摘要目的 探讨同步荧光素眼底血管造影与吲哚氰绿脉络膜血管造影联合相干光断层扫描(OCT)指导下的光动力疗法对慢性或复发性中心性浆液性脉络膜视网膜病变(CSC)的治疗效果.方法 病例系列研究.选择18例(20只眼)已确诊的CSC患者,病程1～24个月.采用同步荧光素眼底血管造影与吲哚氰绿脉络膜血管造影联合频域OCT检测,根据检查图像中显示的活动性病变(定义为局灶性或弥漫性视网膜色素上皮荧光素渗漏、脉络膜血管通透性增加、视网膜神经上皮脱离区域内的色素上皮脱离)进行半剂量光动力治疗.治疗后随访6～20个月,观察患者病变区结构和功能改变.治疗前后患者最佳矫正视力(BCVA)和黄斑中心凹区视网膜厚度(CFT)比较,采用配对t检验；治疗后BCVA与CFT相关性分析,采用直线相关分析法；治疗后黄斑中心凹光感受器细胞层内外节连接部(IS-OS)和视网膜外界膜完整眼与IS-OS和视网膜外界膜不完整眼的BCVA比较,采用两独立样本t检验.结果 18例(20只眼)患者经光动力治疗后3个月BCVA为0.72±0.32,末次随访时为0.78±0.29,分别与治疗前BCVA(0.35 ±0.16)比较,差异均有统计学意义(=6.444,6.883;P＜0.05).末次随访时的BCVA与治疗前相比,有15只眼(75.0％)视力提高,5只眼(25.0％)视力不变.患者治疗后1个月CFT为(193.3±30.6)μm,治疗后3个月为(194.9 ±28.3)μm,末次随访时为(190.6±33.7) μm,分别与治疗前(369.0±120.9)μm比较,差异均有统计学意义(t=-6.836,-6.826,-7.316；P＜0.05).患者末次随访的BCVA与CFT无相关性(r=0.166,P＞0.05)；而光感受器细胞IS-OS和视网膜外界膜完整眼与不完整眼的BCVA相比,差异有统计学意义(t=-3.53,P ＜0.05).所有患者治疗后1个月视网膜下积液均吸收,随访期间病变无复发.结论 同步荧光素眼底血管造影与吲哚氰绿脉络膜血管造影联合OCT指导的半剂量光动力疗法对CSC患者的治疗效果好且安全.

abstractsObjective To evaluate the effect of Spectralis HRA + OCT-guided photodynamic therapy with half-dose verteporfin in the treatment of chronic or recurrent central serous chorioretinopathy.Methods It was a retrospective case series.Twenty eyes of 18 patients with chronic or recurrent central serous chorioretinopathy were included.PDT was applied with half-dose verteporfin (3 mg/m2 ) on the site of active area shown on Spectralis HRA + OCT (defined as focal or diffuse retinal pigment epithelial leakage,choroidal hyperpermeability,or pigment epithelial detachment located within the neurosensory detachment),and patients were observed to determine the anatomic and functional outcomes. Statistical analysis was performed using SAS ( version 9.2).A P value of 0.05 was considered statistically significant.Comparisons of pre- and post-treatment best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were performed using a paired t test.The relationship between BCVA and CFT post-treatment was analyzed by linear correlation analysis.Comparisons of the BCVA of eyes with and without the integrity of photoreceptor IS-OS and/or external limiting membrane at the last follow-up visit were performed using two sample t test.Results The median CSC duration was 4.5 months ( ranged 1 month to 2 years).The median follow-up period after PDT was 8 months (ranged 6 to 20 months).The mean BCVA before PDT was 0.35 ± 0.16 ( ranged 0.05 to 0.6),at 3 months after PDT was 0.72 ± 0.32 ( ranged 0.1 to 1.5 ) and at the last follow-up visit was 0.78 ± 0.29 ( ranged 0.3 to 1.5 ) ( t =6.444,6.883,P ＜ 0.05 ).Fifteen eyes (75.0％) had improved vision,and 5 eyes (25.0％) had stable vision.The mean CFT was reduced from ( 369.0 ± 120.9) μm before PDT to ( 193.3 ± 30.6) μm 1 month after PDT,( 194.9 ± 28.3 ) μm 3 month after PDT and ( 190.6 ±33.7) μm at the last follow-up visit (t =-6.836,-6.826,-7.316;P ＜ 0.05).At the last follow-up visit BCVA was not correlated with CFT (r =0.166,P ＞ 0.05 ),but BCVA of the eyes with the integrity of photoreceptor IS-OS and/or external limiting membrane was better than that of without (t =- 3.53,P ＜ 0.05 ).Subretinal fluid disappeared in all eyes 1 month after PDT and there was no recurrence during the follow-up.Conclusions Spectralis HRA + OCT-guided photodynamic therapy with half-dose of verteporfin seems effective and safe for the treatment of chronic or recurrent central serous chorioretinopathy.