半剂量维替泊芬和半能量PDT治疗慢性中心性浆液性脉络膜视网膜病变

目的　探讨使用半剂量维替泊芬和半能量激光的光动力学疗法（ｐｈｏｔｏｄｙｎａｍｉｃｔｈｅｒａｐｙ，ＰＤＴ）治疗慢性中心性浆液性脉络膜视网膜病变（ｃｈｒｏｎｉｃｃｅｎｔｒａｌｓｅｒｏｕｓｃｈｏｒｉｏｒｅｔｉ-ｎｏｐａｔｈｙ，ＣＣＳＣ）的疗效和安全性。方法　分析２０１１年８月至２０１３年８月期间在我科就诊的ＣＣＳＣ患者２５例（３３眼），所有患者接受静脉注射剂量为３ｍｇ?ｍ－２体表面积的维替泊芬和能量为２５Ｊ?ｃｍ－２的ＰＤＴ治疗，治疗后１个月、３个月、６个月和１２个月复查，重复进行ＢＣＶＡ、裂隙灯、间接眼底镜和ＯＣＴ检查，治疗后６个月复查眼底荧光血管造影检查。结果　末次随访时视力改善者３１眼、稳定者２眼，最佳矫正视力（０．１５±０．０９）ＬｏｇＭＡＲ，与治疗前的（０．５０±０．１８）ＬｏｇＭＡＲ相比差异有统计学意义（ｔ＝１０．３３４，Ｐ＜０．００１）；ＯＣＴ检查示，显效率在治疗后１个月、３个月、６个月和末次随访时分别为４８．５％、８４．８％、９３．９％和１００．０％。ＣＣＳＣ眼治疗后１个月黄斑中心凹下脉络膜厚度为（３９１．５３±１０１．１８）μｍ，与治疗前的（４８３．２１±８９．１３）μｍ相比明显降低（ｔ＝－３．９０２，Ｐ＜０．００１），黄斑中心凹下平均脉络膜厚度随时间推移不断下降。治疗后６个月ＦＦＡ结果显示３３眼渗漏病灶均完全消失。未观察到复发、视网膜色素上皮萎缩、脉络膜新生血管形成等并发症发生。结论　使用半剂量维替泊芬和半能量ＰＤＴ治疗对于单纯黄斑区神经上皮脱离的ＣＣＳＣ是有效和安全的。

Half-dose verteporfin and half laser power PDT for chronic central serous chorioretinopathy

Objective To explore the effectiveness and safety of half-dose verteporfin and half laser power photodynamic therapy ( PDT) in treating chronic central serous chorioretinopathy( CCSC ) . Methods Twenty-five cases ( 33 eyes) with CCSC treated in our department from August 2011 to August 2013 were analyzed. All the cases received PDT treatment with half-dose verteporfin and half laser power ( 25 J . cm -2 ) PDT. Patients were followed up at I month ,3 months .6 months and 12 months. The visual acuity , best corrected visual acuity ( BCVA) , slit lamp ,indirect ophthalmoscope and OCT scan were examined in every follow-up. FFA was performed at 6 months after PDT treatment. Results At last visit . BCVA was improved in 31 eyes and stabled in 2 eyes. The average BCVA was ( 0. 15 + 0. 09 ) LogMAR , which was significant better than that before PDT (0. 50 +0. 18) LogMAR ] ( t = 10. 334 ,P < 0. 001) ; OCT scan showed that the effectiveness rate were 48. 5% , 84. 8% , 93. g% and 100. 0% at I month. 3 months, 6 months and last visit, respectively. Subfoveal mean choroidal thickness ( SFMCT) in CCSC eyes at I month after PDT (391. 53 + 101. 18) ym] was significantly thinner than that before PDT (483. 21 + 89. 13) Vm ] ( t = - 3. 902 ,P < 0. 001 ) . SFMCT reduced gradually as the time prolonged. FFA at 6 months after treatment detected that the leakage lesion disappeared in all cases. There was no recurrence ,retinal pigment epithelium atrophy and CNV. Conclusion Half-dose verteporfin and half laser power PDT treatment is effective and safe for CCSC with macular neuroepithelium detachment.