三分之一剂量维替泊芬光动力疗法治疗中心性浆液性脉络膜视网膜病变

发布时间：2018-05-25 13:32

本文选题：中心性浆液性脉络膜视网膜病变 + 光动力疗法　；参考：《中南大学》2010年硕士论文

【摘要】： 目的：观察三分之一剂量维替泊芬联合光动力疗法(PDT)治疗中心性浆液性脉络膜视网膜病变(CSC)的临床疗效。方法：确诊为CSC的患者42例47眼,其中急性22例22眼,慢性20例25眼；男性38例,女性4例,男女之比约9.5：1；年龄26-52岁,平均42.1岁。患者均接受三分之一常规剂量维替泊芬(2mg/m2)注射,注药15min后接受波长为689nm激光照射83s。治疗后1周、1月、3月和6月随访,比较最佳矫正视力(BCVA)、眼底荧光血管造影(FFA)、吲哚青绿血管造影(ICGA)、光学相干断层扫描(OCT),观察不良反应。结果：42例47眼中,PDT治疗6月后患者眼前黑影明显减轻或消失38眼(80.9%)；视力提高≥两行23眼(48.9%),视力提高一行14眼(29.8%),视力无变化10眼(21.3%)。1月后OCT显示网膜下液完全吸收44眼(93.6%),FFA和ICGA示渗漏消失的44眼(93.6%)；6月后OCT显示网膜下液完全吸收47眼(100%),FFA和ICGA示渗漏消失47眼(100%)。视力和OCT均显示治疗前至1月明显好转,1月至6月基本稳定。急性CSC治疗1月后BCVA好于慢性CSC(P0.01)；急性初发CSC治疗1月后BCVA均≥1.0,较急性复发视力佳(P0.05)。急性和慢性CSC治疗前黄斑区视网膜神经上皮层(RNEL)厚度的最小值均明显大于治疗后(P0.01)；治疗1月后慢性CSC黄斑区RNEL的厚度明显小于急性CSC(P0.01)。PDT治疗1月后的BCVA (logMAR)与黄斑区RNEL厚度最小值两者显著相关(r=-0.808,P0.01)。随访期间,复发2例,重复治疗5例,全身及眼底均未见明显并发症。结论：1.三分之一剂量维替泊芬为光敏剂的PDT治疗急性和慢性CSC均能改善症状,提高和稳定视力,停止或减轻脉络膜血管渗漏,促进视网膜解剖复位,无明显不良反应。 2.慢性CSC,建议尽早激光治疗,对于渗漏点位于黄斑中心和旁中心的患者,建议首选PDT。
[Abstract]:Objective: to observe the clinical effect of 1/3 dose of telipofen combined with photodynamic therapy in the treatment of central serous chorioretinopathy. Methods: 42 cases (47 eyes) were diagnosed as CSC, including 22 cases of acute disease (22 eyes) and 20 cases of chronic diseases (25 eyes), male 38 cases, female 4 cases, the ratio of male to female was about 9.5: 1. The age ranged from 26 to 52 years (mean 42.1 years). All patients were injected with 1/3 routine dose of vitipofen (2mg / m2). The wavelength of 689nm laser irradiation was 83 s after injection of 15min. One week, one month, three months and six months after treatment, the best corrected visual acuity (BCVA), fundus fluorescein angiography (FFAA), indocyanine green angiography (ICGAA) and optical coherence tomography (Oct) were compared. Results in 42 cases, 47 eyes of 42 cases were treated with PDT for 6 months. After 6 months of treatment, 38 eyes (80.9 eyes) were obviously relieved or disappeared. Visual acuity was improved more than two lines in 23 eyes (48.9 eyes), visual acuity improved by one line in 14 eyes (29.8%), visual acuity did not change in 10 eyes (21.3%). One month later, OCT showed complete absorption of 44% subomentum fluid. After 6 months, OCT showed that 47 eyes were completely absorbed by subomentum fluid, and ICGA showed that the leakage disappeared in 47 eyes. Visual acuity and OCT showed significant improvement between January and January, and remained stable from January to June. After one month of acute CSC, BCVA was better than that of chronic CSCC P0.01.The BCVA of acute primary CSC was more than 1.0, which was better than that of acute recurrent visual acuity (P0.05). The minimum retinal neuroepithelial layer thickness of macular area before acute and chronic CSC treatment was significantly larger than that of P0.01a after treatment, and the thickness of RNEL in chronic CSC was significantly lower than that of BCVA log Mar and macular area after one month of acute CSC(P0.01).PDT treatment. There was a significant correlation between the minimum thickness of RNEL and the values of r-0.808 (P0.01). During the follow-up period, there were 2 cases of recurrence and 5 cases of repeated treatment. No obvious complications were found in the whole body and the fundus of the eyes. Conclusion 1. 1/3 dose of vitipofen as a Guang Min agent in the treatment of acute and chronic CSC can improve symptoms, improve and stabilize visual acuity, stop or reduce choroidal vascular leakage, promote anatomical reattachment of the retina without obvious adverse reactions. 2. For chronic CSCs, laser therapy is recommended as early as possible, and PDT is recommended for patients with leakage sites located in the central and paracentral macula.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774.1

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