七叶素片与高密度阈值下微脉冲激光治疗中心性浆液性视网膜脉络膜病变对比研究——一项前瞻性队列研究

The Comparison Study of Tablet Aescin Therapy versus High-Density Subthreshold Micropulse Treatment Laser for Central Serous Chorioretinopathy—A Prospective Cohort Study

目的:对比观察七叶素片药物(商品名:迈之灵)与高密度阈值下微脉冲激光治疗中心性浆液性视网膜脉络膜病变(Central Serous Chorioretinopathy, CSC)的疗效。方法:单中心,随机,单盲前瞻性队列研究。纳入2019年12月至2021年8月根据临床特征及多模影像结果确诊的CSC患者55例(55眼),按1:1比例随机分为迈之灵治疗组与高密度阈值下微脉冲激光治疗(Subthreshold Micropulse Treatment Laser, SMTL)对照组,其中迈之灵组28例(28眼),SMTL组27例(27眼)。比较两组基线与治疗后1,4,8,12周最佳矫正视力(BCVA),黄斑中心视网膜下积液厚度(CFT),黄斑中心视敏度及抑郁与焦虑量表评分(HADs)的变化。结果:治疗后1,4,8,12周两组BCVA均较基线提高,比较差异均有显著性意义(p < 0.05)。两组CFT治疗后4,8,12周均较基线降低,比较差异有显著性意义(p < 0.05)。SMTL组治疗后8,12周黄斑中心视敏度较基线改善(p = 0.002;0.002),而迈之灵组则在治疗后12周黄斑中心视敏度较基线改善(p = 0.041)。两组治疗后早期HADs与基线比较差异没有显著性意义。结论:高密度微脉冲激光与口服迈之灵治疗CSC均能有效提高BCVA,降低CFT,促进视网膜下积液吸收。而微脉冲激光治疗比较口服迈之灵则能更好改善CSC的黄斑中心视敏度,治疗后早期1、4周内两种治疗均不能快速改善CSC患者的焦虑与抑郁。

Objective: To compare the anatomic and functional efficacy of oral Tablet Aescin versus high-density subthreshold micropulse treatment laser (SMTL) for the treatment of central serous chorioretinopathy (CSC). Methods: one center, randomized controlled prospective cohort study. Fifty-five patients (55 eyes) with CSC as randomized in a 1:1 allocation ratio were enrolled in this study from December 2019 to June 2021. All patients were diagnosed according to clinical characteristics and findings on multimodal imaging. Outcomes of Tablet Aescin and high-density SMTL including best-corrected visual acuity (BCVA) and macular central Fluids thickness (CFT), retinal sensitivity (measured using microperimetry), hospital anxiety and depression score (HADs) at baseline, 1, 4, 8, 12 weeks after treatment were evaluated. Results: twenty-eight patients (28 eyes) treated Tablet Aescin and twenty-seven Patients (27 eyes) treated with SMTL were included. The BCVA of Tablet Aescin group improved at 1, 4, 8, 12 weeks after treatment, (p < 0.05) while that of SMTL group improved as same as the Tablet Aescin group (p < 0.05), and significantly decreased CFT than that of the baseline between two groups at 4, 8, 12 weeks respectively (p < 0.05). Retinal sensitivity of the SMTL group improved at 8, 12 weeks after treatment (p = 0.002;0.002), while that of Tablet Aescin group improved at 12 weeks (p = 0.041). However, the results of HADs analysis showed no significant differences between the two groups after treatment at 1, 4 weeks. Conclusions: Tablet Aescin may be an effective candidate for the treatment of CSC as same as SMTL, improved BCVA and decreased CFT, but the SMTL could more effectively improve retinal sensitivity than the Tablet Aescin treatment. The two kinds of therapy were unable to resolve CSC patient’s HADs at early stage after treatment during 1, 4 weeks.