半剂量光动力疗法治疗后慢性中心性浆液性脉络膜视网膜病变患者脉络膜厚度变化分析

Choroidal thickness after half-dose verteporfin photodynamic therapy in chronic central serous chorioretinopathy

目的观察慢性中心性浆液性脉络膜视网膜病变（CSC）患者半剂量维替泊芬光动力疗法（PDT）治疗前、后的脉络膜厚度变化特点。方法系列病例研究。2010年10月至2011年10月在中山大学中山眼科中心就诊的30例（35只眼）CSC患者入选本研究。所有患者均接受荧光素眼底血管造影（FFA）检查、吲哚氰绿血管造影检查（ICGA）及相干光断层扫描（OCT），被确诊为慢性CSC。所有患者接受PDT治疗，并于治疗前及治疗后1、3、6个月采用频域OCT加强深度成像测定黄斑中心凹下脉络膜厚度（SFCT）及距黄斑中心凹1．5mm处上、下、鼻、颞四方位脉络膜厚度。治疗前、后各时间点脉络膜厚度的比较采用单因素重复测量方差分析，进一步两两比较采用LSD．t检验。结果30例（35只眼）慢性CSC患者中，男性26例，女性4例，男女比例为6．5：1；年龄33～66岁。所有患眼治疗前平均SFCT值为（435．54±102．91）μm，PDT治疗后1、3、6个月SFCT分别为（373．63±106．01）、（360．69±111．06）、（369．00±108．12）μm，均较治疗前明显降低（F=108．34，P〈0．01）；6个月时后极部脉络膜厚度均值较3个月时有所增加，但差异无统计学意义（LSD—t检验：P〉0．05）。其他4个测量点脉络膜厚度变化趋势与SFCT一致。结论慢性CSC患者半剂量维替泊芬PDT治疗后6个月内后极部脉络膜厚度较治疗前降低。

[Abstract] Objective To observe the choroidal thickness in eyes with chronic central serous chorioretinopathy（CSC） after half-dose photodynamic therapy （PDT）. Methods Case series study. Consecutive 30 patients （35 eyes） with chronic CSC admitted from October 2010 to October 2011 in Zbongshan Ophthalmic Center were recruited in this study. Optical coherence tomography （OCT） , fundus fluorescein angiography, indoeyanine green angiography （ICGA） were performed in each patient to confirm the diagnosis. ICGA-guided PDT was performed in each patient. Choroidal thickness at subfoveal and 1500 ~m superior,inferior, nasal and temporal to the fovea were measured before PDT, 1,3 and 6 months after PDT using enhanced depth imaging OCT. Data were analyzed with one-way repeated measures ANOVA and LSD-t test when pairwise comparison was needed. Results Thirty patients, aged from 33 to 66 years old, including 26 males and 4 females （ gender ratio 6. 5 ： 1 ） were recruited. Subfoveal choroidal thickness （SFCT） in chronic CSC eyes was （435.54± 102.91 ）μm at baseline, which decreased significantly to （ 373.63 ± 106.01 ） μm, （ 360.69 ± 111.06 ） μm and （ 369.00 ± 108.12 ） μm at 1 month, 3 months and 6 months after PDT respectively （F = 108.34 ,P 〈 0. 01 ）. At 6 months after PDT, SFCT was slightly thicker than that at the 3rd month, but no statistical significance was noted（ LSD-t test： P 〉 0. 05）. The changing trends of choroidal thickness at the other 4 measuring points were similar to that of the SFCT. Conclusion Choroidal thickness is reduced within 6 months post-PDT in chronic CSC eyes.