CCSC临床特征和PDT治疗疗效观察

Clinical features and PDT effect of patients with CCSC

目的:观察慢性中心性浆液性脉络膜视网膜病变(chronic central serous chorioretinopathy,CCSC)临床特征和应用光动力疗法(photodynamic therapy,PDT)治疗的疗效和安全性。方法:采用PDT方法治疗确诊为CCSC患者11例15眼。回顾性分析其临床资料,并对比分析PDT治疗前后患者最佳矫正视力(best-corrected visual acuity,BCVA)、眼底荧光素血管造影(fundus fluorescein angiography,FFA)、吲哚青绿血管造影(indocyanine green angiography,ICGA)、光学相干断层扫描(optic coherence tomography,OCT)、眼底自发荧光(fundus autofluorescence,FAF)的资料,观察CCSC的临床表现特点和PDT治疗CCSC的疗效和并发症。治疗后随访时间平均10.3±4.71mo。结果:所选11例患者平均年龄46.72±8.10岁。PDT治疗前,CCSC病程平均21.1±16.65mo,BCVA(log MAR)平均0.50±0.22。FFA活动性渗漏点的面积平均1.27±1.45mm2,5眼渗漏点位于或临近黄斑中心凹无血管区,8眼有广泛视网膜色素上皮(retinal pigment epithelium,RPE)功能失代偿,呈弥漫性窗样缺损和多灶性渗漏。ICGA可见活动性渗漏点附近脉络膜血管扩张,通透性增加。OCT检查15眼有浆液性神经上皮脱离,7眼合并浆液性色素上皮层脱离,中心凹厚度平均297.27±107.23μm。FAF可见神经上皮脱离区和RPE失代偿区域有自发荧光异常变化。PDT治疗后末次随访时,BCVA(log MAR)平均0.73±0.30,比治疗前提高(P<0.05)。FFA渗漏点面积平均0.05±0.12mm2,比治疗前明显减少(P<0.05)。OCT黄斑中央凹厚度平均173.733±38.944μm,比治疗前明显下降(P<0.05)。视网膜下液吸收时间平均4.60±3.906mo。治疗中和观察期间没有严重不良事件发生。结论:CCSC具有发病年龄较大、病程长的特点。因为黄斑区视网膜持续脱离合并广泛RPE功能失代偿和光感受器不可逆性损伤,患者多有明显视力损伤。PDT通过改变病变区脉络膜血管高灌注和高通透性,促进RPE结构和功能的恢复,可以促进视网膜下液吸收,有效提高患者视力,是一种治疗CCSC有效、安全的方法。

· AIM： To review the clinical features and photodynamic therapeutic effect of patients with chronic central serouschorioretinopathy（CCSC）. · METHODS： Fifteen eyes of eleven patients diagnosed as CCSC were treated with photodynamic therapy （ PDT ）, whose clinical data were retrospectively reviewed. The best-corrected visual acuity （BCVA）, fundus fluorescein angiography （FFA）, indocyanine green angiography （ ICGA）, optic coherence tomography （OCT） and fundus autofluorescence （FAF） before and after PDT were compared to evaluate therapeutic efficiency and safety of PDT on CCSC. The mean followup time was 10 months. · RESULTS： Mean age of the patients was 46.72±8.10 years. Mean duration of CCSC before PDT was 21. 1 ± 16.65 months. The mean log MAR BCVA at baseline was 0.50 ± 0. 22. The area of activefluorescein leakage was 1.27±1.45mm^2. Five eyes had leakage points within or near the foveal area, and 8 eyes had diffuse retinal pigment epithelium（RPE） decompensation with multiple window defect and multifocal leakage. ICGA revealed dilated choroid- capillaries and choroid hyperpermeability near the active leakage sites. Serous detachments of neurosensory retina were observed in 15 eyes on OCT, of which 7 eyes associated with RPE detachments. The mean foveal thickness was 297.27±107.23μm. Abnormal FAF alterations were detected in the area of retinal detachments and decompensation of RPE. After PDT treatment, the mean log MAR BCVA was 0.73±0.30 with significant improvement compared with before treatment （P〈0.05）. The mean area of fluorescein leakage was 0.05±0.12 mm^2 with statistically significant less compared with before PDT （P〈0.05）. The central foveal thickness decreased from 297. 267±107. 228μm to 173. 733±38. 944μm （P〈0.05）. The average time for absorption of subretinal fluid was 4.60±3. 906 months. No serious adverse events were observed in treatment process and during the follow-up period. · CONCLUSION： Clinical features of CCSC include older age at onset and longer duration. Persistent serous retinal detachment of macular and diffuse decompensation of RPE may lead to permanent photoreceptor damage, consequently resulting in severe and irreversible visual loss. PDT with verteporfin could influence choroid vascular hyper-perfusion or hyper-permeability and help RPE to recover its normal structure and function, and thus facilitate the absorption of subretinal fluid and increased mean BCVA in eyes with CCSC, which provided an effective and safe treatment option for patients with CCSC.