摘要目的 观察半剂量维替泊芬光动力疗法(PDT)治疗慢性中心性浆液性脉络膜视网膜病变(CSC)的有效性与安全性.方法 临床确诊为慢性CSC的35例患者35只眼纳入研究.所有患眼均采用国际标准视力表行最佳矫正视力(BCVA)检查,结果转换为最小分辨角对数(logMAR)视力记录;应用光相干断层扫描(OCT)检查测量黄斑中心凹视网膜厚度(CMT).患眼平均logMAR BCVA为0.28±0.22,平均CMT为(384.5±85.0)μm.所有患眼均以半剂量维替泊芬行常规PDT治疗,治疗后1、3、6个月随访观察患眼视网膜下液(SRF)吸收情况.SRF完全吸收视为治愈,再次出现SRF视为复发.复发者于治疗后6个月随访结束后再次给予半剂量维替泊芬PDT治疗.对比分析治疗前后患眼logMAR BCVA、CMT和SRF的变化情况以及治疗后6个月未复发患眼与其对侧健康眼CMT的差异.观察患眼在治疗与随访期间眼部与全身不良反应的发生情况.结果 治疗后1个月,35只跟中,SRF完全吸收29只眼,治愈率82.9％;未完全吸收6只眼,占17.1％.治疗后3个月,所有患眼SRF完全吸收,治愈率100.0％.治疗后6个月,35只眼中,复发3只眼,占8.6％;再次半剂量维替泊芬PDT治疗后,SRF完全吸收.治疗后1、3、6个月,患眼平均logMAR BCVA分别为0.14±0.13、0.05±0.11、0.05±0.12;较治疗前明显提高,差异均有统计学意义(t＝5.410、7.830、7.758,P＜0.05).患眼平均CMT分别为(224.3±61.4)、(199.6±32.7)、(205.3±39.6)μm;较治疗前明显降低,差异均有统计学意义(t＝11.856、11.781、11.900,P＜0.05).治疗后6个月,未复发的32只眼平均CMT为(198.5±33.9) μm,对侧健康眼平均CMT为(232.3±17.5) μm.未复发患眼的平均CMT较对侧健康眼明显降低,差异有统计学意义(t＝-3.988,P＜0.05).所有患眼在治疗与随访期间均未见明显的眼部与全身不良反应.结论 半剂量维替泊芬PDT能安全、有效地治疗慢性CSC,提高患眼视力,但可能造成CMT变薄.

abstractsObjective To evaluate the efficacy and safety of half-dose verteporfin photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC).Methods 35 eyes (35 patients) with chronic (or recurrent) CSC treated with half-dose verteporfin PDT.Best-corrected visual acuity(BCVA),central macular thickness (CMT) were measured before and after treatment (1,3 and 6 months).The mean BCVA was 0.28± 0.22,mean CMT was(384.5 ± 85.0) μm.The situation of subretinal fluids (SRF) absorption was observed.Results In 35 eyes,SRF of 29 eyes (82.9％) completely absorbed and 6 eyes (17.1％) not completely absorbed after one month of treatment.SRF of all eyes (100.0％) completely absorbed after three months of treatment.After 6 months of treatment,SRF of 3 eyes (8.6％) were recurrence,which might be completely absorbed when a half-dose maintenance therapy PDT was used again.The mean BCVA significantly improved to 0.14±0.13 at 1 months,0.05±0.11 at 3 months and 0.05± 0.12 at 6 months after PDT (t=5.410,7.830,7.758; P＜0.05).The mean CMT decreased to (224.3± 61.4) μm at 1 months,(199.6±32.7) μm at 3 months and (205.3±39.6) μm at 6 months after PDT (t=11.856,11.781,11.900; P＜0.05).The mean CMT of controlled 32 eyes after treatment was (198.5± 33.9) μm,much lower than the fellow eyes(232.3 ± 17.5) μm (t =-3.988,P＜0.05).Conclusions Half-dose verteporfin PDT was safe and effective in treating chronic CSC,but may cause thinning of CMT.