光相干断层扫描血管成像引导半剂量光动力疗法治疗急性中心性浆液性脉络膜视网膜病变的有效性研究  

Efficacy of optical coherence tomography angiography guided half-dose photodynamic therapy in the treatment of acute central serous chorioretinopathy

作　　者：李思莹 汤稷旸 赵明威[1] 曲进锋[1] Li Siying;Tang Jiyang;Zhao Mingwei;Qu Jinfeng(Department of Ophthalmology,Peking University People's Hospital,Eye Diseases and Optometry Institute,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases,Beijing 100044,China)

机构地区：[1]北京大学人民医院眼科眼病与视光医学研究所,视网膜脉络膜疾病诊治研究北京市重点实验室,北京大学医学部眼视光学院,北京100044

出　　处：《中华眼底病杂志》2023年第4期275-281,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：国家重点研发计划(2020YFC2008200)。

摘　　要：目的观察光相干断层扫描血管成像(OCTA)引导半剂量光动力疗法(PDT)治疗急性中心性浆液性脉络膜视网膜病变(CSC)的疗效。方法前瞻性随机对照试验。2019年4月至2020年4月于北京大学人民医院眼科中心检查确诊的急性CSC患者72例72只眼纳人研究。将患眼随机分为OCTA、吲哚青绿血管造影(ICGA)组,分别为31例31只眼、33例33只眼。患眼均行最佳矫正视力(BCVA)、眼底彩色照相、OCTA、ICGA检查。采用国际标准视力表行BCVA检查,统计时换算为最小分辨角对数(logMAR)视力。OCTA组将脉络膜毛细血管层粗颗粒强反射区定为治疗区;ICGA组将与荧光素眼底血管造影渗漏点附近对应的脉络膜高灌注区定为治疗区。根据彩色眼底像中勾画的治疗区域对患眼进行半剂量PDT治疗。对比观察两组患眼治疗后1、3、6个月视网膜下液(SRF)完全吸收率、BCVA、中心凹视网膜厚度(CRT)变化情况以及治疗后3、6个月SRF复发率。两组间连续变量比较采用t检验或Wilcoxon秩和检验;分类变量比较采用χ^(2)检验。结果治疗后1、3、6个月,OCTA组、ICGA组SRF完全吸收率分别为74.2%(23/31)、63.6%(21/33),87.1%(27/31)、84.8%(28/33),96.8%(30/31)、91.9%(31/33);OCTA组治疗后不同时间SRF完全吸收率非劣效于ICGA组[95%可信区间(CI)-11.9%~33.1%,P=0.402;95%CI-14.7%~19.3%,P=0.107;95%CI-6.3%~16.1%,P=0.226]。治疗后3、6个月,两组患眼SRF复发率比较,差异无统计学意义(χ^(2)=0.009、0.047,P=0.925、0.828);治疗后6个月,CRT比较,差异有统计学意义(t=2.017,P=0.047);治疗后1、3、6个月,logMARBCVA比较,差异无统计学意义(t=0.529、0.762、1.017,P=0.581、0.403、0.243)。结论随访6个月时间内,OCTA引导下的半剂量PDT治疗急性CSC患者,其SRF完全吸收率不劣于ICGA引导下的PDT。Objective To observe the efficacy of optical coherence tomography angiography(OCTA)guided half-dose photodynamic therapy(PDT)in the treatment of acute central serous chorioretinopathy(CSC).Methods A prospective randomized controlled trial.A total of 72 patients(72 eyes)with acute CSC in Peking University People's Hospital from April 2019 to April 2020 were included in the study.They were randomly divided into OCTA group(OCTA-guided PDT,31 eyes of 31 patients)and indocyanine green angiography(ICGA)group(ICGA-guided PDT,33 eyes of 33 patients).All patients underwent best corrected visual acuity(BCVA),fundus color photography,OCTA and ICGA examinations.International standard visual acuity chart was used for BCVA examination,which was converted into logarithm of the minimum angle of resolution(logMAR)visual acuity.In OCTA group,the hyper-reflective area on en face OCTA image at choriocapillaris level was identified as treating area.In ICGA group,the area of choroidal vascular hyperpermeability on ICGA which was related to the leakage on fundus fluorescein angiography(FFA)was identified as treating area.The area corresponding to the treating area on FFA or ICGA was outlined on the color fundus photograph to guide PDT laser spot.The complete subretinal fluid(SRF)resolution,BCVA,central retinal thickness(CRT)at 1,3,6 months and SRF recurrent rate at 3,6 months were observed.Continuous variables between the two groups were compared by t-test or Wilcoxon rank sum test.The χ^(2) test was used to compare the categorical variables.Results At 1,3 and 6 months after treatment,the SRF absorption rate in OCTA group and ICGA group was 74.2%(23/31),63.6%(21/33),87.1%(27/31)and 84.8%(28/33),96.8%(30/31),91.9%(31/33),respectively.OCTA-guided PDT was demonstrated noninferior to ICGA-guided PDT for complete SRF resolution at 1,3,6 months[95%confidence interval(CD)-11.9%-33.1%,P=0.402;95%CI-14.7%-19.3%,P=0.107;95%CI-6.3%-16.1%,P=0.226].There was no significant difference in the recurrence rate of SRF between the two groups at 3 and 6

关 键 词：急性中心性浆液性脉络膜视网膜病变 光相干断层扫描血管成像 吲哚青绿血管造影 半剂量光动力疗法 

分 类 号：R774.1[医药卫生—眼科]