Photodiagnosis and photodynamic therapy最新文献

Objective: This study aimed to evaluate the short-term efficacy of neuroplasticity-based binocular visual training compared with conventional spectacle correction combined with occlusion therapy in children diagnosed with ametropic amblyopia.

Methods: A single-center randomized controlled trial was conducted involving 70 children aged 4 to 16 years with a clinical diagnosis of amblyopia. Participants were randomly allocated to an intervention group (spectacle correction combined with 20 sessions of neuroplasticity training) or a control group (spectacle correction combined with occlusion therapy). Primary outcome measures included best corrected visual acuity (BCVA), stereoacuity, and binocular suppression index.

Results: Following 10 training sessions, participants in the intervention group demonstrated statistically significant improvement in BCVA, increasing from 0.72 to 0.88 in the right eye and from 0.70 to 0.90 in the left eye, with outcomes superior to the control group (both p < 0.001). Stereoacuity improved from 253.6 arc seconds (arcsec) to 160.7 arcsec in the intervention group, which was significantly greater than the improvement observed in the control group (250.4 arcsec to 132.7 arcsec); after adjusting for baseline stereoacuity differences using analysis of covariance (ANCOVA), the intergroup difference in corrected stereoacuity outcomes reached statistical significance (p = 0.001). The intervention group showed superior long-term stability of stereoacuity at 3-month follow-up (158.32 ± 35.21 arcseconds versus 145.24 ± 32.09 arcseconds in the control group, p = 0.023), and achieved a significantly higher rate of combined efficacy endpoint (stereoacuity improvement ≥30% plus perceptual eye alignment error ≤30 pixels, 85.7%) compared with the control group (62.3%, p < 0.01), which served as the core basis for the efficacy conclusion. The foveal suppression index decreased from 51.4% to 14.3% in the intervention group. No serious adverse events were reported during the intervention period.

Conclusions: Neuroplasticity training was associated with significant short-term improvements in BCVA and binocular visual function in children with amblyopia, demonstrating a favorable safety and efficacy profile. These findings support its potential application in clinical practice.

Background: Diabetic macular edema (DME) remains a leading cause of vision impairment among adults with diabetes worldwide. Although current therapies such as anti-VEGF injections and laser treatment provide clinical benefit, the optimal approach to simultaneously target macular structure, visual function, retinal perfusion, and inflammatory activity remains uncertain.

Objective: To evaluate the efficacy of Conbercept Plus Dexamethasone compared with Conbercept alone therapy in patients with DME over a 12-month follow-up period.

Methods: Forty-six eyes from 46 patients with DME were enrolled in a prospective controlled trial and assigned to an observation group (n=23, receiving Conbercept Plus Dexamethasone) or a control group (n=23, Conbercept alone treatment). Central macular thickness (CMT), best-corrected visual acuity (BCVA, LogMAR), superficial vascular density (SVD), deep vascular density (DVD) were measured at baseline and at 1, 3, 6, and 12 months post-treatment. At baseline and 3 months after the fourth vitreous cavity injection, levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), and vascular endothelial growth factor (VEGF) were measured in the aqueous humor. Repeated measures ANOVA and correlation analyses were performed.

Results: At baseline and during the first three months, CMT and BCVA did not differ between groups. At 6 and 12 months, the observation group had significantly lower CMT (236.09 ± 21.94 μm and 239.61 ± 28.77 μm) than controls (343.83 ± 60.23 μm and 322.70 ± 56.19 μm; both p<0.001), with BCVA showing a trend toward improvement at 6 months (p=0.060) and significant gain at 12 months (p=0.001). DVD increased significantly in the observation group at 6 and 12 months (p=0.018 and 0.045), while SVD remained similar. Inflammatory cytokines decreased in both groups, but reductions in IL-6, IL-8, IL-10, and VEGF were greater in the observation group (all p<0.05). CMT strongly correlated with BCVA (r=0.778, p<0.001), and weak but significant correlations existed between glycemic indices and retinal parameters.

Conclusions: Conbercept Plus Dexamethasone provides superior long-term structural, functional, and microvascular benefits compared with conventional therapy, likely mediated by enhanced resolution of inflammation. CMT strongly predicts visual outcomes, supporting its use as a primary surrogate marker in clinical management of DME.

The overall incidence of colorectal cancer, particularly the lower part of the rectum normally known as low rectal cancer, is globally on the rise, accounting for approximately 10% of all new oncology cases. KRAS, a common oncogenic mutant gene, has a mutation frequency of up to 40% in colorectal cancer and significantly impacts its prognosis and therapeutic outcomes. Anatomically, low rectal cancer usually develops in a deep and narrow pelvic space, adjacent to critical nerves and organs, posing significant challenges for radical resection. A 52-year-old female presented with an extremely low-lying locally advanced rectal cancer or tumor exhibiting high-risk features with an intravascular tumor thrombus and high proliferative activity. This patient initially underwent an endoscopic photodynamic therapy combined with "oxaliplatin + capecitabine" chemotherapy, bevacizumab, and sintilimab monotherapy, resulting in some significant tumor shrinkage and decrease in volume. Subsequent sequential therapeutic strategies included radiofrequency ablation, second-line chemotherapy combined with bevacizumab, and sintilimab. Following 15 months of intensive neoadjuvant conversion therapy, the tumor continued to decrease in size, ultimately enabling successful radical abdominoperineal resection with rectal resection. This case demonstrates a remarkable successful application of a novel treatment strategy combining photodynamic therapy with radiofrequency ablation for local treatment alongside systemic therapy to give room to surgical opportunities for patients with locally advanced ultra-low rectal cancer.

Oral potential malignant disorders (OPMDs) have a high risk of malignant transformation and recurrence. This case reports describes a novel therapeutic strategy of Er:YAG laser-assisted photodynamic therapy (Er:YAG-PDT) combined with anti-programmed death protein-1 (anti-PD-1) immunotherapy for a patient with refractory OPMDs in the right lower gingiva following oral squamous cell carcinoma (OSCC) surgery on the contralateral side. Initial PDT alone showed limited efficacy, but after integrating Er:YAG laser pretreatment, the patient achieved significant lesion regression, with a complete final clearance. The 6-month follow-up showed good local lesion control in the patient peripheral blood analysis revealed elevated natural killer (NK) cell level and reduced regulatory T (Treg) cell percentage, suggesting activated adaptive immunity, while similar CD8⁺ T cell levels indicated maintained immune homeostasis. This case report highlights the potential of combined Er:YAG-PDT and anti-PD-1 therapy for OPMDs, while emphasizing the need for optimized monitoring and multi-modal strategies to prevent recurrence in high-risk patients.

Background: Macular neovascularization (MNV) etiology is multifactorial, but direct evidence linking it to abnormalities of large choroidal vessels is lacking. This study aimed to investigate the potential role of abnormal spatial relationships between large choroidal arteries and veins in the pathogenesis of MNV, particularly in eyes with large veins traversing the macular area.

Methods: This retrospective study analyzed 45 eyes from 45 patients (26 with chronic central serous chorioretinopathy [CSC] and 19 with pathologic myopia [PM]) exhibiting large macular veins without a normal venous watershed. All patients underwent simultaneous fundus fluorescein angiography and indocyanine green angiography (ICGA). Arterial and venous phase ICGA images were selected, nonlinearly registered, and superimposed using Fiji/ImageJ software to visualize spatial arteriovenous relationships.

Results: Spatial relationships between large choroidal arteries and veins were clearly discernible in significantly more PM eyes (18/19, 94.7%) than CSC eyes (6/26, 23.1%) (P < 0.0001). Among eyes with clear visualization, various spatial configurations were observed, including crossing, twisting, and independence. Crucially, in two distinct MNV cases-one secondary to chronic CSC (thick choroid) and one secondary to PM (thin choroid)-direct, large-caliber arteriovenous shunts were identified precisely at the MNV site using this imaging approach.

Conclusion: This study provides direct ICGA evidence that abnormal shunts between large choroidal arteries and veins represent a novel, previously underrecognized etiology for MNV formation. This anatomical anomaly may act as an upstream hemodynamic driver across different choroidal backgrounds (thick or thin), potentially altering local hemodynamics and promoting neovascularization. Investigating these underlying arteriovenous relationships could improve CNV risk stratification and inform future treatment strategies.

Objective: To evaluate the clinical outcomes and visual quality after Phorcides planned Contoura topography-guided femtosecond laser-assisted excimer laser in situ keratomileusis (TOPO-G FS-LASIK) for myopia and astigmatism correction.

Methods: Non-randomized retrospective study. 38 eyes in the high ocular residual astigmatism (HORA, >0.75D) group and 44 eyes in the low ocular residual (LORA, <0.75D) group were treated, and the accuracy was evaluated based on the Phorcides planned Contoura TOPO-G FS-LASIK. Routine examinations and specific tests, such as ocular aberrations, optical quality analysis system, a subjective visual quality questionnaire, and contrast sensitivity (CS), were measured and compared within and between groups preoperatively and postoperatively.

Results: At 6m postoperatively, manifest refractive spherical equivalent, uncorrected and corrected distance visual acuity, safety index, effectivity index, target-induced astigmatism, surgical-induced astigmatism, difference vector, angle of error, and correction index were similar in both HORA and LORA groups (P>0.05). Objective scatter index, modulation transfer function cut-off, visual acuity (VA) 100%, and all the CS were similar between the two groups preoperatively and postoperatively (P>0.05). But VA20%/9%, Strehl ratio, the CS of 1.5/3/6/12/18c/d in the HORA group, and 1.5/3/6c/d in the LORA group were significantly elevated 6m postoperatively. The subjective visual quality questionnaire scores were consistent both within and between groups preoperatively and 6m postoperatively.

Conclusions: Phorcides planned Contoura TOPO-G FS-LASIK achieved the predicted outcomes, demonstrating objective and universal applicability. Visual quality in the HORA group was significantly improved, especially the night vision and high-frequency spatial CS.

This study aimed to assess the efficacy and safety of 5-ALA-PDT for treating cervical LSIL and HR-HPV in women of childbearing age. A retrospective analysis was conducted on 237 patients (aged 20-40 years) who underwent 5-ALA-PDT at Minhang Hospital between 2022 and 2024. The treatment protocol involved topical application of 5-ALA, followed by 635-nm laser therapy at a power of 100 J/cm², administered over a duration of 30 min, and repeated in three sessions, with a spacing of one to two weeks between each session. Follow-up: 1 month (adverse reactions, cervical structure); 3-6/12 months (HR-HPV clearance, LSIL regression). The IBM SPSS 26.0 software was used for the analysis of the data, with a significance level of P<0.05 being established as significant. The HR-HPV clearance study revealed that the success rate increased from 67.09% (3-6 months) to 88.19% (12 months), with a higher success rate observed in younger patients (P=0.014/0.018). The following regressions were observed: LSIL regression of the cervical (98.82% to 99.44%), cervical canal (86.30% to 100%), and vaginal (82.25% to 96.77%) epithelium, with a 3-6-month cervical regression greater than that of other sites (P = 0.03). In this study, 65.82% of patients had no adverse reactions, with mild events (e.g., bleeding 22.78%, adhesions 14.34%) resolving within five days. The study concluded that 5-ALA-PDT is a safe and effective treatment for cervical LSIL combined with HR-HPV in women of childbearing age. This treatment promotes HR-HPV clearance and LSIL regression, preserves cervical structure, and accelerates HPV clearance in younger patients.

Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy that poses significant therapeutic challenges due to its refractory nature and high recurrence rate. Although surgery remains the standard treatment, non-surgical alternatives are crucial for elderly patients with extensive lesions or multiple comorbidities. 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) selectively targets and destroys tumor cells through the application of a photosensitizer and corresponding light source. Here, we report the case of a centenarian male with extensive primary perineogenital EMPD. He was unsuitable for surgery due to advanced age, poor general health, large lesion size, and sensitive anatomical location. The patient received ALA-PDT as long-term palliative treatment, with a total of 58 sessions over five years. This regimen achieved durable local control, was well-tolerated, and preserved the patient's quality of life. This is the oldest reported EMPD patient treated with ALA-PDT and the case with the highest cumulative number of ALA-PDT sessions. This suggests that ALA-PDT is a safe and effective long-term palliative treatment option for high-risk elderly patients.

Photodynamic therapy (PDT) and photothermal therapy (PTT) are promising tumor treatment modalities which employ light activation to acquire high temperature and reactive oxygen species (ROS) for the annihilation of cancer cells. In this study, a bilirubin (BR)-gold nanoconjugate (BGNC) was synthesized, characterized, and analyzed as a photosensitizer for synergistic PTT/PDT of HeLa cancer cells. BGNC contained nanoparticles with an average diameter of 33 nm, a zeta potential of -18.6 mV, a band gap energy of 2.7 eV, and a photothermal conversion efficiency of 51.6%, with an intrinsic ROS-generating efficiency. BGNC benefits from the surface plasmon resonance (SPR) and ROS-producing properties of gold nanoparticles, and antioxidant and glutathione (GSH)-reducing properties of BR. Concentration-dependent effects for BGNC in decreasing Hela cell viability were assessed. Hela cell viability further lowered upon 808-nm laser light irradiation of BGNC. The ability of BGNC to generate ROS upon irradiation was confirmed in cell-free as well as cell-containing systems, with a 2.1-fold increment in intracellular ROS in treated cells with BGNC and light irradiation. BGNC also exhibited a concentration-dependent effect to deplete the GSH level. BGNC acted as a two-pronged photosensitizer agent, exhibiting enhanced anticancer efficacy by leveraging both phototherapy and the intrinsic properties of BR.