半剂量维替泊芬和半能量PDT治疗慢性中心性浆液性脉络膜视网膜病变

Half-dose verteporfin and half laser power PDT for chronic central serous chorioretinopathy

目的探讨使用半剂量维替泊芬和半能量激光的光动力学疗法(photodynamic therapy,PDT)治疗慢性中心性浆液性脉络膜视网膜病变(chronic central serous chorioretinopathy,CCSC)的疗效和安全性。方法分析2011年8月至2013年8月期间在我科就诊的CCSC患者25例(33眼),所有患者接受静脉注射剂量为3 mg·m-2体表面积的维替泊芬和能量为25 J·cm-2的PDT治疗,治疗后1个月、3个月、6个月和12个月复查,重复进行BCVA、裂隙灯、间接眼底镜和OCT检查,治疗后6个月复查眼底荧光血管造影检查。结果末次随访时视力改善者31眼、稳定者2眼,最佳矫正视力(0.15±0.09)LogM AR,与治疗前的(0.50±0.18)LogM AR相比差异有统计学意义(t=10.334,P<0.001);OCT检查示,显效率在治疗后1个月、3个月、6个月和末次随访时分别为48.5%、84.8%、93.9%和100.0%。CCSC眼治疗后1个月黄斑中心凹下脉络膜厚度为(391.53±101.18)μm,与治疗前的(483.21±89.13)μm相比明显降低(t=-3.902,P<0.001),黄斑中心凹下平均脉络膜厚度随时间推移不断下降。治疗后6个月FFA结果显示33眼渗漏病灶均完全消失。未观察到复发、视网膜色素上皮萎缩、脉络膜新生血管形成等并发症发生。结论使用半剂量维替泊芬和半能量PDT治疗对于单纯黄斑区神经上皮脱离的CCSC是有效和安全的。

Objective To explore the effectiveness and safety of half-dose verteporfin and half laser power photodynamic therapy（ PDT） in treating chronic central serous chorioretinopathy（ CCSC）. Methods Twenty-five cases（ 33 eyes） with CCSC treated in our department from August 2011 to August 2013 were analyzed. All the cases received PDT treatment with half-dose verteporfin and half laser power（ 25 J · cm- 2） PDT. Patients were followed up at 1 month,3months,6 months and 12 months. The visual acuity,best corrected visual acuity（ BCVA）,slit lamp,indirect ophthalmoscope and OCT scan were examined in every follow-up. FFA was performed at 6 months after PDT treatment. Results At last visit,BCVA was improved in 31 eyes and stabled in 2 eyes. The average BCVA was（ 0. 15 ± 0. 09） LogM AR,which was significant better than that before PDT[（ 0. 50 ± 0. 18） LogM AR]（ t = 10. 334,P 〈0. 001）; OCT scan showed that the effectiveness rate were 48. 5%,84. 8%,93. 9% and 100. 0% at 1 month,3 months,6months and last visit,respectively. Subfoveal mean choroidal thickness（ SFMCT） in CCSC eyes at 1 month after PDT[（ 391. 53 ± 101. 18） μm] was significantly thinner than that before PDT[（ 483. 21 ± 89. 13） μm]（ t =- 3. 902,P〈 0. 001）. SFMCT reduced gradually as the time prolonged. FFA at 6 months after treatment detected that the leakage lesion disappeared in all cases.There was no recurrence,retinal pigment epithelium atrophy and CNV. Conclusion Half-dose verteporfin and half laser power PDT treatment is effective and safe for CCSC with macular neuroepithelium detachment.