半剂量PDT治疗45岁以上中心性浆液性脉络膜视网膜病变疗效观察

Efficacy of half-dose verteporfin photodynamic therapy for central serous chorioretinophathy in patients aged above 45

目的:观察半剂量维替泊芬光动力疗法(photodynamic therapy,PDT)治疗45岁以上中心性浆液性脉络膜视网膜病变(central serous chorioretinophathy,CSC)的有效性。方法:收集2012-01/2016-12在我院就诊的45岁以上CSC患者30例32眼,平均年龄54.34±8.58岁;病程1wk^48mo,中位数6mo。所有患眼均采用国际标准视力表行最佳矫正矫正视力(best corrected visual acuity,BCVA)检查,并转换为最小分辨角对数(LogMAR)视力;采用光学相干断层扫描(optical coherence tomography,OCT)测量黄斑中心凹视网膜厚度(central macular thickness,CMT)及记录视网膜下液(subretinal fluids absorption,SRF)吸收情况;采用荧光素钠血管造影(fluorescence fundus angiography,FFA)观察患眼脉络膜血管渗漏形态。所有患眼均行半剂量维替泊芬PDT,治疗后1、3、6mo随访观察BCVA和黄斑区OCT情况。对比分析治疗前后患眼BCVA、CMT及SRF吸收变化情况。结果:所有患者经PDT治疗后1、3、6mo治愈率分别为44%、63%、75%,差异具有统计学意义(χ~2=6.621,P=0.037)。将所有患者按病程分为两组,A组患者病程<6mo,B组病程≥6mo,两组患者治疗前BCVA分别为0.6149±0.4117、0.8167±0.4370;治疗前CMT分别为409.47±129.422、395.82±153.756μm。经治疗后两组间BCVA值差异无统计学意义(F=0.303,P=0.823),但具有时间差异性(F=32.837,P<0.001)。A组患者的BCVA治疗后1mo与治疗前比较,差异具有统计学意义(t=3.347,P=0.005);治疗后1、3mo比较,差异有统计学意义(t=4.768,P<0.001);治疗后3、6mo相比,差异无统计学意义(t=2.024,P=0.063)。B组患者的BCVA治疗后1、3、6mo与治疗前两两比较,差异均具有统计学意义(P<0.05)。治疗后两组间患者CMT差异无统计学意义(F=0.064,P=0.978),但具有时间差异性(F=26.447,P<0.001),A组患者的CMT治疗后1、3、6mo与治疗前两两比较,差异均具有统计学意义(P<0.05);B组患者的CMT治疗后1、3、6mo与治疗前两两比较,差异均具有统计学意义(P<0.05)。结论:半剂量PDT疗法可有效改善45岁以上CSC患者的视力,对视网膜下液的吸收仍有较好疗效。

AIM： To eva photodynamic uate the efficacy of half-dose chorioretinophathy years old. therapy for central （CSC） in patients aged verteporfin serous above 45 METHODS： Thirty-two eyes of 30 patients aged above 45 years old with central serous chorioretinophathy were included, and all the eyes received half-dose verteporfin photodynamic therapy （PDT）. Best - corrected visual acuity （BCVA）, central macular thickness （CMT） and subretinal fluids absorption （SRF） were measured before and after treatment （1.3 and 6too）. RESULTS. The rate of SRF absorbing completely was 44% at 1too, 63% at 3mo and 75% at 6mo. The difference in cure rate of the three time points was statistically significant （X2 = 6. 621, P= 0. 037）. All the patients were divided into two groups according to the duration, patients in Group A were treated less than 6mo, Group B were ≥6mo. The mean LogMAR BCVA in the two groups were respectively 0. 6149±0. 4117 and 0.8167±0. 4370 before treatment and the mean CMT were 409.47±129. 422μ m and 395. 82 ± 153.756μm before treatment. The difference between the two groups in the LogMAR BCVA was not statistically significant （ F= 0. 303, P= 0. 823）, but the time difference within the subjects was statistically significant （ F= 32. 837 , P〈 0. 001） . In Group A, the differences of the LogMAR BCVA at pre-treatment, l mo and 3mo was all statistically significant （ P〈 0.05）, but the differences of the LogMAR BCVA at 3mo and 6mo was not statistically significant （t = 2.024, P = 0.063）. In Group B, the differences of the LogMAR BCVA at any two time points were all statistically significant （P〈0.05）. The difference between the two groups in the CMT was not statistically significant （ F= 0. 064, P= 0. 978）, but the time difference within the subjects was statistically significant （F= 26.447, P〈0.001 ）. In Group A,the differences of the CMT at any two time points were all statistically significant （P〈0.05）. So were in Group B （P〈0.05）. CONCLUSION ： Half-dose verteporfin PDT was effective in treating CSC aged above 45 years old, it still could improve BCVA and subretinal fluids absorption.