光动力疗法治疗类固醇相关性中心性浆液性脉络膜视网膜病变的疗效观察

Photodynamic therapy for steroid-associated central serous chorioretinopathy

目的探讨半剂量光动力疗法(PDT)治疗类固醇相关性中心性浆液性脉络膜视网膜病(CSC)变的短期疗效。方法回顾性病例研究。分析自2014年9月至2019年11月有外源性类固醇应用史的CSC并接受半剂量PDT治疗的患者20例(32只眼),观察治疗前后视力、荧光素眼底血管造影(FFA)渗漏点及相干光层析成像术(OCT)视网膜解剖学的变化。结果20例患者中男性14例,女性6例,年龄(45.25±9.81)岁(26~62岁),单眼发病8例,双眼发病12例,合并泡性视网膜脱离4例6只眼,其中2例为双眼泡性视网膜脱离。随访时间1~42个月,中位数3个月。治疗后1个月,31只眼(96.9%)的渗漏点消退,仅1只眼渗漏点持续存在(3.1%)。末次随访时2只眼出现黄斑区以外的新渗漏点。PDT后1个月视网膜下液完全吸收者23只眼(76.7%),减少者5只眼(16.7%),无明显减少者2只眼(6.6%),仅表现为黄斑区浆液性色素上皮脱离(PED)的2只眼PED均吸收。末次随访时仍有2只眼(6.6%)有残存的视网膜下液。基线时患眼的平均logMAR视力为(0.73±0.58),治疗后1个月平均logMAR视力为(0.63±0.72),末次随访平均logMAR视力为(0.59±0.65)。14只患眼测量了PDT治疗前后的脉络膜厚度,显示治疗前中心凹下脉络膜平均厚度为(451.74±156.47)μm,PDT后1个月为(436.00±158.11)μm,末次随访时为(414.39±154.27)μm。二者均有下降趋势,但无统计学差异分别为(P=0.067和P=0.195)。结论对于类固醇相关的CSC,半剂量PDT可以在短期内有效地控制病情并改善黄斑区的解剖学结构,对患者的视力改善有一定作用。

Objective To evaluate the short-term effect of half-dose photodynamic therapy on steroid related central serous chorioretinopathy(CSC).Methods Retrospective case study。A total of 20 cases(32 eyes)with steroid related central serous chorioretinopathy who received half-dose photodynamic therapy(PDT)in Tongren Eye Center from September 2014 to November 2019 were included.The best corrected visual acuity(BCVA),retinal and choroidal changes in fundus fluorescein angiography(FFA)and optical coherence tomography(OCT)were evaluated.Results Among the 20 patients,14 were male and 6 were female,the age range was 26 to 62 years with a mean age of(45.25±9.81)years.There were 8 cases with unilateral CSC and 12 cases with bilateral CSC.Bullous retinal detachment was found in 4 cases,of which 2 were bilateral.All patients were followed up for one to forty-two months,with a median follow-up time of three months.The leakage point seen on FFA vanished at one month after the PDT treatment in 31 eyes(96.9%),sustained only in 1 eye(3.1%).New leakage points were found in 2 eyes at the last visit.The subretinal fluid absolved completely in 23 eyes(76.7%),reduced in 5 eyes(16.7%),and persistent in 2 eyes(6.6%).There were 2 eyes with only serous pigment retinal detachment(PED)in the macular and the PED disappeared at one month after the treatment.The subretinal fluid was persistent in 2 eyes at the last visit(6.6%).The average logMAR BCVA was(0.73±0.58)at baseline,(0.63±0.72)one month post treatment,and(0.59±0.65)at last visit.Subfoveal choroidal thickness was measured before and after PDT treatment in 14 eyes,with a result of(451.74±156.47)μm before treatment,(436.00±158.11)μm one month after treatment and(414.39±154.27)μm at last visit.Both showed a decreasing trend but with no statistical significance(P=0.067 and P=0.195 respectively).Conclusions For patients with steroid-related CSC,half-dose PDT treatment can effectively control the disease,restore the normal anatomical structure and potential benefit the visual acuity.