两种模式微脉冲激光治疗急性中心性浆液性脉络膜视网膜病变的疗效比较  

Comparison of Two Modes of Micropulse Laser in Treatment of Acute Central Serous Chorioretinopathy

作　　者：钟雯[1] 喻晓兵[2] 戴虹[2] ZHONG Wen;YU Xiaobing;DAI Hong(Department of Ophthalmology,the Sixth Hospital of Beijing,Beijing 100730,China;Department of Ophthalmology,National Clinical Research Center for Geriatric Diseases,Beijing Hospital)

机构地区：[1]北京市第六医院眼科,北京市100730 [2]北京医院眼科·国家老年医学中心·中国医学科学院老年医学研究院

出　　处：《中国激光医学杂志》2021年第6期306-311,357,共7页Chinese Journal of Laser Medicine & Surgery

基　　金：首都临床特色应用研究项目(Z181100001718079)。

摘　　要：目的比较两种模式下的微脉冲激光光凝治疗急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的临床疗效和安全性。方法回顾性分析2018年7月至2020年1月,临床确诊的急性CSC患者57例64只眼,分为两组,A组患者28例32只眼进行阈值功率滴定后行微脉冲激光光凝,治疗功率为滴定功率的4倍,光凝范围为黄斑病变区域;B组患者29例32只眼进行固定功率全黄斑覆盖微脉冲激光光凝,治疗功率400 m W,光凝范围为上下血管弓内的整个黄斑区域。比较两组治疗前、治疗后1、3和6个月的最佳矫正视力(best corrected visual acuity,BCVA),黄斑中心区厚度(central macular thickness,CMT)、黄斑区视网膜容积(macular retinal volume,MRV)及视网膜下液(subretinal fluid,SRF)的变化。结果两组治疗后BCVA较治疗前均有提高(P<0.05);CMT、1 mm和6 mm直径的MRV及SRF均较治疗前降低(P<0.05)。治疗前、治疗后1、3和6个月,两组间BCVA、CMT、MRV及SRF差异均无统计学意义(P>0.05)。在末次随访中,A组3例(占9.38%)转为慢性CSC,B组有2例(占6.25%)转为慢性CSC;A组滴定的光斑可见视网膜损伤,B组未发现视网膜损伤。结论两种模式微脉冲激光光凝治疗急性CSC均有效,可提高患者视力,吸收视网膜下液。固定功率全黄斑覆盖微脉冲激光治疗模式相对更安全、更简便。Objective To compare the clinical efficacy and safety of two modes of micropulse laser photocoagulation in treating acute central serous chorioretinopathy(CSC).Methods A retrospective study was made.Totally 57 cases(64 eyes)of acute CSC diagnosed clinically were included in this study.The patients were divided into two groups.28 patients(32 eyes)in Group A were treated with titration parameters micropulse laser photocoagulation in the lesion areas,and 29 patients(32 eyes)in Group B with fixed parameters full macular coverage micropulse laser photocoagulation.For Group A,the set power was 4 times of the titration power,and the photocoagulation range covered the whole macular lesion area.For Group B,the power was set at 400 mW and the range of photocoagulation covered the whole macular area in the upper and lower vascular arch.The changes of the best corrected visual acuity(BCVA),macular central macular thickness(CMT),macular retinal volume(MRV)and subretinal fluid(SRF)were observed and compared between the two groups before treatment and 1,3 and 6 months after the treatment respectively.Results For both groups,the BCVA was improved,CMT,1 mm and 6 mm diameter MRV and SRF decreased(P<0.05)after the treatment.There was no significant difference in BCVA,CMT,MRV and SRF between the two groups before the treatment and 1,3 and 6 months after the treatment.It was found in the last follow-up that 3 cases(9.38%)in Group A and 2 cases(6.25%)in Group B turned to chronic CSC.The light spots titrated in Group A showed retinal damage,and no retinal damage was found in group B.Conclusions Both modes of micropulse laser photocoagulation are effective in treating acute CSC,which will improve the visual acuity and absorb subretinal fluid.The fixed parameter full macular coverage micropulse laser treatment is relatively safer and more convenient.

关 键 词：微脉冲激光 急性中心性浆液性脉络膜视网膜病变 滴定功率 固定参数 全黄斑覆盖 

分 类 号：R616.4[医药卫生—外科学] R773.4[医药卫生—临床医学]