摘要
目的探讨半剂量维替泊芬光动力学疗法(photodynamic therapy,PDT)治疗飞行员中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的飞行适应性及航空医学的鉴定原则。方法分析1例预警机飞行员单眼CSC的临床诊断、治疗过程及医学鉴定情况,复习相关文献。结果本例飞行员诊断为右眼中心性浆液性脉络膜视网膜病变6个月,保守治疗无效。眼科检查未见治疗禁忌症,行半剂量维替泊芬PDT治疗。3.0 mg/m^(2)的维替泊芬静脉注入开始后15 min,使用波长689 nm、能量50 J/cm^(2)半导体激光照射83 s。治疗后避光休息48 h。1个月后复查,右眼视物变形症状消失,视力正常,眼底自发荧光、对比敏感度、Amsler格检查恢复正常,黄斑相干光断层扫描(optical coherence tomography,OCT)显示黄斑区色素上皮层轻度紊乱、视网膜下液体完全吸收。根据飞行员体检标准,给予飞行合格。治疗后正常参加原机型飞行60 h(其中包20 h夜间飞行)。结论军事飞行员半剂量PDT治疗慢性CSC后,视功能恢复正常者可以考虑放飞。飞行适应性评价除常规定期视功能检查外,应进行眼底自发荧光、对比敏感度、Amsler格检查、黄斑OCT等与CSC相关的特殊眼科检测。半剂量PDT是治疗军事飞行员慢性CSC的有效方法。
Objective To discuss the effects of half-dose vitipofen photodynamics(PDT)treaing central serous chorioretinopathy(CSC)adopted a pilot to flight and the principle of related aeromedical evaluation.Methods A pilot with central serous chorioretinopathy was analyzed on clinical diagnosis,treatment,and aeromedical evaluation.The related literatures were reviewed.Results CSC of the pilot had been diagnosed for 6 months and the conservative treatment was inefficient.No contraindications were found in ophthalmic examination before the treatment.As the half-dose vatipofen photodynamic(3.0 mg/m^(2))was injected into vein for 15 minutes,the pilot was irradiated by a wavelength of 689 nm with the energy of 50 J/cm^(2) for 83 s,and then he was asked to keep light out for 48 h.One month later,the re-examination showed that the right-eye metamorphopsia disappeared and normal vision returned.The examinations of spontaneous fluorescence of the fundus,contrast sensitivity,and amsler grid returned to normal,and the macular OCT showed that the pigment epithelium in the macular area was slightly disturbed and the liquid under the retina was completely absorbed.The flight qualification was decided according to the pilot’s physical examination standard.After the treatment,the pilot had completed 60 h--flight in his original type of aircraft(including 20 h of night flight).Conclusions If the military pilot with chronic CSC treated by half-dose PDT and returned normal visual function the flying qualification would be considered.Besides the reference on regular visual function examination,the evaluation of flight adaptability should also include such examination as fundus spontaneous fluorescence,contrast sensitivity,Amsler lattice examination,macular OCT and other special ophthalmic tests related to CSC.Half-dose PDT is an effective method to treat chronic CSC in military pilots.
作者
杜向红
刘勇
陈威
王鑫
王华
杨庆红
赵燕燕
Du Xianghong;Liu Yong;Chen Wei;Wang Xin;Wang Hua;Yang Qinghong;Zhao Yanyan(Department of Ophthalmology,Air Force Medical Center,PLA,Beijing 100142,China)
出处
《中华航空航天医学杂志》
CSCD
2020年第1期23-26,I0002,共5页
Chinese Journal of Aerospace Medicine
基金
全军后勤科研重大项目(AKJ15J003)
总后勤科研重点项目(BKJ13J002)。
