微脉冲激光光凝联合中药四苓散治疗急性中心性浆液性脉络膜视网膜病变的临床观察  

Clinical observation on micropulse laser photocoagulation combined with traditional Chinese medicine Siling San in the treatment for acute central serous chorioretinopathy

作　　者：段文娟[1] 柯发勇 苏晓庆 彭绍民 Duan Wenjuan;Ke Fayong;Su Xiaoqing;Peng Shaomin(Aier Eye Group,Lanzhou Aier Eye Hospital,Lanzhou 730000,China;Aier Eye Hospital of Anhui Medical University,Hefei 230000,China)

机构地区：[1]爱尔眼科集团兰州爱尔眼科医院,兰州730000 [2]安徽医科大学附属爱尔眼科医院,合肥230000

出　　处：《中华眼外伤职业眼病杂志》2023年第9期660-667,共8页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：兰州市科技发展指导性计划项目(2020-ZD-145);爱尔眼科医院集团科研项目(AF2101D6)。

摘　　要：目的观察577 nm微脉冲激光光凝联合口服中药四苓散治疗急性中心性浆液性脉络膜视网膜病变(aCSC)的效果.方法前瞻性随机对照研究.纳入兰州爱尔眼科医院2021年1月至2022年12月收治的aCSC 91例(91只眼)作为研究对象.所有患者行荧光素眼底血管造影(FFA)荧光渗漏点在距黄斑中心区500μm以内随机分为4组:577 nm微脉冲激光光凝联合口服中药四苓散治疗组(31例),单独微脉冲激光光凝治疗组(20例),中药治疗组(20例)和空白对照组(20例).随访6个月,观察4组患者黄斑中心区厚度(CMT)、黄斑中心区下方脉络膜厚度、黄斑旁中心区下方脉络膜厚度及最佳矫正视力(BCVA,logMAR).结果治疗后2周联合治疗组CMT降低,与空白对照组比较差异有统计学意义[(333.45±85.73)μm vs(414.45±84.71)μm;t=-3.29,P=0.001],同一时间点微脉冲激光治疗组和中药组分别与空白对照组比较差异无统计学意义[(375.15±87.11)μm vs(414.45±84.71)μm,(424.80±86.06)μm vs(414.45±84.71)μm;t=-1.45,0.38;P=0.151,0.704];微脉冲激光治疗组治疗后1个月,较空白对照组CMT降低,差异有统计学意义[(353.85±103.81)μm vs(409.45±85.43)μm;t=-2.35,P=0.021],同一时间点,中药治疗组较空白对照组差异无统计学意义[(399.90±76.04)μm vs(409.45±85.43)μm;t=-0.40,P=0.688].治疗后1个月BCVA联合治疗组较空白对照组视力提高(0.33±0.12 vs 0.53±0.13;t=-5.88,P<0.001),同一时间点,微脉冲治疗组及中药组较空白对照组比较差异无统计学意义(0.47±0.11 vs 0.53±0.13,0.51±0.09 vs 0.53±0.13;t=-1.52,-0.55;P=0.132,0.581);治疗后2个月,微脉冲激光治疗组BCVA较空白对照组恢复,差异有统计学意义(0.43±0.09 vs 0.52±0.11;t=-3.03,P=0.003),同一时间点,中药组较空白对照组差异无统计学意义(0.48±0.08 vs 0.52±0.11;t=-1.35,P=0.182).结论577 nm微脉冲激光光凝联合口服中药四苓散治疗aCSC,可促进CMT及视功能尽快恢复,视网膜下浆液快速吸收.Objective To observe the efficacy of 577 nm micropulse laser photocoagulation combined with Siling San in the treatment for acute central serous chorioretinopathy(aCSC).Methods This was a prospective randomized controlled study.A total of 91 eyes of 91 patients diagnosed with aCSC from Jan.2021 to Dec.2022 in Lanzhou Aier Eye Hospital with fluorescein fundus angiography(FFA)leakage point within 500μm from macular central area were included as research subjects and randomly divided into four groups:the 577 nm micropulse combined with Siling San group(31 cases),the micropulse laser treatment group(20 cases),the traditional chinese medicine group(20 cases)and the blank control group(20 cases).Central macular foveal thickness(CMT),subfoveal choroidal thickness,subfoveal parachoroidal thickness and best corrected visual acuity(BCVA,logMAR)were observed before treatment and the follow-up time was 6 months after treatment.Results CMT of the combined treatment group decreased at 2 weeks after treatment,and the difference was statistically significant compared with that of the blank control group[(333.45±85.73)μm vs(414.45±84.71)μm,t=-3.29,P=0.001].At the same time,there was no statistically significant difference between the micropulse laser treatment group and the traditional Chinese medicine group when compared separately with the blank control group[(375.15±87.11)μm vs(414.45±84.71)μm,(424.80±86.06)μm vs(414.45±84.71)μm,t=-1.45,0.38;P=0.151,0.704].At 1 month after treatment,CMT of the micropulse laser treatment group was significantly lower than that of the blank control group[(353.85±103.81)μm vs(409.45±85.43)μm,t=-2.35,P=0.021],while at the same time,there was no statistically significant difference between the traditional Chinese medicine treatment group and the blank control group[(399.90±76.04)μm vs(409.45±85.43)μm,t=-0.40,P=0.688].At 1 month after treatment,BCVA of the combined treatment group improved compared with that of the blank control group,and the difference was statistically signifi

关 键 词：激光 中心性浆液性脉络膜视网膜病变 中药 四苓散 

分 类 号：R774.1[医药卫生—眼科]