CAJ | 학술논문

背景近年来慢性中心性浆液性脉络膜视网膜病变(CSC)的光动力疗法(PDT)被认为是最有前景的治疗方法之一,但有关其治疗的用药剂量、远期效果及安全性的研究少见报道.目的观察60％剂量维替泊芬PDT对慢性CSC治疗作用的远期效果及安全性.方法采用回顾性病例分析和系列病例治疗前后自身对照研究设计.纳入2009年1月至2010年5月在河南省眼科研究所经荧光素眼底血管造影(FFA)、OCT和吲哚青绿血管造影(ICGA)检查确诊的慢性CSC患者21例25眼,其中男18例,占85.71％,女3例,占14.29％;单眼患者17例,双眼患者4例;年龄34 ～ 56岁,平均(43±5)岁.所有患者均行60％剂量维替泊芬(3.6 mg/m2) PDT治疗,于治疗后2周、1个月和3个月进行复查,观察指标包括治疗前与治疗后3个月最佳矫正视力(BCVA)、OCT、FFA及ICGA表现的比较.所有患者均随访5年以上.结果治疗后3个月患眼BCVA为0.9±0.2,明显优于治疗前的0.5±0.1,差异有统计学意义(t=19.17,P=0.00).治疗后3个月患眼黄斑区中心凹下脉络膜厚度值为(326.56±39.47) μm,明显低于治疗前的(486.24±47.53) μm,差异有统计学意义(t =25.17,P=0.00).治疗后患眼荧光素渗漏均消失.随访5年以上,均无复发,未见全身或局部不良反应.结论 60％剂量维替泊芬PDT治疗慢性CSC的远期效果和安全性好于全剂量维替泊芬.
배경 근년래만성중심성장액성맥락막시망막병변(CSC)적광동력요법(PDT)피인위시최유전경적치료방법지일,단유관기치료적용약제량、원기효과급안전성적연구소견보도.목적 관찰60％제량유체박분PDT대만성CSC치료작용적원기효과급안전성.방법 채용회고성병례분석화계렬병례치료전후자신대조연구설계.납입2009년1월지2010년5월재하남성안과연구소경형광소안저혈관조영(FFA)、OCT화신타청록혈관조영(ICGA)검사학진적만성CSC환자21례25안,기중남18례,점85.71％,녀3례,점14.29％;단안환자17례,쌍안환자4례;년령34 ～ 56세,평균(43±5)세.소유환자균행60％제량유체박분(3.6 mg/m2) PDT치료,우치료후2주、1개월화3개월진행복사,관찰지표포괄치료전여치료후3개월최가교정시력(BCVA)、OCT、FFA급ICGA표현적비교.소유환자균수방5년이상.결과 치료후3개월환안BCVA위0.9±0.2,명현우우치료전적0.5±0.1,차이유통계학의의(t=19.17,P=0.00).치료후3개월환안황반구중심요하맥락막후도치위(326.56±39.47) μm,명현저우치료전적(486.24±47.53) μm,차이유통계학의의(t =25.17,P=0.00).치료후환안형광소삼루균소실.수방5년이상,균무복발,미견전신혹국부불량반응.결론 60％제량유체박분PDT치료만성CSC적원기효과화안전성호우전제량유체박분.
Background It is thought in recently that photodynamic therapy (PDT) is an effective treatment method for chronic central serous chorioretinopathy (CSC), but the dosage of verteporfin and its long-term efficacy and complications is rarely elucidated ever before.Objective This study was to observe the long-term efficacy and safety of 60％ dose verteporfin PDT for chronic CSC.Methods This is a retrospective study and a self-controlled design was used.The clinical data of 25 eyes of 21 chronic CSC patients who received 60％-dose verteporfin PDT in Henan Eye Institute from January 2009 to May 2010 were reviewed, with the male 18 (85.71％) and female 3 (14.29％) as well as monocular CSC 17 patients and binocular CSC 4 patients.The average ages of the patients were (43±5) years.Fundus fluorescein angiography (FFA) , indocyanine green angiography (ICGA), optical coherence tomography(OCT) and best corrected visual acuity (BCVA) were examined in all the patients before and after treatment.PDT with the 60％-dose verteporfin (3.6 mg/m2) was carried out on the CSC eyes.The treated eyes were examined 2 weeks, 1 month and 3 months after PDT.The BCVA,subfoveal choroid thickness,FFA and ICGA findings before and after PDT were compared.The following-up duration was 5 years or more.Results The BCVA before and 3 months after PDT were 0.5 ±0.1 and 0.9±0.2, respectively, with a statistically significant difference between them (t =19.17,P =0.00).The subfoveal choroidal thickness value 3 months after PDT was (326.56±39.47) μm,which was significantly reduced in comparison with (486.24 ±47.53) μm before PDT (t =25.17, P =0.00).FFA and ICGA showed that the leakage of fluorescein (hyperfluorescence) was disappeared in all the treated eyes.No systemic or local adverse effects and recurrence were observed during the follow-up period.Conclusions On the basis of the results of this study and available information,60％-dose verteporfin PDT seems to have a better long-term efficacy and safety than full-dose verteporfin in treating chronic CSC.