CAJ | 학술논문

目的利用频域OCT的EDI(Enhanced depth imaging)技术观测急性中心性浆液性脉络膜视网膜病变(CSC)患者经光动力治疗(PDT)或视网膜激光光凝治疗(LP)后脉络膜厚度的短期变化.方法回顾性病例对照研究.经最佳矫正视力(BCVA)、裂隙灯显微镜、前置镜、眼底照相,荧光素钠眼底血管造影(FFA)以及吲哚青绿血管造影(ICGA)等检查确诊为急性CSC的39例患者39眼纳入本研究.以FFA造影为标准,对于渗漏点位于黄斑中心凹无血管区(FAZ)内的患眼,行ICGA造影引导下的半剂量维速达尔PDT治疗；渗漏点位于FAZ外的患眼行LP治疗.在OCT-EDI模式下,取通过黄斑中心凹的水平、垂直两条单线扫描为测量线.以黄斑中心凹为圆心,1500 μm为半径设定中心凹、下、上、鼻、颞共5个测量点,测量脉络膜厚度.治疗前后脉络膜厚度变化采用重复测量方差分析.结果经PDT治疗后,5处测量点的脉络膜厚度均较基线显著下降,差异有统计学意义；经LP治疗后,仅中心凹上、颞侧2处测量点脉络膜厚度较基线的下降具有统计学意义.结论 PDT治疗作用于脉络膜血管,降低脉络膜高渗性,使黄斑区脉络膜厚度显著下降；LP治疗的作用靶点是RPE的渗漏点,脉络膜厚度仅在局部下降.
목적 이용빈역OCT적EDI(Enhanced depth imaging)기술관측급성중심성장액성맥락막시망막병변(CSC)환자경광동력치료(PDT)혹시망막격광광응치료(LP)후맥락막후도적단기변화.방법 회고성병례대조연구.경최가교정시력(BCVA)、렬극등현미경、전치경、안저조상,형광소납안저혈관조영(FFA)이급신타청록혈관조영(ICGA)등검사학진위급성CSC적39례환자39안납입본연구.이FFA조영위표준,대우삼루점위우황반중심요무혈관구(FAZ)내적환안,행ICGA조영인도하적반제량유속체이PDT치료；삼루점위우FAZ외적환안행LP치료.재OCT-EDI모식하,취통과황반중심요적수평、수직량조단선소묘위측량선.이황반중심요위원심,1500 μm위반경설정중심요、하、상、비、섭공5개측량점,측량맥락막후도.치료전후맥락막후도변화채용중복측량방차분석.결과 경PDT치료후,5처측량점적맥락막후도균교기선현저하강,차이유통계학의의；경LP치료후,부중심요상、섭측2처측량점맥락막후도교기선적하강구유통계학의의.결론 PDT치료작용우맥락막혈관,강저맥락막고삼성,사황반구맥락막후도현저하강；LP치료적작용파점시RPE적삼루점,맥락막후도부재국부하강.
Objective To retrospectively evaluate choroidal thickness after treatment by photodynamic therapy (PDT) or laser photocoagulation (LP) in eyes with acute central serous chorioretinopathy (CSC) using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT).Methods In this retrospective study,39 eyes of 39 patients with idiopathic acute CSC were recruited,after the following comprehensive ocular examinations were performed:best-corrected visual acuity (BCVA),slit-lamp biomicroscopy,indirect ophthalmoscopy,fundus photography,fluorescein angiography (FFA),and indocyanine green angiography (ICGA).Patients were divided into 2 types based on FFA characteristics:points of leakage in the foveal avascular zone (FAZ) and points of leakage out from the FAZ.The first type,which is not amenable to LP,was treated with a half-dose of verteporfin PDT guided by ICGA,whereas the other type was treated with LP.Subfoveal choroidal thickness and choroidal thickness at 1500 μm temporal,nasal,superior,and inferior to the fovea were measured.The choroidal thickness was measured with enhanced depth imaging OCT before treatment at baseline,and 1 and 3 months after treatment.The results of the choroidal thickness measurements were analyzed using a repeated measurement ANOVA.Results In the PDT group,choroidal thickness at all evaluating points had decreased significantly within 3 months compared to baseline.Whereas in the LP group,choroidal thickness had decreased significantly within 3 months only at 1500 μm superior and temporal to the fovea compared to baseline.Conclusion PDT reduces choroidal vascular hyperpermeability by remodeling the choroidal vascular system resulting in the reduction of choroidal thickness in the macular region and may work by a different mechanism than LP,which targets RPE.