非损伤阈值下微脉冲激光治疗慢性中心性浆液性脉络膜视网膜病变  

Non-invasive subthreshold micropulse laser in the treatment of chronic central serous chorioretinopathy

作　　者：邱新文[1] 周爱云 邱丘 任旋[1] 兰丽霞[1] 宋志杰 叶波[1] QIU Xinwen;ZHOU Aiyun;QIU Qiu;REN Xuan;LAN Lixia;SONG Zhijie;YE Bo(Department of Fundus Diseases,Nanchang Aier Eye Hospital,Nanchang 330002,Jiangxi Province,China)

机构地区：[1]南昌爱尔眼科医院眼底病科,江西省南昌市330002

出　　处：《眼科新进展》2020年第11期1049-1054,共6页Recent Advances in Ophthalmology

基　　金：江西省卫生健康委科技计划项目(编号20202029)。

摘　　要：目的探讨非损伤阈值下微脉冲激光(subthreshold micropulse laser,SML)治疗慢性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSCR)的疗效与安全性。方法前瞻性非随机病例对照研究。慢性CSCR患者60例(60眼),分为3组非治疗观察(non-therapeutic observation,NTO)组、光动力疗法(photodynamic therapy,PDT)组、SML组,每组20例(20眼)。通过光学相干断层扫描血管成像、自发荧光、黄斑完整评估仪等获取研究前后患眼的最佳矫正视力(best corrected visual acuity,BCVA)、视网膜敏感度(retinal sensitivity,RS)、视网膜下液(subretinal fluid,SRF)高度及消失时间、中心黄斑厚度(central macular thickness,CMT)、黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)、脉络膜毛细血管血流面积(choriocapillaris flow area,CFA)等数据以及评估椭圆体带、视网膜色素上皮(retinal pigment epithelium,RPE)等损伤。结果NTO组仅4眼SRF消失,消失时间为(2.98±0.34)个月;PDT组患眼经(1.25±0.44)次PDT治疗后SRF均消失,消失时间为(1.87±1.32)个月;SML组患眼经(2.70±1.63)次治疗后SRF均消失,消失时间为(3.50±2.06)个月,PDT组与SML组治疗次数及SRF消失时间相比差异均有统计学意义(均为P<0.05)。末次随访时,NTO组BCVA、RS稍改善,CMT、SCFT及CFA均较入组时下降,但末次随访时NTO组上述指标与PDT组、SML组比较差异均有统计学意义(均为P<0.05);PDT组、SML组BCVA、RS及CFA均较治疗前明显改善,CMT与SCFT均较治疗前下降,两治疗组间各指标比较差异均无统计学意义(均为P>0.05)。NTO组持续存在椭圆体带损伤,PDT组、SML组椭圆体带形态均改善,自发荧光均未见明显变化,均未见脉络膜新生血管,SML组未见滴定激光斑点。结论慢性CSCR积极治疗可以避免黄斑结构与功能进一步损伤;SML治疗与PDT治疗结果类似,均能有效改善慢性CSCR患眼视功能与恢复视网膜形态结构,但SML治疗次数相对较多、�Objective To evaluate the efficacy and safety of noninvasive subthreshold micropulse laser(SML)in the treatment of chronic central serous chorioretinopathy(CSCR).Methods A prospective non-randomized case-control study was carried on 60 patients(60 eyes)with chronic CSCR were divided into three groups non-therapeutic observation(NTO)group,photodynamic therapy(PDT)group and SML group with 20 cases in each group.Several data including best corrected visual acuity(BCVA),retinal sensitivity(RS),subretinal fluid(SRF)height and absorption time,central macular retinal thickness(CMT),subfoveal choroidal thickness(SFCT)and choriocapillaris flow area(CFA)were obtained before and after the study by optical coherence tomography angiography,autofluorescence and macular analyzer integrity assessment and evaluate the damage of ellipsoid zone(EZ)and retinal pigment epithelium(RPE).Results Only 4 patients in the NTO group had SRF disappeared for(2.98±0.34)months,and all patients in the PDT group had SRF disappeared for(1.87±1.32)months after(1.25±0.44)times of PDT treatment.After treatment for(2.70±1.63)times,SRF disappeared for(3.50±2.06)months in the SML group.There were statistically significant differences in the number of treatments and the disappearance time of SRF between the PDT group and the SML group(both P<0.05).At the last follow-up,BCVA and RS were slightly improved,CMT,SCFT and CFA were not significantly decreased in NTO group compared with those before treatment,and there were significant differences between NTO group and PDT group and SML group(all P<0.05).BCVA,RS and CFA were significantly increased in PDT group and SML group,while CMT and SCFT were significantly decreased,and there were no statistically significant differences in the indicators between the two treatment groups(all P>0.05).EZ injury was persistent in NTO group.In PDT group and SML group,EZ morphology improved and recovered,AF showed no obvious change,and no choroidal neovascularization was observed.No RPE laser damage spots were found in SML

关 键 词：中心性浆液性脉络膜视网膜病变 阈值下微脉冲激光 光动力疗法 光学相干断层扫描血管成像 自发荧光 

分 类 号：R774.5[医药卫生—眼科]