半剂量PDT治疗45岁以上中心性浆液性脉络膜视网膜病变疗效观察

Efficacy of half-dose verteporfin photodynamic therapy for central serous chorioretinophathy in patients aged above 45

摘要:

目的：观察半剂量维替泊芬光动力疗法(photodynamic therapy，PDT)治疗45岁以上中心性浆液性脉络膜视网膜病变(central serous chorioretinophathy，CSC)的有效性。

方法：收集2012-01/2016-12在我院就诊的45岁以上CSC患者30例32眼，平均年龄54.34±8.58岁； 病程1wk～48mo，中位数6mo。所有患眼均采用国际标准视力表行最佳矫正矫正视力(best corrected visual acuity，BCVA)检查，并转换为最小分辨角对数(LogMAR)视力； 采用光学相干断层扫描(optical coherence tomography，OCT)测量黄斑中心凹视网膜厚度(central macular thickness，CMT)及记录视网膜下液(subretinal fluids absorption，SRF)吸收情况； 采用荧光素钠血管造影(fluorescence fundus angiography，FFA)观察患眼脉络膜血管渗漏形态。所有患眼均行半剂量维替泊芬PDT，治疗后1、3、6mo随访观察BCVA和黄斑区OCT情况。对比分析治疗前后患眼BCVA、CMT及SRF吸收变化情况。

结果：所有患者经PDT治疗后1、3、6mo治愈率分别为44%、63%、75%，差异具有统计学意义(χ²=6.621，P=0.037)。将所有患者按病程分为两组，A组患者病程<6mo，B组病程≥6mo，两组患者治疗前BCVA分别为0.6149±0.4117、0.8167±0.4370； 治疗前CMT分别为409.47±129.422、395.82±153.756μm。经治疗后两组间BCVA值差异无统计学意义(F=0.303，P=0.823)，但具有时间差异性(F=32.837，P<0.001)。A组患者的BCVA治疗后1mo与治疗前比较，差异具有统计学意义(t=3.347，P=0.005)； 治疗后1、3mo比较，差异有统计学意义(t=4.768，P<0.001)； 治疗后3、6mo相比，差异无统计学意义(t=2.024，P=0.063)。B组患者的BCVA治疗后1、3、6mo与治疗前两两比较，差异均具有统计学意义(P<0.05)。治疗后两组间患者CMT差异无统计学意义(F=0.064，P=0.978)，但具有时间差异性(F=26.447，P<0.001)，A组患者的CMT治疗后1、3、6mo与治疗前两两比较，差异均具有统计学意义(P<0.05)； B组患者的CMT治疗后1、3、6mo与治疗前两两比较，差异均具有统计学意义(P<0.05)。

结论：半剂量PDT疗法可有效改善45岁以上CSC患者的视力，对视网膜下液的吸收仍有较好疗效。

Abstract:

AIM: To evaluate the efficacy of half-dose verteporfin photodynamic therapy for central serous chorioretinophathy(CSC)in patients aged above 45 years old.

METHODS: Thirty-two eyes of 30 patients aged above 45 years old with central serous chorioretinophathy were included, and all the eyes received half-dose verteporfin photodynamic therapy(PDT). Best-corrected visual acuity(BCVA), central macular thickness(CMT)and subretinal fluids absorption(SRF)were measured before and after treatment(1,3 and 6mo).

RESULTS: The rate of SRF absorbing completely was 44% at 1mo, 63% at 3mo and 75% at 6mo. The difference in cure rate of the three time points was statistically significant(χ²=6.621, P=0.037). All the patients were divided into two groups according to the duration, patients in Group A were treated less than 6mo, Group B were ≥6mo. The mean LogMAR BCVA in the two groups were respectively 0.6149±0.4117 and 0.8167±0.4370 before treatment and the mean CMT were 409.47±129.422μm and 395.82±153.756μm before treatment. The difference between the two groups in the LogMAR BCVA was not statistically significant(F=0.303, P=0.823), but the time difference within the subjects was statistically significant(F=32.837,P<0.001). In Group A, the differences of the LogMAR BCVA at pre-treatment,1mo and 3mo was all statistically significant(P<0.05), but the differences of the LogMAR BCVA at 3mo and 6mo was not statistically significant(t=2.024,P=0.063). In Group B, the differences of the LogMAR BCVA at any two time points were all statistically significant(P<0.05). The difference between the two groups in the CMT was not statistically significant(F=0.064,P=0.978), but the time difference within the subjects was statistically significant(F=26.447,P<0.001). In Group A,the differences of the CMT at any two time points were all statistically significant(P<0.05). So were in Group B(P<0.05).

CONCLUSION: Half-dose verteporfin PDT was effective in treating CSC aged above 45 years old, it still could improve BCVA and subretinal fluids absorption.