光动力疗法治疗中心性渗出性脉络膜视网膜病变疗效观察

Therapeutic effect of photodynamic therapy on central exudative chorioretinopathy

目的观察光动力疗法（PDT）治疗中心性渗出性脉络膜视网膜病变（CEC）的临床疗效及安全性。方法回顾28例经眼底检查、荧光素眼底血管造影（FFA）及光相干断层扫描（OCT）确诊的CEC患者28只息眼PDT治疗前后的临床资料，对比分析治疗前后的视力、眼底像、FFA及OCT检查结果，统计重复治疗的次数，观察治疗的安全性。28例患者平均年龄31．5岁，就诊时最佳矫正视力0．02～0．8。28只眼共治疗38次，其中，22只眼治疗1次，3只眼治疗2次，2只眼治疗3次，1只眼治疗4次。PDT治疗后平均随访时间26个月。结果PDT治疗后末次随访时，视力提高≥2行的视力明显改善者21只眼，占75．00％；视力波动在1行以内的视力稳定者5只眼，占17．86％；视力下降≥2行的视力下降者2只眼，占7．14％。FFA检查显示：21只眼CNV完全闭合，占75．00％；3只眼CNV部分闭合，占10．71％；4只眼CNV未闭合或CNV扩大，占14．29％。有6只眼出现视网膜色素上皮损害，占21．43％。结论PDT治疗CEC对于大多数患者是安全有效的，对于小病变，可以适当减小光斑治疗；对于一次治疗效果不佳的患者，重复治疗应考虑其病因。

Objective To investigate the therapeutic effect of photodynamic therapy （PDT） on central exudative chorioretinopathy （CEC）. Methods Clinical data of 28 patients who had undergone PDT because of the choroidal neovascularisation （CNV） caused by CEC, which had been diagnosed by examination of ocular fundus, fluorescein angiography （FFA）, and optic coherence tomography （OCT） treated with PDT who diagnosed through fluorescein angiography （FFA）, were retrospectively analyzed. The changes of the best corrected visual acuity （BCVA）,ocular fundus characteristics, and the results of FFA and OCT before and after PDT were observed and analyzed. Emphasize＇the numeration of the times of the re-treatment and the observation of the safety of the PDT. Results At the end of the follow-up period after PDT, The BCVA improved obviously （≥2 lines） in 21 eyes （75. 00%）, kept stable （changed within 1 line） in 5 eyes （17. 86%）, and decreased （≥2 lines） in 2 eyes （7.14%）. The result of FFA showed completely closed CNV in 21 eyes （75.00%）, partly closed CNV in 3 eyes （10.71%）, unclosed or enlarged CNV in 4 eyes （14.29%）. The frequency of PDT was 38 times in 28 eyes, including once in 22, twice in 3, thrice in 2, and 4 times in 1. There were 6 eyes had damage of retinal pigment epithelium （RPE） （21.30%）. Conclusions PDT is a safe and effective treatment for most patients with CNV caused by CEC. The laser spots should be properly reduced to avoid the RPE damage treating the small lesions. For those patients whose the curative effect is not good, the pathogenic factors should be considered.