间接光凝和直接光凝治疗中心性浆液性脉络膜视网膜病变的疗效对比观察

Comparative evaluation of indirect and direct laser photocoagulation for central serous chorioretinopathy

目的评价间接光凝治疗中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的临床疗效。方法CSC患者41例(42眼),对渗漏点位于黄斑中心凹1/3 PD(500μm)以内的20眼进行间接光凝为观察组,对渗漏点位于黄斑中心凹1/3 PD(500μm)以外的22眼进行直接光凝为对照组,于治疗前及治疗后1周、1个月、2个月、3个月检查并记录最佳矫正视力(best corrected visual acuity,BCVA)、眼底、黄斑中心凹视网膜厚度(central foveal thickness,CFT)等情况并进行比较。结果观察组、对照组治疗前BCVA分别为0.59±0.20、0.60±0.22,治疗后3个月分别为0.90±0.18、0.91±0.04,两组治疗后视力均明显提高,差异均有统计学意义(均为P<0.01);两组间相比,治疗前与治疗后3个月BCVA差异均无统计学意义(均为P>0.05)。两组治疗后不同时间点CFT均低于治疗前,差异有统计学意义(均为P<0.01);两组治疗后1个月CFT均低于治疗后1周,差异均有统计学意义(均为P<0.01),治疗后1个月、2个月、3个月CFT比较,差异均无统计学意义(均为P>0.05)。两组治疗前及治疗后不同时间点CFT组间比较,差异均无统计学意义(均为P>0.05)。结论和直接光凝相比,间接光凝对CSC同样具有良好的疗效,为不能进行直接光凝的旁中心凹渗漏的CSC提供了一种安全有效的治疗方法。

Objective To evaluate the clinical effects of indirect laser photocoagulation for central serous chorioretinopathy（ CSC）. Methods Forty-one patients（ 42 eyes） with CSC were divided into two groups based on fundus fluorescein angiography（ FFA） ： the observation group whose leakage located at 1 /3 PD（ 500 μm） near the macula and the control group whose leakage located at 1 /3 PD（ 500 μm） outside the macula. Twenty eyes of the observation group underwent indirect laser photocoagulation,and twenty-two eyes of the control group underwent direct laser photocoagulation. The follow-up time was 3 months. The best corrected visual acuity（ BCVA）,fundus and central foveal thickness（ CFT） were observed at pre-operation and postoperative 1 week,1 month,2 months,3 months,and the results were compared.R esults The preoperative BCVA in the observation group and control group were 0. 59 ± 0.20 and 0. 60 ± 0. 22,respectively,which at the postoperative 3 months were 0. 90 ± 0. 18 and 0. 91 ± 0. 04,respectively,there were statistical differences（ all P 〈0. 01）. There was no statistical difference in preoperative and postoperative BCVA at 3 months between two groups（ all P 〈0. 05）. The postoperative CFT at different time of two groups were all lower than pre-operation（ all P 〈0. 01）; CFT at postoperative 1 month of two groups were lower than that at postoperative 1 week（ all P 〈0. 01）,no statistical difference was found among postoperative 1 month,2 months and 3 months（ all P 〈0. 05）. There was no statistical difference in preoperative and postoperative CFT at different time between two groups（ all P 〈0. 05）. Conclusion Indirect laser photocoagulation shows the same effect with direct photocoagulation for CSC. It provides a safe and effective method for CSC with parafoveal leaks.