方法：临床确诊为PM合并CNV患者32例32眼，随机选取16例16眼为PDT治疗(PDT组)，另16例16眼为PDT联合玻璃体腔注射ranibizumab治疗组(联合组)，两组黄斑水肿无显著性差异。对比分析治疗前及治疗后1，6mo患者最佳矫正视力(best corrected visual acuity，BCVA)、光学相干断层扫描(optic coherence tomograph，OCT)及眼底荧光血管造影(fundus fluorescein angiography，FFA)的变化。

结果：治疗后1mo与治疗前相比：PDT组BCVA平均值提高，黄斑中心厚度(fovea centralis thickness，CMT)平均值降低，差异具有统计学意义(P<0.05)； 联合组BCVA平均值明显提高，CMT平均值明显降低，差异具有显著统计学意义(P<0.01)； 两组组间比较BCVA变化、CMT变化差异具有统计学意义(P<0.05)。治疗后6mo与治疗前相比，PDT组BCVA平均值提高，CMT平均值降低，差异具有统计学意义(P<0.05)； 联合组BCVA平均值明显提高，CMT平均值明显降低，差异具有显著统计学意义(P<0.01)； 两组组间比较BCVA变化、CMT变化差异具有统计学意义(P<0.05)。治疗后6mo和1mo相比：PDT组与联合组BCVA平均值、CMT平均值差异均无统计学意义(P>0.05)。FFA检查显示： 治疗后1mo，PDT组 CNV病灶渗漏停止或渗漏减少者11眼(69%)，持续渗漏5眼(31%)； 联合治疗组 CNV病灶渗漏停止或渗漏减少者13眼(81%)，持续渗漏3眼(19%)。治疗后6mo：PDT组CNV病灶渗漏停止或渗漏减少者10眼(62.5%)，持续渗漏4眼(25%)，2眼(12.5%)出现渗漏复发； 联合治疗组 CNV病灶渗漏停止或渗漏减少者15眼(94%)，持续渗漏1眼(6%)。

结论：PDT治疗与PDT联合玻璃体腔注射ranibizumab治疗均可以部分或完全封闭PM所致的CNV，减少CNV引起的视力下降； 联合治疗的效果及稳定性要优于单纯的PDT治疗。

METHODS: There were patients(32 eyes)who were diagnosed as PM with CNV. Randomly selected 16 cases(16 eyes)which were given the PDT treatment(PDT group). The remaining were given both PDT and intravitreal injection with ranibizumab(combination group). There is no significant difference on macular edema between two groups. We analyzed the changes in the best corrected visual activity(BCVA), optic coherence tomograph(OCT)and fundus fluorescein angiography(FFA)before and 1, 6mo after treatment.

RESULTS: One month after the treatment in PDT group: the BCVA increased while the CMT decreased compared with that of pretreatment(P<0.05). One month after the treatment in combination group: the BCVA increased while the CMT decreased significantly compared with that of pretreatment(P<0.01); the changes of BCVA and CMT showed statistically significant between the two groups(P<0.05). Six month after the treatment in PDT group: the BCVA increased while the CMT decreased compared with that of pretreatment(P<0.05). Six month after the treatment in combination group: the BCVA increased while the CMT decreased significantly compared with that of pretreatment(P<0.01); compared with changes of BCVA and CMT in two groups, the difference was significant after treatment(P<0.05). Compared 1mo with 6mo after treatment: there was no significant difference in the BCVA and CMT changes(P<0.05). One month after treatment: in PDT group, FFA showed no leakage or reduced leakage of CNV in 11 eyes(69%), and the fundus remained leaky in 5 eyes(31%); in combination group, FFA showed no leakage or reduced leakage of CNV in 13 eyes(81%); the fundus remained leaky in 3 eyes(19%). Six month after treatment: in PDT group, FFA showed no leakage or reduced leakage in 10 eyes(62.5%); the fundus remained leaky in 4 eyes(25%); two eyes(12.5%)relapsed leakage; in combination group, FFA showed no leakage or reduced leakage of CNV in 15 eyes(94%); the fundus remained leaky in 1 eye(6%).

CONCLUSION: Not only PDT but also PDT and intravitreal injection with ranibizumab can block CNV of pathologic myopia completely or partly, and reduce the danger causing descent of vision. Effects and the stability of the combination therapy is superior to PDT treatment.