577 nm阈下值微脉冲激光治疗中心性浆液性脉络膜视网膜病变的效果及安全性

Efficacy and safety of subthreshold micropulse laser(577 nm)therapy in central serous chorioretinopathy

目的探讨577 nm阈下值微脉冲激光治疗中心性浆液性脉络膜视网膜病变(CSC)的临床效果和安全性。方法回顾性分析67例(67眼)CSC患者的临床资料,将采用577 nm阈下值微脉冲激光光凝治疗的患者纳入577 nm微脉冲激光治疗组(n=23),将采用传统黄色激光光凝治疗的患者纳入黄色激光治疗组(n=23),将未治疗的患者纳入对照组(n=21)。于初诊、治疗后1周、1个月、3个月、6个月,分别检测3组患者的最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT),并于末次随访时复查黄斑部光学相干断层成像,观察视网膜下积液及视网膜色素上皮损害情况。结果治疗后1周、1个月、3个月、6个月,577 nm微脉冲激光治疗组和黄色激光治疗组的BCVA和CMT均较初诊时和对照组下降(均P<0.05),但577 nm微脉冲激光治疗组和黄色激光治疗组的BCVA和CMT差异均无统计学意义(均P>0.05)。末次随访时,577 nm微脉冲激光治疗组和黄色激光治疗组的视网膜下积液者比例均低于对照组(均P<0.05),但577 nm微脉冲激光治疗组与黄色激光治疗组之间差异无统计学意义(P>0.05);黄色激光治疗组出现视网膜色素上皮局部萎缩变薄4例(17.39%),而577 nm微脉冲激光治疗组和对照组均未出现视网膜色素上皮萎缩变薄患者。结论采用577 nm阈下值微脉冲激光治疗CSC,可有效地促进视网膜下积液的吸收,提高患者视力,并维持视网膜色素上皮的完整性,其效果与传统黄色激光相当,但安全性更高。

Objective To explore the clinical efficacy and safety of subthreshold micropulse laser(577 nm)therapy in central serous chorioretinopathy(CSC).Methods The clinical data of 67 patients(67 eyes)with CSC were analyzed retrospectively,and patients receiving subthreshold micropulse laser(577 nm)photocoagulation therapy were enrolled in the 577 nm micropulse laser therapy group(n=23),patients receiving traditional yellow laser photocoagulation therapy in the yellow laser therapy group(n=23),and patients did not receive any treatment in the control group(n=21).Best corrected visual acuity(BCVA)and central macular thickness(CMT)were measured in the three groups at the initial diagnosis,one week,and one,three and six months after treatment.Besides,at the last follow-up optical coherence tomography(OCT)was applied to macular region recheck,and subretinal fluid and retinal pigment epithelium damage were observed as well.Results One week,one,three and six months after treatment,BCVA and CMT in the 577 nm micropulse laser therapy group and the yellow laser therapy group were lower than those at the initial diagnosis or in the control group(all P<0.05),whereas there was no statistically significant difference in BCVA or CMT between the 577 nm micropulse laser therapy group and the yellow laser therapy group(all P>0.05).At the last follow-up,the proportion of patients with subretinal fluid in the 577 nm micropulse laser therapy group or the yellow laser therapy group was lower than that in the control group(all P<0.05),but no statistically significant difference was found between the 577 nm micropulse laser therapy group and the yellow laser therapy group(P>0.05);there were four(17.39%)cases suffering local atrophy and thinning of retinal pigmented epithelium in the yellow laser therapy group,whereas no cases of atrophy and thinning of retinal pigmented epithelium was observed in the 577 nm micropulse laser therapy group and the control group.Conclusion The use of subthreshold micropulse laser(577 nm)therapy for CSC can effectively promote the absorption of subretinal fluid,improve patients′visual acuity,and maintain the integrity of retinal pigmented epithelium,which is similar to traditional yellow laser therapy in efficacy,but having a higher safety.