循血綠眼底攝影指引雷射治療老年性黃斑部變性之中心窩外境界不明的脈絡膜新生血管

Indocyanine Green Angiography-Guided Laser Photocoagulation Treatment of Extrafoveal Occult Choroidal Neovascularization in Age-Related Macular Degeneration

楊昌叔(Chang-Sue Yang) ； 李鳳利(Fenq-Lih Lee) ； 林嘉理(Chia-Lee Lin) ； 許紋銘(Wen-Wing Hsu) ； 劉榮宏(Jorn-Hon Liu)

《中華民國眼科醫學會雜誌》 39卷3期 (2000/09) Pp. 247-256

https://doi.org/10.30048/ACTASOS.200009.0005

摘要

背景：循血綠眼底攝影{Indocyanine green (ICG) angiography}對診斷老年性黃斑部變性(age-related macular degeneration，ARMD)的脈絡膜新生血管(choroidal neovascularization，CNV)的偵測和精確定位上，確實比傳統螢光眼底血管攝影(fluorescein angiography，FA)更有幫助。本篇研究的目的，是藉循血綠眼底攝影指引來雷射治療黃斑中心窩外的境界不明新生血管(extrafoveal occult CNV)，評估其臨床治療效果。
方法：收集滲出型老年性黃斑部變性病例，採用掃描雷射眼底鏡(scanning laser ophthalmoscope，SLO)來實行循血錄眼底血管攝影。選擇符合雷射治療的脈絡膜新生血管是引用傳統的雷射準則，在循血綠攝影下呈境界分明的點或盤狀過螢光(focal or plaque hyper-fluorescence)，位置在黃斑中心窩外。採用氫氣雷射治療，術後定期複查循血綠眼底攝影，以早期發現殘留或再發新生血管(Persistent or recurrent CNV)，並立刻重複雷射。
結果：合計21眼有黃斑中心窩外境界不明的脈絡膜新生血管接受雷射治療，病人追蹤期平約為13個月。雷射治療後眼底外觀上結果(anatomic outcome)，眼底病灶完全緩解有10眼(45%)，部份緩解有5眼(24%)，治療後無反應或惡化有6眼(28%)。雷射術後病人最終視力結果(visual outcome)，有進步二行或以上的有5眼(24%)，能維持視力穩定的有12眼(57%)，視力惡化有4眼(19%)。雷射治療後完全或部份緩解的，新生血管再復發的有8眼(53%，8/15)。
結論：本篇初步研究結果顯示，藉循血綠眼底攝影指引，對境界不明的黃斑中心窩外脈絡膜新生血管，雷射治療後，大部分病眼在眼底病灶及視力上皆有進步或達到穩定，證明是臨床上可行的治療方法。這初步研究有持將來大規模、對照研究來進一步證實其臨床應用價值。

並列摘要

Background. Indocyanine green (ICG) angiography increased the detection and delineation of poorly-defined or occult choroidal neovascularization (CNV) when compared with fluorescein angiography. We conducted this study to evaluate the efficacy of ICG angiography-guided laser photocoagulation of extrafoveal occult CNV in age-related macular degeneration (ARMD).
Methods. The authors performed ICG angiography with scanning laser ophthalmoscope (SLO) in eyes with exudative ARMD. Patients were selected for laser treatment, using conventional guidelines, when ICG angiography demonstrated a well-delineated area of focal or plaque hyper-fluorescence, presumed to be choroidal neovascularization. Argon laser photocoagulation treatment was applied under ICG angiography guidance. Follow-up ICG angiography was performed to allow early detection of the persistent or recurrent CNV after laser therapy, if present, repeated laser treatment was applied.
Results. There were 21 patients (21 eyes) who had extrafoveal occult CNV receiving argon laser treatment under ICG angiography guidance. The anatomic outcome showed complete resolution in 10 eyes (48%), partial resolution in 5 eyes (24%), no change or worse in 6 eyes (28%). Visual outcome was improved in 5 eyes (24%), stabilization of vision in 12 eyes (57%) and worse in 4 eyes (19%). Mean follow up period was 13 months. The recurrence of CNV after laser therapy was noted in 8 eyes (53%).
Conclusion. Our preliminary study showed that ICG angiography-guided laser treatment can produce visual outcome improvement or stabilization in many cases of extrafoveal occult CNV in ARMD. Further control studies and longer follow-up are necessary to confirm the efficacy of this modality of therapy.

並列關鍵字

Age-related Macular Degeneration ； Fluorescein Angiography ； Indocyanine Green Angiography ； Laser Photocoagulation ； Occult Choroidal Neovascularization