靶向导航激光连续波阈值下功率治疗慢性中心性浆液性脉络膜视网膜病变的疗效观察

Observation of the curative effect of targeted navigation laser with continuous wave power under the threshold in the treatment of chronic central serous chorioretinopathy

目的观察靶向导航激光连续波阈值下功率治疗慢性中心性浆液性脉络膜视网膜病变(CCSC)的安全性和有效性。方法回顾性临床研究。2018年11月至2020年6月于南京医科大学附属眼科医院检查确诊的CCSC患者28例28只眼纳人研究。其中,男性17例17只眼,女性11例11只眼;均单眼发病。患者平均年龄(36.24±5.14)岁,平均病程(4.7±1.3)个月。患眼均行最佳矫正视力(BCVA)、荧光素眼底血管造影、眼底自身荧光、频域光相干断层扫描及其血管成像、多焦视网膜电图和微视野检查。BCVA采用国际标准视力表进行,统计时换算为最小分辨角对数(logMAR)视力。采用靶向导航激光系统行连续波阈值下功率治疗。治疗后2周及1、3个月采用与治疗前相同的设备和方法行相关检查,观察患眼BCVA、中心凹下脉络膜厚度(SFCT)、黄斑中心凹视网膜厚度(CMT)、黄斑中心10°范围平均光敏度(MS)以及黄斑中心区1环、2环P1波振幅密度变化。治疗前后CMT、SFCT、MS以及黄斑中心E1环、2环?,波振幅密度比较采用〖检验。结果治疗前和治疗后2周,1、3个月,患眼平均logMARBCVA分别为0.74±0.16、0.57±20.16、0.22±0.05、0.21±20.06,平均CMT分别为(512.33±31.56)、(350.40±36.61)、(256.49±22.38)、(253.45±223.65)um,平均SFCT分别为(462.82±25.38)、(462.37±39.54)、(461.51±29.36)、(461.25±234.55)цт,平均MS分别为(16.32±5.41)、(17.53±4.23)、(19.52±4.12)、(21.35±2.77)dB。患眼治疗前与治疗后不同时间BCVA(t=6.52、5.71、6.01,t=0.00、0.00、0_00)、CMT(t=3.08、6.57、4.90,P=0.01、0.00、0.00)、SFCT(t=7.01、6.54、4.85,>0.08、0.07、0.17)、MS(t=6.17、4.25、5.46,t=0.02、0.00、0.00)比较,差异均有统计学意义。患眼黄斑中心区1环、2环P1波振幅密度分别为(64.37±18.25)、(85.31±13.98)、(98.35±14.52)、(98.40±22.17)nV/deg^(2)和(36.12±18.32)、(44.02±17.15)、(62.35±14.85)、(63.17±15.79)nV/deg^(2)。患眼治疗前与治疗后不同时间黄斑中心区1环(t=5.11、9.03、4.27,=0.03、0.00、0.00)、2环(t=5.11、9.03、4.27,P=0.03、0.00、0.00)Р1波振幅密度比较,差异均有统计学意义。结论靶向导航激光连续波阈值下功率治疗CCSC可提高患眼BCVA、黄斑区视网膜振幅密度及黄斑中心凹MS,降低CMT、SFCT。

Objective To observe the safety and effectiveness of targeted navigation laser with continuous wave threshold power in the treatment of chronic central serous chorioretinopathy(CCSC).Methods A retrospective clinical study.From November 2018 to June 2020,28 eyes of 28 patients with CCSC diagnosed in the Eye Hospital of Nanjing Medical University were included in the study.Among them,there were 17 males with 17 eyes and 11 females with 11 eyes;all of them had a monocular disease.The average age of the patients was 36.24±5.14 years,and the average course of the diseases was 4.7±1.3 months.All affected eyes underwent best corrected visual acuity(BCVA),fluorescein fimdus angiography,fundus autofluorescence,frequency domain optical coherence tomography and angiography,multifocal electroretinogram(mf-ERG)and micro field inspection.BCVA was carried out using the international standard visual acuity chart,which was converted into the logarithmic minimum angle of resolution(logMAR)visual acuity during statistics.A targeted navigation laser system was used for continuous wave power therapy under the threshold.Two weeks and 1,3 months after treatment,the same equipment and methods as before treatment were used to perform related examinations to observe the BCVA,subfoveal choroidal thickness(SFCT),foveal retinal thickness(CMT),the mean light sensitivity(MS)in the 10°range of the macular center,and the amplitude density of Pj wave at ring 1 and 2.The t test was used to compare CMT,SFCT,retinal amplitude density and MS before and after treatment.Results Before treatment and 2 weeks,1 and 3 months after treatment,the average logMAR BCVA of the eyes were 0.74±0.16,0.57±0.16,0.22±0.05,0.21±0.06,and the average CMT was 512.33±31.56,350.40±36.61,256.49±22.38,253.45±23.65um respectively,the average SFCT was 462.82±25.38,462.37±39.54,461.51±29.36,461.25±34.55 jim,the average MS was 16.32±5.41,17.53±4.23,19.52±4.12,21.35±2.77 dB respectively.At different times before and after treatment,BCVA(t=6.52,5.71,P=0.00,0.00,0.00),CMT(t=3.08,6.57,4.90;P=0.01,0.00,0.00),SFCT(t=7.01,6.54,4.85;P=0.08,0.07,0.17),MS(t=6.17,4.25,5.46;Р=0.02,0.00,0.00),the difference was statistically significant.The amplitude density of P1 wave at ring 1 in the affected eye was 64.37±18.25,85.31±13.98,98.35±14.52,98.40±22.17 nV/deg^(2),and the ampliUide density of P1 wave at ring2 was 36.12±18.32,44.02±17.15,62.35±14_85,63.17±15.79 nV/deg^(2).The amplitude density of wave at ring 1(t=5.11,9.03,4.27;P=0.03,0.00,0.00)and ring 2(t=5.11,9.03,4.27;P=0.03,0.00,0.00)before and after treatment showed statistical significance.Conclusion Targeted navigation laser continuous wave threshold power treatment for CCSC can increase the BCVA,macular retinal amplitude density and macular foveal MS,and reduce CMT and SFCT.