半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

目的:观察半量维替泊芬光动力学疗法(photodynamic therapy,PDT)治疗急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的短期疗效。方法:2009-04/2009-09确诊为急性CSC患者12例12眼,行单次半量维替泊芬(3mg/m2)光动力学治疗,术前和术后1,4,12wk进行三维光学相干断层扫描(3D-OCT)的检测,且于术前、术后4wk和12wk进行视网膜荧光造影(FFA)、脉络膜血管造影(ICG)和眼底自发荧光(FAF)检查,观察治疗的有效性和安全性。结果:术前3D-OCT均显示浆液性神经上皮脱离,造影中均存在墨迹样或炊烟样的渗漏及脉络膜血管扭曲扩张弥漫荧光渗漏;术后1wk,3D-OCT有6眼的视网膜下积液吸收;术后4wk时有9眼在OCT中显示渗液完全吸收,7眼在FFA中显示荧光渗漏消失、3眼渗漏减轻,9眼在ICG中显示扭曲扩张的脉络膜血管管径恢复正常、3眼管径略改善,且9眼在术前渗漏点处的异常自发荧光基本恢复正常;术后12wk,仅有1例视网膜下积液仍未完全吸收,余11眼渗液均完全吸收,12眼在造影中均未显示异常荧光渗漏,在FAF上显示在原有浆液性脱离区域内出现点片状散在强自发荧光点。治疗后12wk,视力从术前平均0·43升高至0.8,其中2眼视力术后无明显变化。随访期间12眼均未见任何不良反应。结论:半量维替泊芬PDT治疗急性CSC短期内安全有效。

Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy

AIM: To evaluate the efficacy of photodynamic therapy (PDT) with half-dose verteporfin for treating acute central serous chorioretinopathy (CSC). METHODS: Twelve eyes of 12 patients diagnosed with acute CSC from Apr.2009 to Sep.2009 received one single session of PDT using half-dose (3mg/m2) verteporfin. All eyes were imaged by three-dimensional optical coherence tomography (3D-OCT) before and 1 week, 4,12 weeks and 3 months after PDT to observe the resolution of subretinal fluid(SRF). fundus fluorenscense angiography(FFA), indocyanine green angiography(ICG), and fundus autofluorescence(FAF) were applied to measure the visual acuity(VA) and angiographic changes before and 4, 12 weeks after PDT to evaluate the reliability and effectiveness of PDT. RESULTS: Before PDT, 12 eyes presented serous neuroepithelial detachment in 3D-OCT image, showed indbot diffusion or smokestack phenomenon in FFA,and revealed dilated and tortuous choroidal vessels with diffuse hyperpermeability in ICG pictures.After one week, 3D-OCT showed that SRF was absorbed in 6 eyes. Four weeks after PDT, 9 eyes had complete resolution of SRF; 7 eyes showed a complete absence, and 3 eyes reduction of fluorescein leakage in FFA; the calibers of originally dilated and tortuous choroidal vessels appeared normal in 9 eyes and narrower in 3 eyes as shown in ICG; abnormal autofluorescence had almost resolved in all eyes. Twelve weeks after PDT, 11 eyes had complete resolution of SRF, only one eye unchanged; all eyes showed absence of fluorescein leakage in angiographic graphs and dots of hypoautofluorescence with uniform size and fluorescent intensity in the leak site. The mean VA improved from 0.43 to 0.8, with 2 eyes unchanged. None of the patients developed any systemic adverse event associated with the operation in the follow-up period. CONCLUSION: PDT with half-dose verteporfin is effective and safe in treating acute CSC.