CAJ | 학술논문

目的观察分析不同病程中心性浆液性脉络膜视网膜病变(CSC)患眼光动力疗法(PDT)治疗前后光相干断层扫描(OCT)图像特征与视力预后的关系.方法临床确诊为CSC并行PDT治疗的93例患者103只眼纳入研究.根据病程将患者分为＜4个月组(A组)、4～6个月组(B组)、＞6个月组(C组),分别为28、42、33只眼.治疗前后所有患者均行最佳矫正视力(BCVA)检查;同时行黄斑区OCT检查,观察视网膜色素上皮(RPE)结构特征及中心凹外核层(ONL)厚度.治疗前RPE正常连续、隆起或脱离、紊乱或萎缩在A组患眼中所占比例分别为63.0％、37.0％、0.0％;在B组患眼中所占比例分别为41.9％、53.5％、4.7％;在C组患眼中所占比例分别为24.2％、57.6％、18.2％.3组间具有不同RPE结构特征的患眼数比较,差异有统计学意义(x2=19.88,P=0.001).A、B、C组患眼ONL厚度为(220.42±49.88)、(145.81±19.65)、(98.15±33.02) μm.3组间ONL厚度比较,差异有统计学意义(P=0.000).对比观察治疗前具有不同RPE结构特征的患眼治疗后BCVA的差异;分析患眼治疗前后ONL厚度与治疗后BCVA的相关性.结果 A、B、C组组内治疗前RPE正常连续眼与RPE隆起或脱离眼治疗后平均BCVA比较,差异均无统计学意义(P=0.599、0.151、0.789).B、C组组内治疗前RPE紊乱或萎缩眼治疗后平均BCVA较RPE隆起或脱离眼明显降低,差异有统计学意义(P=0.025、0.036).治疗后A、B、C组患眼平均ONL厚度分别为(139.14±26.23)、(119.14±21.09)、(97.61±29.92) μm.A、B组患眼ONL厚度均较治疗前降低,差异有统计学意义(P=0.000、0.010);C组患眼ONL厚度较治疗前无明显变化,差异无统计学意义(P=0.192).A组患眼治疗后BCVA与治疗前ONL厚度呈显著负相关(r=-0.684,P=0.000);C组患眼治疗后BCVA与治疗后ONL厚度呈正相关(r=0.413,P=0.017);B组患眼治疗后BCVA与治疗前、治疗后ONL厚度均无相关性(r=0.278、0.117,P=0.074、0.462).结论 CSC患眼随病程延长RPE紊乱或萎缩的比例逐渐增加,ONL厚度逐渐变薄.PDT治疗后,病程＜6个月的CSC患眼ONL厚度降低,病程＞6个月的CSC患眼ONL厚度无明显变化.治疗前RPE紊乱或萎缩患眼的视力预后较RPE正常连续、隆起或脱离患眼差.病程＜4个月及＞6个月的CSC患眼视力预后与ONL厚度相关. 目的觀察分析不同病程中心性漿液性脈絡膜視網膜病變(CSC)患眼光動力療法(PDT)治療前後光相榦斷層掃描(OCT)圖像特徵與視力預後的關繫.方法臨床確診為CSC併行PDT治療的93例患者103隻眼納入研究.根據病程將患者分為＜4箇月組(A組)、4～6箇月組(B組)、＞6箇月組(C組),分彆為28、42、33隻眼.治療前後所有患者均行最佳矯正視力(BCVA)檢查;同時行黃斑區OCT檢查,觀察視網膜色素上皮(RPE)結構特徵及中心凹外覈層(ONL)厚度.治療前RPE正常連續、隆起或脫離、紊亂或萎縮在A組患眼中所佔比例分彆為63.0％、37.0％、0.0％;在B組患眼中所佔比例分彆為41.9％、53.5％、4.7％;在C組患眼中所佔比例分彆為24.2％、57.6％、18.2％.3組間具有不同RPE結構特徵的患眼數比較,差異有統計學意義(x2=19.88,P=0.001).A、B、C組患眼ONL厚度為(220.42±49.88)、(145.81±19.65)、(98.15±33.02) μm.3組間ONL厚度比較,差異有統計學意義(P=0.000).對比觀察治療前具有不同RPE結構特徵的患眼治療後BCVA的差異;分析患眼治療前後ONL厚度與治療後BCVA的相關性.結果 A、B、C組組內治療前RPE正常連續眼與RPE隆起或脫離眼治療後平均BCVA比較,差異均無統計學意義(P=0.599、0.151、0.789).B、C組組內治療前RPE紊亂或萎縮眼治療後平均BCVA較RPE隆起或脫離眼明顯降低,差異有統計學意義(P=0.025、0.036).治療後A、B、C組患眼平均ONL厚度分彆為(139.14±26.23)、(119.14±21.09)、(97.61±29.92) μm.A、B組患眼ONL厚度均較治療前降低,差異有統計學意義(P=0.000、0.010);C組患眼ONL厚度較治療前無明顯變化,差異無統計學意義(P=0.192).A組患眼治療後BCVA與治療前ONL厚度呈顯著負相關(r=-0.684,P=0.000);C組患眼治療後BCVA與治療後ONL厚度呈正相關(r=0.413,P=0.017);B組患眼治療後BCVA與治療前、治療後ONL厚度均無相關性(r=0.278、0.117,P=0.074、0.462).結論 CSC患眼隨病程延長RPE紊亂或萎縮的比例逐漸增加,ONL厚度逐漸變薄.PDT治療後,病程＜6箇月的CSC患眼ONL厚度降低,病程＞6箇月的CSC患眼ONL厚度無明顯變化.治療前RPE紊亂或萎縮患眼的視力預後較RPE正常連續、隆起或脫離患眼差.病程＜4箇月及＞6箇月的CSC患眼視力預後與ONL厚度相關.
목적 관찰분석불동병정중심성장액성맥락막시망막병변(CSC)환안광동력요법(PDT)치료전후광상간단층소묘(OCT)도상특정여시력예후적관계.방법 림상학진위CSC병행PDT치료적93례환자103지안납입연구.근거병정장환자분위＜4개월조(A조)、4～6개월조(B조)、＞6개월조(C조),분별위28、42、33지안.치료전후소유환자균행최가교정시력(BCVA)검사;동시행황반구OCT검사,관찰시망막색소상피(RPE)결구특정급중심요외핵층(ONL)후도.치료전RPE정상련속、륭기혹탈리、문란혹위축재A조환안중소점비례분별위63.0％、37.0％、0.0％;재B조환안중소점비례분별위41.9％、53.5％、4.7％;재C조환안중소점비례분별위24.2％、57.6％、18.2％.3조간구유불동RPE결구특정적환안수비교,차이유통계학의의(x2=19.88,P=0.001).A、B、C조환안ONL후도위(220.42±49.88)、(145.81±19.65)、(98.15±33.02) μm.3조간ONL후도비교,차이유통계학의의(P=0.000).대비관찰치료전구유불동RPE결구특정적환안치료후BCVA적차이;분석환안치료전후ONL후도여치료후BCVA적상관성.결과 A、B、C조조내치료전RPE정상련속안여RPE륭기혹탈리안치료후평균BCVA비교,차이균무통계학의의(P=0.599、0.151、0.789).B、C조조내치료전RPE문란혹위축안치료후평균BCVA교RPE륭기혹탈리안명현강저,차이유통계학의의(P=0.025、0.036).치료후A、B、C조환안평균ONL후도분별위(139.14±26.23)、(119.14±21.09)、(97.61±29.92) μm.A、B조환안ONL후도균교치료전강저,차이유통계학의의(P=0.000、0.010);C조환안ONL후도교치료전무명현변화,차이무통계학의의(P=0.192).A조환안치료후BCVA여치료전ONL후도정현저부상관(r=-0.684,P=0.000);C조환안치료후BCVA여치료후ONL후도정정상관(r=0.413,P=0.017);B조환안치료후BCVA여치료전、치료후ONL후도균무상관성(r=0.278、0.117,P=0.074、0.462).결론 CSC환안수병정연장RPE문란혹위축적비례축점증가,ONL후도축점변박.PDT치료후,병정＜6개월적CSC환안ONL후도강저,병정＞6개월적CSC환안ONL후도무명현변화.치료전RPE문란혹위축환안적시력예후교RPE정상련속、륭기혹탈리환안차.병정＜4개월급＞6개월적CSC환안시력예후여ONL후도상관.
Objective To observe the characteristics of optical coherence tomography (OCT) in central serous chorioretinopathy (CSC) patients with different symptom duration before and after photodynamic therapy (PDT),and investigate its relationship with vision prognosis.Methods 93 CSC patients (103 eyes) who had undergone the treatment of PDT were enrolled in this study.The eyes were divided into 3 groups according to symptom duration including group A (＜ 4 months,28 eyes),group B (4-6 months,42 eyes),group C (＞6 months,33 eyes).The best corrected visual acuity (BCVA) and OCT were performed before and after treatment.Before the treatment,the percentage of patients with regular retinal pigment epithelium (RPE),irregular bump or detachment of RPE and disordered RPE were 63.0％,37.0％,0.0％ in group A;41.9％,53.5％,4.7％ in group B and 24.2％,57.6％,18.2％ in group C,respectively.The difference of percentage of RPE structure was no significance among the three groups (x2 =19.88,P=0.001).The outer nuclear layer (ONL) thickness was (220.42±49.88),(145.81± 19.65),(98.15±33.02) μm in group A,B,C respectively,the difference between three groups was significant (P =0.000).The BCVA differences in different RPE structure and the relationship between ONL thickness and vision prognosis were recorded and analyzed.Results The difference of ONL thickness in eyes with regular RPE and irregular bump or detachment of RPE in group A,B and C were not significant (P=0.599,0.151,0.789).The ONL thickness in eyes with disordered RPE were decreased significantly compared to eyes with irregular bump or detachment of RPE in group B and C (P=0.025,0.036).The ONL thickness were (139.14±26.23),(119.14±21.09),(97.61±29.92) μm after PDT,respectively.Compared with ONL thickness before PDT,there was statistically significant decreasing after PDT in group A and B (P=0.000,0.010),but there was no statistically significant difference after PDT in group C (P=0.192).After PDT,BCVA was negatively related to ONL thickness before PDT in group A (r=-0.684,P=0.000),and was positively related to ONL thickness after PDT in group C (r=0.413,P=0.017),but was neither related to ONL thickness before nor after PDT in group C (r=0.278,0.117;P =0.074,0.462).Conclusions With the duration of symptom being longer,the rate of irregular bump or detachment of RPE and disordered RPE are increased gradually,ONL thickness is getting thinner.After PDT,the ONL thickness became thinner in eyes with symptom duration less than 6 months and has no difference in eyes with symptom duration more than 6 months.The difference of BCVA in eyes with different RPE structure is significant.The vision prognosis of CSC with duration less than 4 months or more than 6 months are related to ONL thickness.