中心性浆液性脉络膜视网膜病变光动力治疗后微视野的改变

目的 研究低剂量光动力治疗中心性浆液性脉络膜视网膜病变（CSC）患眼治疗前后与最佳矫正视力相比微视野计监测视网膜功能的作用。方法 前瞻性自身对照研究。收集2011年3月4日至2011年7月28日就诊于北京同仁眼科医院接受低剂量光动力治疗（PDT）的CSC患者34例（34眼）。在治疗前、治疗后3个月、6个月、12个月进行最佳矫正视力（BCVA）、光相干断层扫描（OCT）评价，治疗前、治疗后3个月进行微视野计中心12度和固视稳定性评价。对两种检查方法治疗前后的检查结果进行χ2检验，对治疗前后检查结果进行前后对照的单因素方差分析，对BCVA与微视野视网膜敏感度相关性进行线性相关分析检测。结果 治疗后12个月BCVA为（85.5±6.8）个字母，较治疗前的（78.1±6.9）个字母明显提高（t=78.05，P<0.01）。治疗后3个月微视野敏感性为（17.2±2.1）dB，较治疗前的（14.1±3.8）dB明显提高（t=19.28，P<0.01）。治疗后12个月OCT检测黄斑中心厚度为（239.2±21.0）μm，较治疗前的（432.7±142.5）μm明显减小（t=18.34，P<0.01）。治疗前和治疗后3个月BCVA的变化与微视野敏感度变化经Mann-Whitney秩和检验差异无显著统计学意义（Z=-1.191，P>0.05）。经线性相关检测，治疗前（r=0.5，P<0.05）、后（r=0.6，P<0.05）患眼BCVA结果与微视野平均敏感度相关，而OCT黄斑中心区厚度与微视野敏感度无相关性（r=0.01和0.002，P均>0.05）。结论 低剂量PDT治疗可以有效地提高CSC患眼的BCVA、促进黄斑区视网膜下液吸收，改善黄斑区视网膜敏感度。微视野黄斑区视网膜敏感度检查在辅助BCVA随访评价CSC患眼治疗后黄斑区视功能变化中有较好的作用。

Changes in the microperimeter of patients with central serous chorioretinopathy treated by low-fluence photodynamic therapy

Objective To compare the effect of low-fluence photodynamic therapy （PDT） in patients with central serous chorioretinopathy （CSC） by evaluation with MP-1 microperimetry and BCVA and to monitor central retinal functional changes. Methods This was a prospective longitudinal self-controlled case series study. Thirty-four patients （34 eyes） with CSC who received low-fluence PDT were enrolled from March 4 2011 to July 28 2011 in our hospital. BCVA and OCT were evaluated at baseline and at 3， 6， and 12 months after PDT. Retinal sensitivity in the central 12 degrees and fixation stability were evaluated by MP-1 microperimetry at baseline and at 3 months after PDT. The changes in BCVA and mean central retinal sensitivity were analyzed by a chi-square test. Linear regression was used to compare the retinal sensitivity measured by microperimetry and BCVA. Results The mean BCVA at 12 months after PDT （85.5±6.8）letters was significantly higher than that at baseline （78.1±6.9）letters （t=78.05， P<0.01）. The mean retinal sensitivity measured by microperimetry at 3 months after PDT was （17.2±2.1）dB， which was significantly higher than that at baseline （13.8±3.7）dB （t=19.28， P<0.01）. The retinal thickness measured by OCT at 12 months after PDT （239.2±21.0）μm was significantly thinner than that at baseline （432.7±142.5）μm （t=18.34， P<0.01）. Mann-Whitney nonparametric analysis showed that the changes in BCVA and microperimetry from baseline to 3 months after treatment were not significantly different （Z=-1.1191， P=0.234）. Linear regression analysis showed that BCVA was correlated with microperimetry both at baseline （r=0.5， P<0.05） and after treatment （r=0.6， P<0.05）， while OCT showed no relationship to microperimetry（r=0.01， 0.002； P=0.79， 0.68）. Conclusion Low-fluence PDT in patients with CSC can improve BCVA， promote the absorption of the subretinal fluid in the macular region， and improve retinal sensitivity in the macular region. The microperimeter is a useful tool combined with BCVA to monitor the functional changes of eyes with CSC.