Purpose To evaluate shortterm visual acuity effects of a single photodynamic therapy(PDT) treatment with Visudyne (CIBA Vision Corp, Duluth, Ga) for choroidal neovascularization (CNV) in age-related macular degeneration (AMD). Methods Definitely diagnostic AMD patients with classic CNV were treated with PDT (5 cases, 7 eyes). The data of visual acuity testing, ophthalmic examination, color photographs, optic coherence tomography, fluorescein angiograms and indocyanine green angiogram before photodynamic therapy and 1 week ,1 month after it were used to evaluate the effects of a single treatment of PDT with Visudyne. Results The visual acuity of all the treated eyes at the follow-up examination at 1 month after PDT were not reduced. Distinct reduction of fluorescein leakage from CNV was noted in all patients by 1 week after PDT. Fluorescein leakage from a portion of the CNV reappeared by 1 month after treatment in 2 eyes. Conclusion PDT with Visudyne achieved short-term cessation of fluorescein leakage from CNV without loss of vision or growth of classic CNV in some patwo ients with AMD. (Chin J Ocul Fundus Dis,2000,16:213-216)
Objective To assess the effectiveness and safety of photodynamic therapy (PDT) for patients with nonresectable bile duct cancer. Methods Two reviewers independently searched The Cochrane Library (issue 4, 2006), MEDLINE (1966 to February 2007), CNKI (1994 to February 2007) and VIP (1989 to February 2007), respectively. The quality of included studies was assessed according to the guidance in the Cochrane Handbook of Systematic Reviews of Interventions. Results Two randomized controlled trials involving 71 patients with nonresectable bile duct cancer met the inclusion criteria and were included. Both of these trials reported that the median survival time in patients who were treated with endoprostheses and PDT was longer than for those treated with endoprostheses alone (493 days versus 98 days, and 21 months versus 7 months, in the two trials respectively) One trial reported that the global quality of life in patients in the PDT with endoprostheses group was significantly better than that for the endoprostheses alone group: the difference of Karnofshy index between the two groups was 25.4 (14.4-36.3). The other trial reported no difference between the two groups. No severe adverse effects were observed during either trial. Conclusion Current evidence demonstrates that PDT can improve the survival time of patients with nonresectable bile duct cancer, and reduce the burden of treatment. The treatment might increase biliary infectious rate, but this can be managed by antibiotics therapy. No severe adverse effects are observed. More randomized controlled trials, with large sample sizes, may lead to more accurate results.
ObjectiveTo understand the research advance of photodynamic therapy (PDT) on cholangiocarcinoma. MethodDomestic and international publications online which involving the research of PDT on cholangiocarcinoma in recent years were reviewed. Results①PDT was a new therapy on tumor from the tissue and cell level, which could destroy the target tissue and cell under the photochemical reaction and kill the tumor cell according to the characteristics of the selective intake of tumor tissue on particular photosensitizer. It could mainly induce tumor cell apoptosis and necrosis, destroy the tumor microvascular, stimulate the immune and inflammatory response.②PDT on the research level of the treatment of cholangiocarcinoma had achieved fairly good curative effects, which could make the tumor shrinkage, reduce the harm to normal bile duct cell, and prolong the survival, improve the survival rate and the quality of life.③Proliferating cell nuclear antigen (PCNA), vascular endothelial growth factor-C (VEGF-C), and cyclooxygenase-2 (COX-2) played important roles in the development of cholangiocarcinoma. PDT could inhibit the expressions of PCNA, VEGF-C, and COX-2, and then could promote cell apoptosis, and then inhibit cell proliferation. ConclusionsPDT is a new technology in treatment of malignant tumor, which whether used alone or combined with other methods has less adverse reaction and could obviously improve the local symptoms in treatment of cholangiocarcinoma. But many problems about PDT need to be solved at present, in the base areas, such as research and development of new photosensitizer and precise mechanism of killing tumor, in the clinical applications, such as selection and application of photosensitizer, ways and parameters of the laser, formulation of treatment plans and the reduction of the complications.
Objective To explore application value of photodynamic therapy (PDT) in treatment of unresectable hilar cholangiocarcinoma. Method The literatures about PDT in the treatment of the unresectable hilar cholangiocarcinoma in the PubMed, MedLine, Embase, CNKI, and Wanfang databases were reviewed. Results The PDT combined with stent or chemotherapy was the main method in the treatment of the unresectable hilar cholangiocarcinoma, which could make the tumor down-staging, obviously reduce the jaundice, improve the quality of life, improve the survival rate, prolong the stent patency and be treated repeatedly. Especially, it was suitable for the patients with elderly, poor health, intolerance of surgery, could partly replace the R1 or R2 operation of hilar cholangiocarcinoma and avoid the risk of surgery and postoperative complications. The therapeutic effective of the PDT was related to the early therapy and times of therapy. However, the shortcomes of the PDT were that the depth of killing tumor was not enough and there was a certain incidence of adverse reaction. Conclusions Therapeutic effect of PDT combine with stent or chemotherapy for unresectable hilar cholangiocarcinoma is better than that of single therapy. It is expected to be a first-line scheme of palliative treatment for unresectable hilar cholangiocarcinoma.
目的 评估光动力疗法联合曲安奈德治疗渗出型老年性黄斑变性（AMD）的临床疗效及对患者生活质量的影响。 方法 将2007年12月－2010年12月就诊的35例（38只眼）渗出型AMD患者采用随机数字表法随机分为两组，治疗组18例（20只眼）采用光动力疗法联合玻璃体腔内注射曲安奈德治疗，对照组17例（18只眼）单用光动力疗法。评估患者视力和眼底影像学改变，同时也评估对患者生活质量的影响。两组均随访12个月。 结果 随访12个月后，光动力疗法联合曲安奈德治疗组视力不变者8例9只眼，占45.0%；视力提高者9例10只眼，占50.0%；视力下降者1例1只眼，占5.0%。吲哚青绿血管造影结果显示，脉络膜新生血管（CNV）渗漏停止7例7只眼，占35.0%；持续渗漏或渗漏增加者1例1只眼，占5.0%；渗漏减少者11例12只眼，占60.0%。光动力疗法治疗组视力不变者6例6只眼，占33.3%；视力提高者4例5只眼，占27.8%；视力下降者7例7只眼，占38.9%。吲哚青绿血管造影结果显示，CNV渗漏停止3例3只眼，占16.7%；持续渗漏或渗漏增加者5例6只眼，占33.3%；渗漏减少者9例9只眼，占50.0%。联合治疗组与单用光动力疗法组在视力改变方面差异有统计学意义（χ2=4.67，P=0.03），在吲哚青绿血管造影结果方面差异有统计学意义（χ2=3.35，P=0.01）。中文译本低视力者生存质量量表评估生活质量治疗组平均得分（102.02 ± 16.20）分，对照组平均得分为（91.27 ± 11.81）分，两组比较差异有统计学意义（P＜0.05）。 结论 光动力疗法联合曲安奈德治疗渗出型AMD疗效优于单用光动力疗法。
ObjectiveTo observe the efficacy of optical coherence tomography angiography (OCTA) guided half-dose photodynamic therapy (PDT) in the treatment of acute central serous chorioretinopathy (CSC). MethodsA prospective randomized controlled trial. A total of 72 patients (72 eyes) with acute CSC in Peking University People's Hospital from April 2019 to April 2020 were included in the study. They were randomly divided into OCTA group (OCTA-guided PDT, 31 eyes of 31 patients) and indocyanine green angiography (ICGA) group (ICGA-guided PDT, 33 eyes of 33 patients). All patients underwent best corrected visual acuity (BCVA), fundus color photography, OCTA and ICGA examinations. International standard visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity. In OCTA group, the hyper-reflective area on en face OCTA image at choriocapillaris level was identified as treating area. In ICGA group, the area of choroidal vascular hyperpermeability on ICGA which was related to the leakage on fundus fluorescein angiography (FFA) was identified as treating area. The area corresponding to the treating area on FFA or ICGA was outlined on the color fundus photograph to guide PDT laser spot. The complete subretinal fluid (SRF) resolution, BCVA, central retinal thickness (CRT) at 1, 3, 6 months and SRF recurrent rate at 3, 6 months were observed. Continuous variables between the two groups were compared by t-test or Wilcoxon rank sum test. The χ2 test was used to compare the categorical variables. ResultsAt 1, 3 and 6 months after treatment, the SRF absorption rate in OCTA group and ICGA group was 74.2% (23/31), 63.6% (21/33), 87.1% (27/31) and 84.8% (28/33), 96.8% (30/31), 91.9% (31/33), respectively. OCTA-guided PDT was demonstrated noninferior to ICGA-guided PDT for complete SRF resolution at 1, 3, 6 months [95% confidence interval (CI) －11.9%-33.1%, P=0.402; 95%CI －14.7%-19.3%, P=0.107; 95%CI －6.3%-16.1%, P=0.226]. There was no significant difference in the recurrence rate of SRF between the two groups at 3 and 6 months after treatment (χ2=0.009, 0.047; P=0.925, 0.828). The difference of CRT was statistically significant at 6 months (t=2.017, P=0.047). There was no significant difference in logMAR BCVA at 1, 3 and 6 months after treatment (t=0.529, 0.762, 1.017; P=0.581, 0.403, 0.243). ConclusionsDuring 6 months follow-up, OCTA-guided PDT was demonstrated noninferior to ICGA-guided PDT for the SRF absorption rate in patients with acute CSC.
Objective To assess the efficacy and safety of photodynamic therapy (PDT) for cutaneous bowen disease. Methods We electronically searched PubMed, OVID, Cochrane Central Register of Controlled Trials, CBM, and CNKI databases from January, 1966 to March, 2010. The language was confined to English and Chinese. We screened the retrieved randomized controlled trials (RCTs) according to the predefined inclusion criteria, evaluated the quality of the included studies, and performed meta-analysis with RevMan 5.0.23 software. Results Five RCTs were included; among all 496 skin leisions on 354 patients, 237 were in trial group while the other 259 were in control group. The healing rate of PDT was higher than that of both placebo (RR=4.16, 95%CI 1.69 to 10.25) and topical fluorouracil (RR=1.38, 95%CI 1.12 to 1.71), and was similar to that of cryotherapy. The cosmetic outcome evaluation of PDT was better than that of both cryotherapy (RR=1.48, 95%CI 1.18 to 1.87) and topical fluorouracil treatment (RR=1.51, 95%CI 1.05 to 2.15). The recurrence rate of PDT was lower than that of placebo (RR=0.29, 95%CI 0.10 to 0.86), and was similar with cryotherapy or topical fluorouracil treatment respectively. The healing rate of PDT with red light source was higher than that of PDT with green light (RR=1.29, 95%CI 1.02 to 1.65), and the recurrence rate of the former was lower than that of the latter (RR=0.20, 95%CI 0.05 to 0.87). There was no difference between 2-fold illumination scheme and single illumination scheme in the healing rate or the cosmetic outcome evaluation. The adverse effects include pain, cacesthesia, inflammatory reaction, hyperpigmentation, and crusting. Conclusion The limited evidence indicates that the efficacy of PDT is better than those of placebo, cryotherapy or topical fluorouracil treatment, the recurrence rate of PDT is lower than that of placebo, and the adverse effects are similar comparing to control groups. The PDT with red light source is superior to PDT with green light source for having better effectiveness, less recurrence and similar adverse effects. The 2-fold illumination scheme and single illumination scheme have similar efficacy, but the former is more painful.
ObjectiveTo observe and analyze the clinical and imaging features of eyes with cystoid macular degeneration (CMD) secondary to chronic central serous chorioretinopathy (cCSC). MethodsA retrospective clinical study. From February 2018 to June 2023, 9 patients of 15 eyes with cCSC secondary CMD diagnosed by ophthalmology examination in Yunnan University Affiliated Hospital were included in the study. All patients were male. The age was (53.67±3.83) years. The cases of binocular and monocular were 6 and 3 respectively. The visual acuity of the affected eye ranges from 0.02 to 0.1, which cannot be corrected. Visual acuity decreased and the duration of shadow occlusion was ＞1 year. Half dose photodynamic therapy (PDT) was performed on 8 eyes. All the patients underwent the best corrected visual acuity, posterior mydriatic fundus color photography, infrared fundus photography (IR), fundus autofluorescence (AF), fluorescein fundus angiography (FFA), optical coherence tomography (OCT), and multi-wavelength dazzling imaging (MC). The patients who received half dose PDT were followed up until 3 months after treatment. Patients who did not receive treatment were followed up to 2 years after the first diagnosis. ResultsThe light reflection in macular area decreased or disappeared in all eyes, and abnormal macular pigmentation was observed in 12 eyes. IR examination showed diffuse patchy weak fluorescence in the macular area in all affected eyes, and dotted strong fluorescence in the periphery. Fundus AF examination showed disc-like weak AF in the macular area, and scattered small amounts of strong AF in the middle and margins, among which the retinal pigment epithelium (RPE) atrophy trace in the macular area was observed in 7 eyes. By MC examination, the green signal in the macular area of the posterior pole of all affected eyes was uneven and mottled. FFA examination showed that no abnormal fluorescein leakage was observed in 15 eyes and 8 eyes showed strong fluorescence caused by diffuse permeation fluorescence. A small amount of active fluorescein was found in 7 eyes. OCT examination showed that there were several cystic cavities of different sizes in all the affected eyes, RPE atrophied to different degrees, and RPE cell compensatory ridges and tubular structures in the outer retina were seen in 6 eyes; 7 eyes with CMD and active leakage showed signs of subcortical fluid accumulation. Choroidal hypertrophy was seen in all affected eyes, with significant expansion of the great vascular layer and compression of the middle vascular layer and capillary layer. In 8 eyes treated with half-dose PDT, 6 eyes were ineffective at 3 months after treatment. The treatment was effective in 2 eyes. In 7 eyes that did not receive half-dose PDT, CMD structure did not improve significantly after 2 years of follow-up. The visual acuity decreased with the prolongation of the disease. ConclusionsCMD is more common in cCSC with a long course of disease, which has significant effects on vision and poor prognosis. Fundus color photography shows that the reflection in the macular area of the pole is weakened or disappeared, which may be combined with macular abnormal pigmentation. IR and AF examination show uneven fluorescence in macular area. The green signal in macular area is not uniform according to MC inspection. FFA shows strong fluorescence caused by diffuse permeable fluorescence and fluorescein leakage in active lesions. OCT examination shows that multiple small sacs or connections between sacs were broken and fused, and RPE atrophied to varying degrees.