1/3量维替泊芬光动力学疗法治疗急性中心性浆液性脉络膜视网膜病变

Photodynamic therapy with one third-dose verteporfin for treating acute central serous chorioretinopathy

摘要:

目的：观察1/3量维替泊芬光动力学疗法(photodynamic therapy，PDT)治疗中心凹下急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy，CSC)的疗效。

方法：我院眼科门诊2010-05/2011-05确诊为急性CSC患者22例22眼，行单次1/3量维替泊芬光动力学治疗，术前和术后1，2，4wk及3mo进行光学相干断层扫描(optical coherence tomography，OCT)的检测，且于术前、术后4wk进行视网膜荧光造影(fundus fluorescein angiography，FFA)、脉络膜血管造影(indocyanine green angiography，ICGA)检查，观察治疗的有效性和安全性。

结果：术前22眼OCT均显示视网膜浆液性神经上皮脱离，造影中均存在明显荧光渗漏及脉络膜血管扭曲扩张弥漫荧光渗漏； 术后1wk，OCT显示7眼视网膜下积液部分吸收； 术后2wk时11眼视网膜下渗液完全吸收，术后4wk时22眼视网膜下渗液完全吸收，22眼FFA显示荧光渗漏消失，15眼ICG显示扭曲扩张的脉络膜血管管径形态有所改变，7眼脉络膜血管形态改变不明显。视力从术前平均0.5升高至0.9，视物变形情况22眼均明显改善。随访期间22眼均未见任何不良反应。

结论：1/3量维替泊芬PDT治疗急性CSC短期内安全有效。

Abstract:

AIM: To evaluate the efficacy of photodynamic therapy(PDT)with one third-dose verteporfin for treating acute central serous chorioretinopathy(CSC).

METHODS: Twenty-two eyes of 22 patients diagnosed with acute CSC from May 2010 to May 2011 received single session of PDT with one third dose(2mg/m²)verteporfin. All eyes were imaged by optical coherence tomography(OCT)preoperative and 1 week, 2, 4 weeks and 3 months after PDT. The resolution of subretinal fluid(SRF)was observed. Fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA)were applied preoperative and 4 weeks after PDT to evaluate the reliability and effectiveness of PDT.

RESULTS: Twenty-two eyes presented serous neuroepitheial detachment in OCT image and showed fluorescence leakage or smokestack phenomenon in FFA, and revealed dilated and tortuous choroidal vessels with diffuse hyperpermeability in ICGA pictures. After one week, OCT showed that SRF was reduced in 7 eyes. The SRF was completely resolute in 11 eyes after 2 weeks. Four weeks after PDT, 22 eyes had complete resolution of SRF and disappear of fluorescein leakage in FFA. The dilated and tortuous choroidal vessels improved in 15 eyes and remained the same in 7 eyes by ICGA. The mean BCVA was 0.5 at baseline and 0.9 at 3 weeks. None of the patients developed any systemic adverse event associated with the operation in the follow-up period.

CONCLUSION: PDT with one third dose verteporfin is effective and safe in treating acute CSC.