特发性脉络膜新生血管光动力疗法治疗后黄斑中心视网膜和脉络膜形态及厚度变化

Analysis of central retinal and choroidal morphology and thickness after photodynamic therapy for idiopathic choroidal neovascularization

目的观察特发性脉络膜新生血管（ICNV）光动力疗法（PDT）治疗后黄斑中心视网膜和脉络膜形态及厚度变化。方法临床确诊为ICNV并经PDT治疗的16例患者16只眼（ICNV组）以及正常健康者16名16只眼（对照组）纳入研究。所有患者均行常规PDT治疗。治疗前及治疗后1、3、6个月检查两组受检者最佳矫正视力（BcVA）；采用光相干断层扫描深层成像技术（EDI—OCT），观察黄斑中心凹处视网膜及脉络膜形态，并测量黄斑中心凹处视网膜厚度（CRT）及脉络膜厚度（CCT）。采用Pearson法分析BCVA与CRT、CCT的相关性。结果治疗后1、3、6个月，ICNV组平均BCVA较治疗前有不同程度提高，差异有统计学意义（F=3．08，P=0．030）。治疗后1个月，ICNV组CNV对应部位有不同程度视网膜水肿；治疗后3个月，视网膜水肿消退，CNV纤维化形成瘢痕13只眼；治疗后6个月，cNV完全瘢痕化。治疗后1、3、6个月，ICNV组CNV对应部位脉络膜层光反射信号减弱。其CRT较治疗前有不同程度降低，差异有统计学意义（F=8．946，P=0．000）。ICNV组CRT与对照组比较，治疗后1个月与之差异有统计学意义（P=0．001）；治疗后3、6个月与之差异均无统计学意义（P=0．128，0．083）。治疗后1、3、6个月，ICNV组CCT与治疗前比较，差异无统计学意义（F=1．674，P=0．170）；与对照组比较，差异也无统计学意义（P=0．186，0．551，0．498）。相关性分析结果显示，BCVA与CRT、CCT均呈轻度负相关，但相关性无统计学意义（r=-0．051，-0．164；P=0.739，0．283）。结论PDT治疗ICNV后BCVA提高，视网膜水肿消退；CRT明显下降，CCT无明显变化。

Objective To observe the retinal and choroidal changes in morphology and thickness after photodynamic therapy（PDT） for idiopathic ehoroidal neovascularization（ICNV）. Methods Sixteen eyes of 16 patients with ICNV were treated with verteporfin PDT. 16 eyes of 16 age-matched normal subjects were observed for the purpose of comparison. The best corrected visual acuity（BCVA） was checked before and 1, 3 and 6 months after PDT treatment. Enhanced depth imaging optical coherence tomography （EDI-OCT） technique was used to measure central retinal thickness （CRT） and central choroidal thickness（CCT）. The correlations between BCVA and CRT, CCT were analyzed by Pearson statistical anaIlyses. Results BCVA was improved at I, 3 and 6 months after PDT, and the difference had statistical significance compared with that before treatment （F=3.08, P=0. 030）. There was edema in the retina at 1 month after PDT. CNV in 13 eyes became fibrotic at 3 months after PDT, and all became fibrotic at 6 months after PDT. The reflex of choroid correspond to CNV was weak at 1, 3 and 6 months after PDT. CRT decreased at 1, 3 and 6 months after PDT （F=8. 946, P=0. 000）. The difference was statistically significant between the CRT of control group and that 1 months after PDT （P=0. 001）, but there was no statistically significant difference between the CRT of control group and that 3 and 6 months after PDT（P=0. 128, 0. 083）. The CCT group had no statistically significant difference before and 1, 3 and 6 months after PDT （F= 1. 674, P= 0. 170）. The CCT group also had no statistically significant differences between the control group and 1, 3 and 6 months after PDT （P=0. 186, 0. 551, 0.98）. The BCVA was inversely correlated with CRT and CCT, and the correlation had no statistical significance （r=-0. 051,-0. 164;P=0. 739,0. 283）. Conclusions PDT may improve BCVA in ICNV. Retinal edema resolves, CRT decreases, but CCT had almost no changes after PDT.