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Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration:: Two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization-verteporfin in photodynamic therapy report 2

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2001年第5期131卷 541-560页

作者： Arnold, J Kilmartin, D Olson, J Neville, S Robinson, K Laird, A Richmond, C Farrow, A McKay, S McKechnie, R Evans, G Aaberg, TM Brower, J Waldron, R Loupe, D Gillman, J Myles, B Saperstein, DA Schachat, AP Bressler, NM Bressler, SB Nesbitt, P Porter, T Hawse, P Harnett, M Eager, A Belt, J Cain, D Emmert, D George, T Herring, M McDonald, J Mones, J Corcóstegui, B Gilbert, M Duran, N Sisquella, M Nolla, A Margalef, A Miller, JW Gragoudas, ES Lane, AM Emmanuel, N Holbrook, A Evans, C Lord, US Walsh, DK Callahan, CD DuBois, JL Moy, J Kenney, AG Milde, I Platz, ES Lewis, H Kaiser, PK Holody, LJ Lesak, E Lichterman, S Siegel, H Fattori, A Ambrose, G Fecko, T Ross, D Burke, S Conway, J Singerman, L Zegarra, H Novak, M Bartel, M Tilocco-DuBois, K Ilc, M Schura, S Joyce, S Tanner, V Rowe, P Smith-Brewer, S Greanoff, G Daley, G DuBois, J Lehnhardt, D Kukula, D Fish, GE Jost, BF Anand, R Callanan, D Arceneaux, S Arnwine, J Ellenich, P King, J Aguado, H Rollins, R Anderson, T Nork, C Duignan, K Boleman, B Jurklies, B Pauleikhoff, D Hintzmann, A Fischer, M Sowa, C Behne, E Pournaras, CJ Donati, G Kapetanios, AD Cavalière, K Guney-Wagner, S Gerber, N Sickenberg, M Sickenberg, V Gans, A Hosner, B Sbressa, A Kozma, C Curchod, M Ardoni, S Harding, S Yang, YC Briggs, M Briggs, S Phil, EB Tompkin, V Jackson, R Pearson, S Natha, S Sharp, J Tompkin, A Lim, JI Flaxel, C Padilla, M Levin, L Walonker, F Cisneros, L Nichols, T Schmidt-Erfurth, U Barbazetto, I Laqua, H Kupfer, R Bülow, R Glisovic, B Bredfeldt, T Elsner, H Wintzer, V Bahlmann, D Michels, S Gordes, R Neppert, B Grote, M Honnicke, K Blumenkranz, MS Little, HL Jack, R Espiritu, LM Unyi, L Regan, J Lamborn, L Silvestri, C Rosa, RH Rosenfeld, PJ Lewis, ML Rodriguez, B Torres, A Munoz, N Contreras, T Galvez, M Hess, D Cubillas, T Rams, I Slakter, JS Sorenson, JA Bruschi, PA Burke, K Schnipper, E Maranan, L Scolaro, M Riff, M Agresta, E Napoli, J Johansson, I Dedorsson, I Stenkula, S Hvarfner, C Carlsson, T Liljedahl, AM Fallstrom, S Jacobsson, E Hendeberg, K Soubrane, G Kuhn, D Emory Eye Center Atlanta GA United States

PURPOSE: To determine if photodynamic therapy with verteporfin (Visudyne;Novartis AG, Bulach, Switzerland), termed verteporfin therapy, can safely reduce the risk of vision loss compared with a placebo (with sham treatment) in patients with subfoveal choroidal neovascularization caused by age-related macular degeneration who were identified with a lesion composed of occult with no classic choroidal neovascularization, or with presumed early onset classic choroidal neovascularization with good visual acuity letter score, METHODS: This was a double-masked, placebo controlled (sham treatment), randomized, multicenter clinical trial involving 28 ophthalmology practices in Europe and North America. The study population was patients with age related macular degeneration, with subfoveal choroidal neovascularization lesions measuring no greater than 5400 mum in greatest linear dimension with either 1) occult with no classic choroidal neovascularization, best-corrected visual acuity score of at least 50 (Snellen equivalent approximately 20/100), and evidence of hemorrhage or recent disease progression;or 2) evidence of classic choroidal neovascularization with a best-corrected visual acuity score of at least 70 (better than a Snellen equivalent of approximately 20/40);assigned randomly (2:1) to verteporfin therapy or placebo therapy. Verteporfin (6 mg per square meter of body surface area) or placebo (5% dextrose in water) was administered by means of intravenous infusion of 30 mi over 10 minutes. Fifteen minutes after the start of the infusion, a laser light at 689 nm delivered 50 J/cm(2) by application of an intensity of 600 mW/cm(2) over 83 seconds using a spot size with a diameter 1000 mum larger than the greatest linear dimension of the choroidal neovascularization lesion on the retina. At follow-up examinations every 3 months, retreatment with the same regimen was applied if angiography showed fluorescein leakage. The main outcome measure was at least moderate vision l

关键词：盲/预防和控制脉络膜新生血管化/诊断脉络膜新生血管化/药物疗法脉络膜新生血管化/病因学双盲法荧光素血管造影术随访研究眼底输注静脉内黄斑变性/并发症黄斑变性/诊断光化学疗法光敏感药/治疗应用卟啉类/治疗应用前瞻性研究安全治疗结果视敏度老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Lutetium texaphyrin (lu-tex): A potential new agent for ocular fundus angiography and photodynamic therapy

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第3期129卷 353-362页

作者： Blumenkranz, MS Woodburn, KW Qing, F Verdooner, S Kessel, D Miller, R Stanford Univ Med Ctr Dept Ophthalmol Stanford CA 94305 USA Pharmacycl Inc Sunnyvale CA USA Ophthalm Imaging Syst Inc Sacramento CA USA Wayne State Univ Dept Pharmacol Detroit MI 48201 USA

PURPOSE: To investigate the suitability of lutetium texaphyrin (lu-tex) as a fluorescence imaging agent in the delineation of retinal vascular and choroidal vascular diseases. The utilization of an efficient fluorescent molecule that is also a photosensitizer represents a unique opportunity to couple diagnosis and therapy. METHODS: Fundus fluorescence angiography comparing lu-tex (motexafin lutetium, Optrin, Pharmacyclics Inc, Sunnyvale, California) with the conventional angiographic dyes, sodium fluorescein, and indocynanine green (ICG), was performed on the eyes of normal and laser-injured New Zealand white rabbits. Plasma pharmacokinetic data and plasma protein binding were assessed in addition to light microscopy of the retina in both imaged and laser-injured eyes. RESULTS: Normal retinal and choroidal vasculature was well delineated by lu-tex angiography. Experimentally induced choroidal and retinal vascular lesions were enhanced by lu-tex and demonstrated different staining patterns than fluorescein or ICG, particularly at the margins of the lesions. Lu-tex cleared rapidly from the plasma, with 39.7% bound to the high-density lipoprotein (HDL) fraction while 15.8% was bound to the low-density lipoprotein (LDL) fraction. No evidence of retinal toxicity after dye administration was observed by either ophthalmoscopy and fundus photography or by light microscopy, CONCLUSION: Lu-tex angiography is a potentially valuable method for retinal vascular and choroidal vascular evaluation, and it has advantages over fluorescein and ICG angiography. The same agent could conceivably be used for both the identification of abnormal vasculature and subsequent photodynamic treatment. (C) 2000 by Elsevier Science Inc. All rights reserved.

关键词：脉络膜/血液供给脉络膜/代谢脉络膜/病理学脉络膜新生血管化/诊断脉络膜新生血管化/药物疗法脉络膜新生血管化/代谢脉络膜新生血管化/病理学疾病模型动物荧光素/诊断应用荧光素血管造影术眼底吲哚花青绿/诊断应用镥/诊断应用镥/药代动力学镥/治疗应用金属卟啉类/诊断应用金属卟啉类/药代动力学金属卟啉类/治疗应用光化学疗法/方法光敏感药/诊断应用光敏感药/药代动力学光敏感药/治疗应用视网膜新生血管化/诊断视网膜新生血管化/药物疗法视网膜新生血管化/代谢视网膜新生血管化/病理学视网膜血管/代谢视网膜血管/病理学动物男(雄)性兔

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Photodynamic therapy with verteporfin for choroidal neovascularization in patients with diabetic retinopathy

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2001年第5期132卷 659-667页

作者： Ladd, BS Solomon, SD Bressler, NM Bressler, SB Johns Hopkins Univ Sch Med & Hosp Wilmer Ophthalmol Inst Retinal Vasc CtrDept Ophthalmol Baltimore MD USA

PURPOSE: To report the use of photodynamic therapy (PDT) with verteporfin in three patients with choroidal neovascularization (CNV) from age-related macular degeneration and underlying diabetic retinopathy. The level of diabetic retinopathy would have excluded these patients from participation in previously reported randomized clinical trials evaluating PDT with verteporfin due to a theoretic concern of damage to the overlying retinal vasculature. DESIGN: Retrospective interventional case series. METHODS: Three patients from a referral practice with at least severe nonproliferative diabetic retinopathy and a history of clinically significant macular edema developed loss of vision from concurrent choroidal neovasculariza-decreased area of fluorescein leakage from CNV. One eye that had new subretinal hemorrhage following treatment appeared to show new vasculopathy on initial evaluation of the post-treatment angiogram. Retrospective review suggested that the subretinal hemorrhage provided increased contrast to more easily visualize vasculopathy that was present before the PDT. CONCLUSIONS: Three patients with diabetic retinopathy undergoing a total of seven PDT treatments with verteporfin in four eyes had no new retinal vascular abnormalities develop. No other atypical responses of CNV to PDT were noted except new subretinal hemorrhage, providing increased contrast of the overlying vasculature, which gave the false impression of the development of new vasculopathy in one eye. Patients with diabetic retinopathy who have concurrent CNV for which PDT with verteporfin is recommended should be cautioned regarding the theoretical concerns of harming the retinal vasculature. Periodic surveillance for such concerns seems warranted until more experience is obtained. (C) 2001 by Elsevier Science Inc. All rights reserved.

关键词：脉络膜新生血管化/药物疗法脉络膜新生血管化/病因学糖尿病视网膜病变/并发症荧光素血管造影术眼底黄斑变性/并发症黄斑变性/药物疗法光化学疗法光敏感药/治疗应用卟啉类/治疗应用回顾性研究治疗结果视敏度老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2001年第4期131卷 518-520页

作者： Gelisken, F Inhoffen, W Partsch, M Schneider, U Kreissig, I Univ Tubingen Augenklin Dept Ophthalmol Abt 3 D-72076 Tubingen Germany

PURPOSE: To report a case of retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization. METHODS: Case report. A 74-year-old woman with exudative age-related macular degeneration and classic subfoveal choroidal neovascularization RE underwent photodynamic therapy with verteporfin. RESULTS: Ophthalmoscopy and fluorescein angiography RE disclosed a retinal pigment epithelial tear in the area of photodynamic therapy. CONCLUSION: This case presents the first report of a retinal pigment epithelial tear after photodynamic therapy with verteporfin for subfoveal choroidal neovascularization in age-related macular degeneration. (Am J Ophthalmol 2001;131:518-520. (C) 2001 by Elsevier Science Inc. All rights reserved).

关键词：脉络膜新生血管化/药物疗法脉络膜新生血管化/病因学荧光素血管造影术黄斑变性/并发症检眼镜检查光敏感药/治疗应用色素上皮眼/病理学卟啉类/治疗应用视网膜脱离/诊断视网膜脱离/病因学视敏度老年人女(雌)性人类

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Therapeutic strategies in choroidal neovascularizations secondary to angioid streaks

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2003年第3期136卷 580-582页

作者： Mennel, S Schmidt, JC Meyer, CH Marburg Germany

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The origin of the hypofluorescent spot after photodynamic therapy

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2003年第3期136卷 584-585页

作者： Parodi, MB Trieste Italy

Flower and Snyder2 postulated that free hemoglobin released from the lysed erythrocytes blocks fluorescein fluorescence in the treated area, and this feature, in association with the reduced blood flow in choriocapillary, might account for the dark area visible in the post-PDT angiography. [...]Flower and associates3 demonstrated by means of a computer model also that even a partial occlusion of the feeder vessel could result in the angiographic appearance of occluded CNV. [...]a hypofluorescence may develop only if choriocapillaris and retinal pigment epithelium are sufficiently present to show angiographically their alterations. [...]due to the extreme thinning of both choriocapillaris and retinal pigment epithelium-Bruch's membrane complex in the areas outside the CNV in eyes affected by PM, no visible hypofluorescence might result from choriocapillaris occlusion and retinal pigment epithelium swelling.

关键词：脉络膜/血液供给脉络膜/病理学脉络膜新生血管化/药物疗法脉络膜新生血管化/病理学荧光素血管造影术光化学疗法光敏感药/治疗应用人类

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