半量光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变的疗效分析

目的 探讨半剂量维替泊芬光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变的安全性和疗效.方法 结合患者病史和眼底检查、眼底荧光血管造影(FFA)及吲哚菁绿造影(ICGA)检查,诊断为慢性CSC的连续病例24例25只眼,以ICG为指导确定光斑大小和位置,采用1/2剂量维替泊芬PDT治疗.术后随访6～12个月.术前后进行最佳矫正视力(ETDRS视力表)、FFA、ICGA和OCT检查.结果 术后6个月时,最佳矫正视力平均提高(20.6±8.7)个字母(0～32个字母).视力稳定者(0～4个字母)2只眼,占8％；视力提高5～9个字母1只眼,占4％,视力提高10～19个字母8只眼,占32％,视力提高20个字母以上14只眼,占56％,无一只眼视力下降.所有患者诉眼前暗影减轻,视物变形改善.荧光血管造影显示,荧光素渗漏消失22只眼,占88％；渗漏减轻3只眼,占12％；无渗漏加重者.ICG示脉络膜血管通透性下降.OCT显示中央视网膜厚度由术前的(323.55±50.55)μm下降至(168.37±25.35) μm.术后未发现与PDT相关的并发症.结论 1/2剂量维替泊芬联合PDT治疗慢性CSC安全,具有良好疗效,但其长期安全性和有效性还有待于进一步对照研究来证实.

Half-dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy

Objective To evaluate safety and efficiency of photodynamic therapy (PDT) with half dose verteporfin for chronic central serous chorioretinopathy (CSC).Methods Twenty-five eyes of 24 patients with symptomatic chronic CSC received mdocyanine green angiography (ICGA) guided PDT with half-dose verteporfin (3 mg/m2).Main outcome measurements included subjective symptoms,best corrected visual acuity (BCVA),optical coherence tomography (OCT) results before and 1,3 and 6 months after PDT; FFA and ICGA before and 6 months after PDT.Patients were followed 6-12months.Results At 6 months afier PDT,the mean BCVA averagely increased 20.6± 8.7 ETDRS letters,2/25 (8％) eyes had stable vision (0-4 letters),1/25 (4％) eyes had gained 5-9 letters,8/25 (32％)eyes had gained 10-19 letters,14/25 (56％) eyes had gained 20 or more letters; no one had lost any letters at the final follow-up.The central retinal thickness on OCT reduced from 323.55± 50.55μ mto168.37± 25.35μ m,22 (88％) eyes had complete resolution of serous retinal detachment.No ocular or systemic adverse event was encountered in the study.Conclusions PDT with half dose verteporfin appear to be a beneficial treatment option for patients with chronic CSC.Further randomized study is warranted to demonstrate the long term safety and efficacy of this treatment.