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目的 观察光动力疗法(photodynamic therapy,PDT)两种不同照光方式治疗孤立性脉络膜血管瘤的疗效.方法 脉络膜血管瘤患者22例,根据不同照光方式分为两组,组合光斑组患者14例,采用不同方式光斑重叠照射治疗瘤体,10例伴视网膜脱落;非组合光斑组患者8例,采用光斑不重叠,仅单个光斑,但光斑照射时间延长一倍,5例伴视网膜脱落.组合光斑组PDT治疗均采用维速达尔6 mg/m2体表面积,10 min推注完毕,5 min后行689 nm激光照射,激光能量密度50 J/em2,时间83 s.组合光斑组采用光斑大小3～5 mm,治疗光斑2～3个,根据肿瘤大小及形状治疗光斑可以部分重叠,术后随访15～38个月,(平均28.5 ±8)个月.非组合光斑组根据肿瘤最大直线距离采用单个光斑覆盖瘤体,激光能量密度100 J/cm2,照射时间166s.术后随访9～ 26个月,(平均19 ±5)个月.结果 (1)14例组合光斑组患者PDT治疗后最后随访视力为指数(FC) ～1.0,平均(0.33±0.38).8例提高二行以上;5例稳定,视力提高患者占64.28％.术后肿瘤最大厚度为0～3.0 mm,平均(1.2±0.9)mm;最大直径为0～8.6 mm,平均(4.5±3.5) mm;6例网脱消失,有视网膜色素上皮游离和沉积.(2)9例非组合光斑组患者,8例术后随防视力为0.04 ～1.0,平均(0.29±0.34);2例提高二行以上,视力提高患者占25.0％;6例稳定.术后肿瘤最大厚度为0～2.8 mm,平均(1.4±1.0)mm;最大直径为0～8.8 mm,平均(4.7±3.6) mm.2例网脱消失.两组患者视力改善和肿瘤萎缩比较,差异无统计学意义(P＞0.05).结论 不同照光方式PDT治疗孤立性脉络膜血管瘤均显示安全有效,可以使瘤体萎缩、网脱消失或减轻、视力提高.“,”Objective To evaluate the efficacy and safety of combined facula photodynamic therapy (PDT) and conventional PDT for circumscribed choroidal hemangioma.Methods Twenty-two eyes (22 patients) of macular circumscribed choroidal hemangioma with vision impairment attributable to subfo veal fluid and retinal detachment were given PDT treatment:14 patients had combined facula PDT with 2-3 overlapped spots and 8 pa tients conventional PDT with 1 spot.The PDT was conducted with a standard concentration of verteporfin and intravenous injection time.Laser was used at 50 J/cm2 for 83 seconds for combined facula PDT and 100 J/cm2 for 166 seconds for conventional PDT.Visual acuity testing,ophthalmoscopy,fundus fluorescein angiography and ultrasonography examinations were performed to evaluate the efficacy and safety of the PDT treatment.Results The mean follow-up time was 28.5 ± 8.0 months for the combined facula group and 19.0 ± 5.0 months for the conventional PDT group.As to the combined facula group,the mean best-corrected visual acuity (BCVA) increased from 0.08 ±0.10 to 0.33 ± 0.38,and 9 patients (60％) had a vision improvement of over 2 lines.In the conventional treatment group,the mean BCVA increased from 0.09 ±0.12 to 0.29 ±0.34,and 2 patients (25％) had a vision improvement of over 2 lines.The mean thickness of the hemangioma decreased from 2.7 ± 0.8 mm to 1.2 ± 0.9 mm after the treatment in the combined facula group and a complete regression of tumor occurred in 4 cases (28.6％) and retinal reattachment to 6 patients (43％).In the conventional PDT group,the mean thickness of the hemangioma decreased from 2.5 ± 0.7 mm to 1.4 ± 1.0 mm after the treatment and a complete regression of tumor occurred in 1 case (12.5％) and retinal reattachment to 2 patient (25％).Based on the analysis made with Fisher's exact probabilities in 2 × 2 table,there was no significant difference in tumor shrinkage between the two groups (P ＞ 0.05).Conclusions Combined facula PDT and conventional PDT treatments are both effective and safe for macular circumscribed choroidal hemangioma,leading to improved or stabilized BCVA as a result of tumor shrinkage and absorption of subretinal fluid.