577nm阈值下微脉冲激光治疗中心性浆液性脉络膜视网膜病变的效果与黄斑结构变化的临床观察  

Clinical Observation on the Effect and Macular Structure Changes of Central Serous Chorioretinopathy Treated with Subthreshold Micropulse Laser at 577nm

作　　者：郑建龙[1] 林洪杰[1] 张安琳[1] 陈适蓉 刘昕宇[1] ZHENG Jianlong;LIN Hongjie;ZHANG Anlin;CHEN Shirong;LIU Xinyu(Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong,Shantou 515041,China)

机构地区：[1]汕头大学·香港中文大学联合汕头国际眼科中心,广东汕头515041

出　　处：《中国医学创新》2021年第14期163-167,共5页Medical Innovation of China

基　　金：广东省医学科学技术研究基金(A2016567)。

摘　　要：目的:探讨577 nm阈值下微脉冲激光(SML)治疗中心性浆液性脉络膜视网膜病变(CSC)的效果与黄斑结构变化。方法:回顾性分析2017年5月-2020年5月在本院确诊的80例CSC患者。按照治疗方案的不同将患者分为微脉冲激光治疗组(观察组,n=40)和传统黄色激光治疗组(对照组,n=40)。观察组采用577 nm SML治疗,对照组采用传统黄色激光治疗。治疗前后采用统一主观视觉质量问卷评价两组患眼视物变暗情况,观察最佳矫正视力(BCVA),SD-OCT检测黄斑中心凹结构参数:视网膜厚度(CRT)、上皮层厚度(CNT)、外核层厚度(ONT)、脉络膜厚度(SFCT)、椭圆体带(EZ)、嵌合体带(IZ);相关性分析视力情况与黄斑区结构变化关系。结果:治疗后,两组急性期患者视物变暗均消失,慢性期患者视物变暗有所改善,两组间比较,差异均无统计学意义(P>0.05)。治疗后,两组BCVA较治疗前均有显著改善,差异均有统计学意义(P<0.05)。治疗后,两组CRT、SFCT较治疗前均有改善,差异均有统计学意义(P<0.05)。治疗后,观察组急性期和慢性期的CRT均显著低于对照组,差异均有统计学意义(P<0.05)。治疗后,观察组急性期和慢性期EZ与IZ与治疗前结构变化比较,差异均有统计学意义(P<0.05)。对照组急性期治疗后EZ和IZ与治疗前比较,差异均有统计学意义(P<0.05);对照组慢性期治疗后IZ与治疗前比较,差异有统计学意义(P<0.05)。Pearson相关性分析显示BCVA(logMAR)与CRT、SFCT参数均呈正相关(P<0.05)。Spearman相关性分析显示,BCVA(logMAR)与EZ、IZ完整程度均呈负相关(P<0.05)。结论:对于急性期CSC患者,577 nm SML与传统黄色激光均使患眼视物变暗消失,而对慢性期CSC患者视物变暗有所改善,577 nm SML可快速改善BCVA,改善黄斑区结构和视觉症状,疗效显著且安全。Objective:To investigate the clinical efficacy and macular structure changes of central serous chorioretinopathy(CSC)treated with subthreshold micropulse laser(SML)at 577 nm.Method:Retrospective analysis was performed on 80 patients with CSC who were diagnosed in our hospital from May 2017 to May 2020.Patients were divided into two groups according to different treatment regimen:micropulsed laser treatment group(observation group,n=40)and traditional yellow laser treatment group(control group,n=40).The observation group was treated with 577 nm SML,while the control group was treated with traditional yellow laser.Before and after treatment,the unified subjective visual quality questionnaire was used to evaluate the darkening situation of the two groups,and the best corrected visual acuity(BCVA)was observed.SD-OCT was used to detect the fovea structural parameters of macular area:central retinal thickness(CRT),central neuroepithelial thickness(CNT),outer nuclear thickness(ONT),subfoveal choroidal thickness(SFCT),ellipsoid zone(EZ),interdigitation zone(IZ).Correlation analysis was used to analyze the relationship between visual acuity and macular structure changes.Result:After treatment,the vision darkening disappeared in acute phase patients of both groups,while the vision darkening improved in chronic phase patients,there were no statistically significant differences between the two groups(P>0.05).After treatment,BCVA in both groups were significantly improved compared with before treatment,the differences were statistically significant(P<0.05).After treatment,CRT and SFCT in both groups were improved compared with those before treatment,the differences were statistically significant(P<0.05).After treatment,the CRT of the observation group were significantly lower than those of the control group in both acute and chronic phases,the differences were statistically significant(P<0.05).After treatment,there were statistically significant differences in the structural changes of EZ and IZ in the acute and chronic stage

关 键 词：阈值下微脉冲激光 黄色激光 中心性浆液性脉络膜视网膜病变 黄斑结构 

分 类 号：R774.1[医药卫生—眼科]