PDT联合玻璃体注射雷珠单抗与单一雷珠单抗治疗慢性中心性浆液性视网膜脉络膜病变转化I型脉络膜新生血管疗效观察

Oberservation of Photodynamic Therapy Combined with Intravitreal Injection of Ranibizumab versus Mono Therapy of Intravitreal Injection of Ranibizumab for Central Serous Chorioretinopathy Switched to Type 1 Choroidal Neovascularization

目的:比较PDT联合玻璃体腔注射雷珠单抗(intravitreal injection Ranibizumab, IVR)与单一IVR治疗慢性中心性浆液性脉络膜视网膜病变(central serous choroidal retinopathy, CSC)转换为伴有I型脉络膜新生血管(choroidal neovascularization, CNV)的疗效。方法:回顾性病例系列研究。临床确诊的慢行CSC79例91只眼,对伴有不规则色素皮脱离的23例26只眼行吲哚青绿血管造影(indocyanine green angiography, ICGA),血管成像OCT (optical coherence tomography angiography, OCTA),部分患者行多光谱眼底照相(multispectral imaging, MSI)检查。确诊转换伴有I型CNV的慢性CSC23例26只眼。其中15例17眼行PDT联合IVR,8例9眼行单一IVR治疗。对比观察两组治疗后4周,8周,12周,24周最佳矫正视力(BCVA)与黄斑中心视网膜厚度(central retinal thickness, CRT)。结果:联合治疗组基线BCVA 56.25 ±16.02个字母;单一治疗组66.84 ±14.01 (P = 0.108)。联合组治疗后8周BCVA与单一治疗组比较差异有显著性意义(P = 0.039),治疗后4周,12周,24周两组比较差异没有显著性意义(P = 0.250;0.068;0.067)。联合治疗组基线CRT为381.18 ±91.06,单一治疗组263.00 ±64.79 μm (P = 0.002)。治疗后4,8,12周联合治疗组与单一治疗组CRT比较差异有显著性意义(P = 0.023;0.029;0.024)。治疗后24周两组CRT没有显著性差异,(P = 0.080)。结论:慢性CSC可转换为伴有I型脉络膜新生血管,PDT联合IVR与单一IVR治疗均可提高视力,降低CRT,联合治疗组降低CRT疗效优于单一IVR。6个月后联合与单一IVR治疗没有显著差异。

Purpose: To compare the efficacy of photodynamic therapy (PDT) combined with intravitreal injection of Ranibizumab (IVR) versus mono IVR for treatment of central serous chorioretinopathy (CSC) switched to type one choroidal neovascularization (CNV). Methods: Retrospective nonconsecutively series cases study. 79 cases 91 eyes of CSC were included. Charts and multimodal imaging were reviewed. Among recurrence or maintained serious pigment retinal epithelium detachment (PED) patients were examined by indocyanine Green angiography, optical coherence tomography angiography and Multispectral Imaging. 23 cases (26 eyes) of CSC were shown to switch to type one CNV. Fifteen cases (17 eyes) were treated with PDT and IVR. Eight cases (9 eyes) were only treated with IVR. The BCVA and central retinal thickness of two groups after 4 weeks, 8 weeks, 12 weeks and 24 weeks treatment were comparative observed. Results: Best corrected visual acuity (ETDRS letter) of patients at baseline were 56.25 ±16.02 in combined therapy group;and 66.84 ±14.01 in mono IVR group (P = 0.108). There was a significant difference between two groups 8 weeks post therapy (P = 0.039). Significant difference were not found 4, 12, 24 weeks after therapy (P = 0.250, 0.068, 0.067). CRT in combined therapy group at baseline were 381.18 ±91.06 μm and 263.00 ±64.79 μm in mono IVR group (P = 0.002). There were significant difference in 4, 8, 12 weeks after therapy (P = 0.023;0.029;0.024). No significant difference was found 24 weeks after therapy (P = 0.080). Conclusion: recurrent CSC had a possibility for conversion of chronic CSC with type one CNV. PDT with IVR and IVR group could improve BCVA and decrease CRT, combined group were better than only IVR injection on decreasing CRT, however, there was no difference in 6 months after therapy.