目的：探讨局限性脉络膜血管瘤（CCH）的临床和影像学特征，并评估光动力疗法（PDT）的个性化治疗效率，经瞳孔热疗（TTT），或它们的组合，随后球后注射倍他米松对CCH的解决。
方法：49名接受PDT的CCH患者，回顾性收集TTT或PDT+TTT治疗。通过分析最佳矫正视力（BCVA）的变化，比较其治疗效果。视网膜下液（SRF）和CCH病变特点。
结果：PDT，分别在17、11和21例患者中给予TTT和PDT+TTT。年龄无显著差异,性别,受影响的眼睛和肿瘤的位置在三组。PDT的基线BCVA分别为0.41±0.28、0.62±0.30和0.24±0.24，TTT和PDT+TTT组，F=6.572,P=0.003。经三种策略治疗的CCH在最大肿瘤基底直径方面表现出显著差异，治疗前SRF面积和黄斑受累（P<0.05）。接受PDT+TTT的患者表现出较大的肿瘤基底直径，更多SRF，黄斑受累比例高于其他组。治疗后，共有38例（77.6％）患者的视觉酸度良好，最终BCVA≥0.5。PDT和PDT+TTT治疗组比TTT组(0.09±0.13)在BCVA中获得了更多的视力改善(0.27±0.23和0.31±0.26)。所有SRF均在治疗后两周内消退，未发现复发的SRF。
结论：三种治疗方法在改善视功能和控制SRF方面表现良好，个体化治疗应主要根据肿瘤部位选择,然后是肿瘤大小和SRF的存在。
OBJECTIVE: To characterize the clinical and imaging features of circumscribed choroidal hemangioma (CCH), and to evaluate individualized treatment efficiency of photodynamic therapy (PDT), transpupillary thermotherapy (TTT), or their combination, followed by retrobulbar injection of betamethasone on CCH resolvement.
METHODS: Forty-nine patients with CCHs who underwent PDT, TTT or PDT+TTT treatments were retrospectively analyzed. Their treatment efficacy was compared by analyzing the change of best corrected visual acuity (BCVA), subretinal fluid (SRF) and CCH lesion characteristics.
RESULTS: PDT, TTT and PDT+TTT were respectively administrated in 17, 11 and 21 patients. No significant difference in age, gender, affected eyes and tumor location across the three groups. Baseline BCVA were 0.41 ± 0.28, 0.62 ± 0.30 and 0.24 ± 0.24 for PDT, TTT and PDT+TTT groups, respectively (F = 6.572, P = 0.003). CCH treated by three strategies showed significant difference in maximum tumor basal diameter, SRF areas and macula involvement prior to the treatment (P < 0.05). Patients receiving PDT+TTT exhibited larger tumor basal diameter, more SRF, higher ratio of macular involvement than other groups. A total of 38 (77.6 %) cases had good visual acidity with final BCVA ≥0.5 after treatments. PDT and PDT+TTT treatment groups acquired more vision improvement (0.27 ± 0.23 and 0.31 ± 0.26) in BCVA than TTT group (0.09 ± 0.13). All SRF were resolved within two weeks of treatment and no recurrent SRF were found.
CONCLUSIONS: The three treatments showed good performance in improving visual function and controlling SRF, and individualized treatment should be selected primarily by the tumor location, and then the tumor size and presence of SRF.
