中心性浆液性脉络膜视网膜病变治疗前后脉络膜厚度的短期观察

OCT-EDI characteristics of choroidal thickness shortly after treatment for acute central serous chorioretinopathy in patients

目的利用频域OCT的EDI（Enhanced depth imaging）技术观测急性中心性浆液性脉络膜视网膜病变（csc）患者经光动力治疗（PDT）或视网膜激光光凝治疗（LP）后脉络膜厚度的短期变化。方法回顾性病例对照研究。经最佳矫正视力（BCVA）、裂隙灯显微镜、前置镜、眼底照相，荧光素钠眼底血管造影（FFA）以及吲哚青绿血管造影（ICGA）等检查确诊为急性CSC的39例患者39眼纳入本研究。以FFA造影为标准，对于渗漏点位于黄斑中心凹无血管区（FAZ）内的患眼，行ICGA造影引导下的半剂量维速达尔PDT治疗；渗漏点位于FAZ外的患眼行LP治疗。在OCT-EDI模式下，取通过黄斑中心凹的水平、垂直两条单线扫描为测量线。以黄斑中心凹为圆心，1500μm为半径设定中心凹、下、上、鼻、颞共5个测量点。测量脉络膜厚度。治疗前后脉络膜厚度变化采用重复测量方差分析。结果经PDT治疗后，5处测量点的脉络膜厚度均较基线显著下降，差异有统计学意义；经LP治疗后，仅中心凹上、颞侧2处测量点脉络膜厚度较基线的下降具有统计学意义。结论PDT治疗作用于脉络膜血管，降低脉络膜高渗性，使黄斑区脉络膜厚度显著下降；LP治疗的作用靶点是RPE的渗漏点，脉络膜厚度仅在局部下降。

Objective To retrospectively evaluate choroidal thickness after treatment by photodynamic therapy （PDT） or laser photocoagulation （LP） in eyes with acute central serous chorioretinopathy （CSC） using enhanced depth imaging spectral-domain optical coherence tomography （EDI-OCT）. Methods In this retrospective study, 39 eyes of 39 patients with idiopathic acute CSC were recruited, after the following comprehensive ocular examinations were performed： best-corrected visual acuity （BCVA）, slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus photography, fluorescein angiography （FFA）, and indocyanine green angiography （ICGA）. Patients were divided into 2 types based on FFA characteristics： points of leakage in the foveal avascular zone （FAZ） and points of leakage out from the FAZ. The first type, which is not amenable to LP, was treated with a half-dose of verteporfin PDT guided by ICGA, whereas the other type was treated with LP. Subfoveal ehoroidal thickness and choroidal thickness at 1500 p.m temporal, nasal, superior, and inferior to the fovea were measured. The choroidal thickness was measured with enhanced depth imaging OCT before treatment at baseline, and 1 and 3 months after treatment. The results of the choroidal thickness measurements were analyzed using a repeated measurement ANOVA. Results In the PDT group, choroidal thickness at all evaluating points had decreased significantly within 3 months compared to baseline. Whereas in the LP group, choroidal thickness had decreased significantly within 3 months only at 1500 txm superior and temporal to the fovea compared to baseline. Conclusion PDT reduces choroidal vascular hyperpermeability by remodeling the choroidal vascular system resulting in the reduction of ehoroidal thickness in the maeular region and may work by a different mechanism than LP, which targets RPE.