两种不同能量的阈值下微脉冲光凝治疗急性中心性浆液性脉络膜视网膜病变疗效分析

doi:DOI:10.3760/cma.j.issn.1674-845X.2017.02.011

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摘要

目的评估并比较50%滴定能量（TP）的577 nm阈值下微脉冲光凝（SMLP）与25%TP的577 nm SMLP治疗急性中心性浆液性脉络膜视网膜病变（CSC）的短期疗效。方法前瞻性非随机对照研究。纳入2014年12月至2016年6月在中山大学中山眼科中心就诊且符合入选标准的单眼急性CSC患者94例（94眼），给予50%的TP-SMLP治疗（50%TP-SMLP组）或者25%的TP-SMLP治疗（25%TP-SMLP组）。治疗前及治疗后1个月均行最佳矫正视力（BCVA）和频域光学相干断层扫描检查（SD-OCT）。通过t检验或秩和检验评估BCVA（LogMAR）及黄斑中心凹厚度（CMT）的改变及2组之间的差异，卡方检验比较2组治疗后视网膜下积液（SRF）完全吸收率。结果 50%TP-SMLP组共纳入55例患者（男性82%），治疗前BCVA为（0.34±0.25）LogMAR，治疗后1个月为（0.12±0.21）LogMAR（t=8.557，P＜0.001）；治疗前CMT为（461±168）µm，治疗后1个月为（227±82）µm（t=10.332，P＜0.001）。25%TP-SMLP组共纳入39例患者（男性92%），治疗前BCVA为（0.35±0.25）LogMAR，治疗后1个月为（0.24±0.22）LogMAR（t=3.759，P=0.001）；治疗前CMT为（471±170）µm，治疗后1个月为（298±97）µm（t=6.610，P＜0.001）。组间比较显示在治疗1个月后，50%TP-SMLP组在提高BCVA（t=2.850，P=0.005）及降低CMT（Z=-3.787，P＜0.001）方面均显著好于25%TP-SMLP组。治疗后1个月50%TP-SMLP组及25%TP-SMLP组的SRF完全吸收率分别为71%与26%（χ²=18.738，P＜0.001）。结论 50%TP-SMLP与25%TP-SMLP治疗急性CSC后1个月均可显著改善患者的BCVA、CMT，促进SRF吸收，且50% TP-SMLP的疗效更好。

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关键词 ：阈值下微脉冲光凝, 滴定能量, 中心性浆液性脉络膜视网膜病变

Abstract：

Objective To evaluate and compare the short-term effects of 25% and 50% titration power (TP) in subthreshold micropulse laser photocoagulation (SMLP) for acute central serous chorioretinopathy (CSC). Methods This was a prospective, non-randomized, controlled study. Ninety-four patients (94 eyes) attending Zhongshan Ophthalmic Center with acute CSC from December 2014 to June 2016 were enrolled. The patients were treated with either 25%TP-SMLP or 50%TP-SMLP. Best-corrected visual acuity (BCVA), fundus photography, fundus spectrum-domain optical coherence tomography (SD-OCT), were performed on every patient before treatment. The patients were re-examined for BCVA and by SD-OCT at the one-month follow-up. Changes in the logarithm of the minimum angle of resolution (LogMAR) of BCVA, central macular thickness (CMT), and rate of complete absorption of subretinal fluid (SRF), were evaluated by t-test or rank sum test and chi-square test. Results Fifty-five patients (82% males) and 39 patients (92% males) were included in the 50%TP-SMLP and 25%TP-SMLP groups, respectively. One month after the 50%TP-SMLP treatment, the BCVA improved (t=8.557, P＜0.001) while the CMT decreased (t=10.332, P＜0.001). One month after the 25%TP-SMLP treatment, both the BCVA and the CMT decreased (t=3.759, P＜0.001 and t=6.610, P＜0.001, respectively). The improvement in BCVA (t=2.850, P=0.005) and decrease in CMT (Z=-3.787, P＜0.001) were considerably better in the 50%TP-SMLP group than that in the 25%TP-SMLP group. At one month after treatment, complete absorption of SRF occurred in 71% and 26% of the eyes in the 50% and 25%TP-SMLP groups, respectively (χ²=18.738, P＜0.001). Conclusion Both 25% and 50%TP-SMLP can significantly improve BCVA, reduce CMT, and accelerate the absorption of SRF for acute CSC. However, the effect of 50%TP-SMLP is much better than that of 25%TP-SMLP.

Key words： Subthreshold micropulsephotocoagulation Titration power Central serous chorioretinopathy

收稿日期: 2016-12-27

通讯作者: 金陈进，Email：jinchj@mail.sysu.edu.cn

引用本文:

周立军,李涛,赖坤贝,黄创新,许发宝,于珊珊,钟晓菁,马丽,陈观娣. 两种不同能量的阈值下微脉冲光凝治疗急性中心性浆液性脉络膜视网膜病变疗效分析[J]. 中华眼视光学与视觉科学杂志, 2017, 19(2): 120-124. ZHOU Lijun, LI Tao, LAI Kunbei, HUANG Chuangxin, XU Fabao,YU Shanshan,ZHONG Xiaojing,MA Li,CHEN Guandi,HU Jun,LU Lin,JIN Chenjin. Short-term effect of subthreshold micropulse laser photocoagulation with two different powers for acute central serous chorioretinopathy. Chinese Journal of Optometry Ophthalmology and Visual science, 2017, 19(2): 120-124. DOI: DOI:10.3760/cma.j.issn.1674-845X.2017.02.011

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