半剂量光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变  

Half-dose photodynamic therapy for chronic central serous chorioretinopathy

作　　者：李鹏程[1] 盛双燕[1] 彭冲[1] 张缨[1] 王智[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院眼科,武汉430022

出　　处：《中华眼底病杂志》2011年第4期327-330,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察半剂量维替泊芬光动力疗法（PDT）治疗慢性中心性浆液性脉络膜视网膜病变（CSC）的疗效。方法慢性CSC患者27例32只跟纳入研究。男性22例，女性5例；年龄31～63岁，平均年龄45．0岁；病程6～32个月，平均病程16．2个月。所有患者均行最小视角对数（logMAR）视力表最佳矫正视力（BCVA）、直接检眼镜眼底检查，荧光素眼底血管造影（FFA）、吲哚青绿血管造影（ICGA）和光相干断层扫描（OCT）检查。logMARBCVA1．6～0．1。局限性神经上皮脱离者28只眼；合并色素上皮脱离（PED）者4只眼。中心视网膜厚度184～465μm，平均视网膜厚度318．6μm。患者知情并答署同意书后行半剂量维替泊芬PDT治疗。治疗后每3个月复查，观察患眼BCVA、视网膜下液吸收情况及视网膜厚度变化。结果末次随访时，OCT检查显示，局限性神经上皮脱离者28只眼中，视网膜下液吸收、视网膜完全平伏者25只眼，占89．3％；视网膜下液部分吸收、视网膜未完全平伏者3只眼，占10．7％。合并PED的4只眼中，视网膜下液吸收、视网膜完全平伏者2只眼，占50．0％；视网膜下液部分吸收、视网膜未完全平伏者2只眼，占50．0％。视网膜完全平伏的27只眼，治疗前平均视网膜厚度为（321．4±88．2）μm，治疗后为（150．4±22．3）μm。治疗前后平均视网膜厚度比较，差异有统计学意义（t=9．09，P〈0．05）；治疗前平均logMARBCVA为0．68±0．09，治疗后平均logMARBCVA为0．44±0．07，其中logMARBCVA低于0．32者12只眼。治疗前后BCVA比较，差异有统计学意义（t=2．65，P〈0．05）。相关性分析结果显示，视网膜完全平伏者治疗后BCVA与视网膜厚度呈显著正相关（r=0．96，P〈0．01）。末次随访时，视网膜完全平伏者未见病变复发，亦未见与治疗相关的并发症。结论半剂量维替泊芬PDT治疗慢性CSC安全有效，特�Objective To observe the clinical effect of half-dose photodynamic therapy （PDT） for chronic central serous ehorioretinopathy. Methods Thirty-two eyes of 27 patients （22 males and 5 females） with chronic central serous chorioretinopathy, diagnosed by best corrected visual acuity （BCVA） of logMAR, direct ophthalmoscope, fundus fluorescein angiography （FFA）, indocyanine green angiography （ICGA） and optical coherence tomography, were enrolled. The age was ranged from 31 to 63 years old, with a mean of 45 years. The course of the disease was ranged from 6 to 32 months, with a mean of 16.2 months. The logMAR BCVA was 1.6 - 0.1. The serous neuroepithelium detachment was found in 28 eyes, and serous neuroepithelium detachment combined with retinal pigment epithelium detachment （PED） was found in 4 eyes. The central retinal thickness was ranged from 184 to 465 μm, with a mean of 318.6 μm. All of the patients were treated with half dose PDT according to the methods in literatures. The above examinations were performed every 3 months after the treatment to observe the BCVA, subretinal fluid and retinal thickness. Results OCT showed that subretinal fluid were absorbed completely and retina remained attached in 25 of 28 eyes （89.3%） and 2 of 4 eyes （50.0%） with PED, while subretinaI fluid were absorbed partly and retina attached incompletely in 3 of 28 eyes （10.7%） and 2 of 4 eyes （50.0%） with PED at the last visit. Twenty-seven eyes with retina remained attached, the mean central retinal thickness （CRT） decreased from （321.4±88.2） to （150.4±22.3） μm （t=9.09, P〈0.05）; the mean logMAR BCVA improved from 0.68±0.09 to 0. 44±0.07 （t=2.65, P〈0.05）. Among those, logMAR BCVA within0.32 were found in 12 eyes. There was a significant positive association between the CRT and BCVA （r=0.96, P〈0.01）. No recurrence or side effect was observed at the last visit. Conclusion ttalf dose PDT is a safe and effective approach for chronic central serous chorioretinopathy

关 键 词：视网膜疾病/治疗 脉络膜疾病/治疗 光化学疗法 

分 类 号：R774.1[医药卫生—眼科]