摘要
目的分析半剂量光动力治疗(photodynamic therapy, PDT)慢性中心性浆液性脉络膜视网膜病变(chronic central serous chorioretinopathy,cCSC)视网膜色素上皮脱离(retinal pigment epithelial detachment,RPED)的疗效和治疗12个月后视力预后、与689 nm基线特征的相关性。方法回顾性分析2015年1月至2017年6月,cCSC单纯性RPED患者27例30只眼,均行半剂量PDT治疗,激光功率密度600 mW/cm2,照射时间83 s,照射光斑直径覆盖整个病灶。PDT治疗后患者严格避光48 h。分析治疗后3、6、9和12个月最佳矫正视力(best corrected visual acuity,BCVA)、中心凹下脉络膜厚度(subfoveal choroidal thickness, SFCT)、黄斑中心凹厚度(central macular thickness, CMT)和RPED的变化。记录治疗后12个月的BCVA,与基线BCVA比较,依据BCVA变化分为BCVA提高组和未提高组,单因素和Logistic回归分析BCVA预后与基线特征的相关性。结果治疗前平均BCVA(Log MAR)为(0. 15±0. 08),平均SFCT为(358. 5±50. 6)μm,平均CMT为(244. 5±91. 4)μm,治疗前与治疗后3、6、9和12个月的log MAR BCVA、SFCT、CMT比较,差异均具有统计学意义(P<0. 05)。治疗后3个月PED完全吸收22只眼(占73. 3%),PED部分吸收或无明显变化8只眼(占26. 7%);治疗6个月后PED完全吸收28只眼(占93. 3%),PED部分吸收或无明显变化2只眼(占6. 7%)。随访观察至9个月所有患者PED完全吸收,且治疗后12个月PED无复发情况。单因素分析结果显示,BCVA提高组与BCVA未提高组在年龄、基线BCVA、SFCT、RPED高度均具有统计学意义(P<0. 05)。Logistic回归结果显示,年龄、基线BCVA、RPED高度、体积是影响患者视力预后的独立相关因素(回归系数=0. 356,0. 052,0. 045,0. 909;P=0. 016,0. 035,0. 003,0. 049;比值比=1. 427,1. 053,1. 046,2. 482;95%可信区间1. 068~1. 907,1. 004~1. 104,1. 016?~1. 078,1. 002~6. 148)。结论半剂量PDT治疗cCSC单纯性RPED安全有效,年龄、基线BCVA和RPED高度、体积可能是cCSC单纯性RPED视力预后�
Objective To report the clinical outcomes of half-dose photodynamic therapy(PDT)for retinal pigment epithelial detachment(RPED)in chronic central serous chorioretinopathy(cCSC)and identify prognostic factors affecting treatment outcomes.Methods A retrospective study was conducted on 30 eyes of 27 patients with RPED in CSC.Half-dose PDT was applied to each patient.Their best-corrected visual acuity,anatomical resolution of RPED,central macular thickness and subfoveal choroidal thickness were analyzed.The BCVA obtained 12 months after the treatment was recorded and compared with the baseline BCVA,and then the patients were divided into the improved and unimproved groups by BCVA changes.Finally,univariate and logistic regression analysis were used to analyze the correlation between the baseline factors and BCVA.Results The preoperative mean log MAR BCVA,SFCT and CMT were(0.15±0.08),(358.5±50.6)μm and(244.5±91.4)μm respectively.The differences of the logMAR BCVA,SFCT and CMT were remarkable(P<0.05)before and after the treatment.RPED disappeared in 73.3%of the cases after 3 months,but was not resolved completely in 26.7%of the cases.It disappeared in 93.3%of the cases after 6 months and in all the cases after 9 months.No recurrence occurred to any case 12 months after the treatment.The results of univariate analysis indicated that patient’s age,baseline BCVA,choroidal thickness,RPED height and volume at baseline could be major factors related to treatment outcomes(P=0.005,0.021,0.015,0.010,0.022,respectively).The outcome of logistic regression showed that the age,baseline BCVA,RPED height and volume were statistically significant,suggesting that they were the independent predictors of visual outcomes(regression coefficient=0.356,0.052,0.045,0.909,odds ratios=1.427,1.053,1.046,2.482;95%confidence interval 1.068~1.907,1.004~1.104,1.016~1.078,1.002~6.148).Conclusion RPED in central serous chorioretinopathy responds well to half-dose PDT,especially in younger patients with less RPED and greater baseline BCVA.
作者
李凤媚
宋艳萍
LI Feng-mei;SONG Yan-ping(Ophthalmic Center of Wuhan General Hospital of PLA,Clinical medical research center for fundus laser in Hubei province,Wuhan 430070,China)
出处
《中国激光医学杂志》
CAS
2019年第2期78-84,共7页
Chinese Journal of Laser Medicine & Surgery
