reduces CNV growth at 3 and 6 months. Fewer retreatments were required. Visual outcome may be improved, although we did not show a statistically significant improvement with this sample size. A larger, randomized trial with longer follow-up is justified. Objective: To assess if posterior juxtascleral application of 40 mg triamcinolone acetonide (TA), given at the same time as initial photodynamic therapy (PDT) for predominantly classic choroidal neovascularization (CNV) related to age-related macular degeneration affects lesion growth at 3 and The control group consists of 73 eyes of 73 patients. Methods: Comparison of 2 consecutive case series collected at different times. The 6 months. Design: Comparative (nonrandomized) interventional study. Participants: The study group consists of 38 eyes of 38 patients. study group had a posterior juxtascleral TA with their initial PDT treatment. The controls were treated with PDT alone. All patients were reviewed at 1, 3, and 6 months. Main Outcome Measures: Change in total lesion size; secondary outcomes: area of ​​leak , best-corrected visual acuity, number of treatments, an d intraocular pressure. Results: There was significantly less growth of total lesion at 3 months (mean difference = 2.47 mm2; 95% confidence interval (CI): +1.22 to +3.72 mm2; P = 0.0002) and 6 months (mean difference = 2.88 mm2; 95% CI: +0.61 to +5.15 ​​mm2; P = 0.0134) in patients given TA with PDT compared with PDT alone. There was also a significant residual area of ​​leak at 3 months in the study group (mean difference = 1.07 mm2; 95% CI: +0.16 to +1.97 mm2; P = 0.02). At 6 months, the The residual area of ​​leak between the two groups became comparable (mean difference = 0.13 mm2; 95% CI = -1.59 to +1.33 mm2; P = 0.86). Mean number of let ters lost on the logarithm of the minimum angle of the resolution chart at At 6 months, 9.1 months (standard error of the mean SEM = 2.21) in the study group compared with 12.4 letters (SEM = 1.91) in the control group (P = 0.30) in the study group showed <15 letters loss, compared with 29 of 73 eyes (39.7%) in the control group. Intraocular pressure was raised in 4 of 38 eyes (10.5%). Fewer retreatments were required in the TA with PDT group 2.03 compared with2.47 P = 0.006). Conclusions: Posterior juxtascleral placemen with TA with PDT at baseline significantly reduces CNV growth at 3 and 6 months. Fewer retreatments were required. Visual outcome may be improved, although we did not show a significant significant improvement with this sample size. A larger, randomized trial with longer follow-up is justified.
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