非损伤阈值下微脉冲激光治疗慢性中心性浆液性脉络膜视网膜病变

目的探讨非损伤阈值下微脉冲激光(subthreshold micropulse laser,SML)治疗慢性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSCR)的疗效与安全性。方法前瞻性非随机病例对照研究。慢性CSCR患者60例(60眼),分为3组:非治疗观察(non-therapeutic observation,NTO)组、光动力疗法(photodynamic therapy,PDT)组、SML组,每组20例(20眼)。通过光学相干断层扫描血管成像、自发荧光、黄斑完整评估仪等获取研究前后患眼的最佳矫正视力(best corrected visual acuity,BCVA)、视网膜敏感度(retinal sensitivity,RS)、视网膜下液(subretinal fluid,SRF)高度及消失时间、中心黄斑厚度(central macular thickness,CMT)、黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)、脉络膜毛细血管血流面积(choriocapillaris...

Non-invasive subthreshold micropulse laser in the treatment of chronic central serous chorioretinopathy

Objective　To evaluate the efficacy and safety of noninvasive subthreshold micropulse laser (SML) in the treatment of chronic central serous chorioretinopathy (CSCR).Methods　A prospective non-randomized case-control study was carried on 60 patients (60 eyes) with chronic CSCR were divided into three groups: non-therapeutic observation (NTO) group, photodynamic therapy (PDT) group and SML group with 20 cases in each group. Several data including best corrected visual acuity (BCVA), retinal sensitivity (RS), subretinal fluid (SRF) height and absorption time, central macular retinal thickness (CMT), subfoveal choroidal thickness (SFCT) and choriocapillaris flow area (CFA) were obtained before and after the study by optical coherence tomography angiography, autofluorescence and macular analyzer integrity assessment and evaluate the damage of ellipsoid zone (EZ) and retinal pigment epithelium (RPE).Results　Only 4 patients in the NTO group had SRF disappeared for (2.98±0.34) months, and all patients in the PDT group had SRF disappeared for (1.87±1.32) months after (1.25±0.44) times of PDT treatment. After treatment for (2.70±1.63) times, SRF disappeared for (3.50±2.06) months in the SML group. There were statistically significant differences in the number of treatments and the disappearance time of SRF between the PDT group and the SML group (both P<0.05). At the last follow-up, BCVA and RS were slightly improved, CMT, SCFT and CFA were not significantly decreased in NTO group compared with those before treatment, and there were significant differences between NTO group and PDT group and SML group (all P<0.05). BCVA, RS and CFA were significantly increased in PDT group and SML group, while CMT and SCFT were significantly decreased, and there were no statistically significant differences in the indicators between the two treatment groups (all P>0.05). EZ injury was persistent in NTO group. In PDT group and SML group, EZ morphology improved and recovered, AF showed no obvious change, and no choroidal neovascularization was observed. No RPE laser damage spots were found in SML group.Conclusion　Active treatment of chronic CSCR can avoid further damage of macular structure and function. SML treatment and PDT treatment ultimately have the same effect and can improve visual function and restore retinal morphological structure. It is safe and non-invasive, and the cost is low. However, SML treatment times increase and the recovery time is longer.