60％剂量维替泊芬光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变的远期效果及安全性

Clinical efficacy and safety of 60%-dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy

背景 近年来慢性中心性浆液性脉络膜视网膜病变（CSC）的光动力疗法（PDT）被认为是最有前景的治疗方法之一,但有关其治疗的用药剂量、远期效果及安全性的研究少见报道.目的 观察60％剂量维替泊芬PDT对慢性CSC治疗作用的远期效果及安全性.方法 采用回顾性病例分析和系列病例治疗前后自身对照研究设计.纳入2009年1月至2010年5月在河南省眼科研究所经荧光素眼底血管造影（FFA）、OCT和吲哚青绿血管造影（ICGA）检查确诊的慢性CSC患者21例25眼,其中男18例,占85.71％,女3例,占14.29％;单眼患者17例,双眼患者4例;年龄34 ～ 56岁,平均（43±5）岁.所有患者均行60％剂量维替泊芬（3.6 mg/m2） PDT治疗,于治疗后2周、1个月和3个月进行复查,观察指标包括治疗前与治疗后3个月最佳矫正视力（BCVA）、OCT、FFA及ICGA表现的比较.所有患者均随访5年以上.结果 治疗后3个月患眼BCVA为0.9±0.2,明显优于治疗前的0.5±0.1,差异有统计学意义（t=19.17,P=0.00）.治疗后3个月患眼黄斑区中心凹下脉络膜厚度值为（326.56±39.47） μm,明显低于治疗前的（486.24±47.53） μm,差异有统计学意义（t =25.17,P=0.00）.治疗后患眼荧光素渗漏均消失.随访5年以上,均无复发,未见全身或局部不良反应.结论 60％剂量维替泊芬PDT治疗慢性CSC的远期效果和安全性好于全剂量维替泊芬.

Background It is thought in recently that photodynamic therapy （PDT） is an effective treatment method for chronic central serous chorioretinopathy （CSC）, but the dosage of verteporfin and its long-term efficacy and complications is rarely elucidated ever before.Objective This study was to observe the long-term efficacy and safety of 60% dose verteporfin PDT for chronic CSC.Methods This is a retrospective study and a self-controlled design was used.The clinical data of 25 eyes of 21 chronic CSC patients who received 60%-dose verteporfin PDT in Henan Eye Institute from January 2009 to May 2010 were reviewed, with the male 18 （85.71%） and female 3 （14.29%） as well as monocular CSC 17 patients and binocular CSC 4 patients.The average ages of the patients were （43±5） years.Fundus fluorescein angiography （FFA） , indocyanine green angiography （ICGA）, optical coherence tomography（OCT） and best corrected visual acuity （BCVA） were examined in all the patients before and after treatment.PDT with the 60%-dose verteporfin （3.6 mg/m2） was carried out on the CSC eyes.The treated eyes were examined 2 weeks, 1 month and 3 months after PDT.The BCVA,subfoveal choroid thickness,FFA and ICGA findings before and after PDT were compared.The following-up duration was 5 years or more.Results The BCVA before and 3 months after PDT were 0.5 ±0.1 and 0.9±0.2, respectively, with a statistically significant difference between them （t =19.17,P =0.00）.The subfoveal choroidal thickness value 3 months after PDT was （326.56±39.47） μm,which was significantly reduced in comparison with （486.24 ±47.53） μm before PDT （t =25.17, P =0.00）.FFA and ICGA showed that the leakage of fluorescein （hyperfluorescence） was disappeared in all the treated eyes.No systemic or local adverse effects and recurrence were observed during the follow-up period.Conclusions On the basis of the results of this study and available information,60%-dose verteporfin PDT seems to have a better long-term efficacy and safety than full-dose verteporfin in treating chronic CSC.