半剂量光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变二年的疗效评估

Observation on long-term efficacy of half-dose photodynamic therapy with chronic central serous chorioretinopathy using optical coherence tomography

目的评估半剂量光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变（CSC）的2年的疗效。方法回顾性病例研究。选择32例（35只眼）已确诊的慢性CSC患者，病程6～60个月。半剂量（3mg／m2体表面积）光动力疗法治疗慢性CSC患者，治疗后随访24个月。治疗前后检查最佳矫正视力（BCVA）、FFA、吲哚青绿脉络膜血管造影（ICGA）、OCT。治疗后3个月和24个月，OCT观察视网膜椭圆体区（EZ）和交叉区（IZ）的结构以及中心神经上皮层厚度（CNT）的变化；治疗前后BCVA和CNT比较采用配对t检验，多重比较未作校正；治疗后3和24个月的EZ、IZ比较采用配对秩和检验；回归分析用于比较功能与结构之间的关系：BCVA与CNT、EZ、IZ的相关性分析。结果32例（35只眼）慢性CSC患者半剂量PDT治疗前logMARBCVA0．53±0．36；治疗后3个月为0．49±0．39；24个月为0．15±0．38。治疗前、治疗后3个月BCVA差异无统计学意义（t=1．952；P〉0．05），治疗后24个月分别与治疗前和治疗后3个月BCVA比较，差异有统计学意义（t=10．761，8．930；P〈0．01）。OCT检查示，随访期内EZ和IZ结构的完整程度有改善．治疗后24个月与3个月相比，差异有统计学意义（Z=-3．419，-4．082；P〈0．01）。患者治疗前CNT为（126．8±34．9）μm、治疗后3个月为（125．6±34．3）μm、治疗后24个月为（124．8±35．1）μm，两两比较，差异无统计学意义（t=1．830，-1．569，0．793；P〉0．05）。治疗前、治疗后3个月、治疗后24个月logMARBCVA与相应CNT呈负相关（β=0．604，-0．634，-0．685；P〈0．05）；治疗后3个月logMARBCVA与相应EZ、IZ呈负相关（β=0．376，-0．394；P〈0．05），治疗后24个月logMARBCVA与相应EZ、IZ呈负相关（β=0．628，-0．496；P〈0．01）。治疗后3个月，33只（94．3％）患眼视网膜下积液完全吸收，在24个月时提升至35只患眼（100．0％）。半剂量光动力疗法平均治疗次数为1．03±0．17。结论通过2年的OCT随访观察，半剂量光动力疗法治疗慢性CSC安全有效，虽然患者视力短期内不提高，但长期随访有显著提高，视力提高与EZ和IZ的结构恢复有关。

Objective To evaluate long-term efficacy of half-dose photodynamic therapy on chronic central serous chorioretinopathy using optical coherence tomography. Methods A retrospective, interventional case series. Thirty-five eyes of 32 patients （35 eyes） with chronic central serous chorioretinopathy were included, with CSC durations from 6 to 60 months. Patients treated with half-dose vertepoffin （3 mg/m2） PDT were followed up for 24 months, Best-corrected visual acuity （BCVA）, fluorescein angiography （FA）, indocyanine green angiography （ICGA） and optical coherence tomography （OCT） pre and post-treatment were all examined to observe the anatomic and functional changes. OCT findings highlighted the alterations of the ellipsoid zone （EZ）, the interdigitation zone （IZ） and the central neural retina thickness （CNT） from 3 month to 24 month post-treatment. Regression analysis was applied to determine the correlation between the visual function （BCVA） and structure status （EZ, IZ, CNT）. Results Thirty-five eyes of 32 patients with chronic CSC were treated with half-dose PDT. The logMAR BCVA was 0.53±0.36 at baseline, 0.49±0.39 at 3 months and 0.15±0.38 at 24 months post-PDT. There was no statistical significance between baseline and 3 month BCVA （t=1.952, P〉0.05）. There existed statistical significance between baseline and 24 month BCVA（t=10.761, P〈0.01） as well as 3month and 24 month BCVA（t=8.930, P〈0.01）. OCT demonstrated the recovery of EZ and IZ. Statistical differences of EZ and IZ integrity degree were found between the 3 month and 24 month （Z=-3.419,-4.082, P〈0.01）. The mean CNT was （126.8±34.9） μm at baseline. And it kept constant at 3 month [（125.6±34.3）μm] and the 24 month visit [（124.8±35.1）μm]. No statistical significance was found between any two values （t=-1.830,- 1.569, 0.793, P〉0.05）. At baseline, 3 month and 24 month, there was negative correlation between logMAR BCVA and CNT （β=-0.604, -0.634, -0.685, P〈0.01） . At 3 month and 24 month, negative correlation between IogMAR BCVA and EZ as well as IogMAR BCVA and IZ were also found（β=-0.376, -0.394, -0.628, -0.496, P〈0.05）. A complete resolution of subrefinal fluid was noted in 94.3% eyes at 3 month, further increased to 100% eyes at 24 month. The mean session of PDT was 1.03±0.17. Conclusions Half-dose PDT was safe and effective for chronic CSC both functionally and morphologically in the long term. Visual benefits may not appear in a short run, yet became remarkable in a long run. Visual benefits might be attributed to recovery of EZ and IZ.