【摘要】：目的觀察577 nm閾下微脈沖激光治療慢性中心性漿液性脈絡膜視網膜病變(CSC)療效及對黃斑色素密度的影響。設計回顧性病例系列。研究對象2015年8月至2016年2月在南方醫(yī)科大學武漢臨床醫(yī)學院確診為慢性CSC行577 nm閾下微脈沖激光治療的患者32例(32眼)。方法患者均行最佳矯正視力(BCVA)、全視網膜鏡、眼底彩色照相及黃斑色素密度(MPOD)、熒光素眼底血管造影(FFA)和吲哚菁綠血管造影(ICGA)、相干光斷層掃描(OCT)及對比敏感度檢查。577 nm閾下微脈沖激光治療光斑直徑100μm,曝光時間0.2 s,負載系數5%,治療能量為50%P,根據檢查結果對滲漏點及其周圍(跨出滲漏點約50~100μm)進行覆蓋性光凝。治療后1、3、6個月復查相關檢查。主要指標BCVA、視網膜中心凹厚度(CFT)和對比敏感度、視網膜下液(SRF)吸收率、預后相關因素及黃斑色素密度。結果治療1、3、6個月后BCVA分別為0.36±0.15、0.35±0.16、0.32±.021,均較前好轉(P均0.05);CFT分別為(305.56±62.53)μm、(298.29±46.42)μm、(253.81±57.18)μm,均較前下降(P均0.05);對比敏感度分別為14.32±1.02、15.68±0.98、17.53±1.32,均較前提高(P均0.05)。閾下微脈沖治療慢性CSC療效與病變類型和年齡相關,當病變?yōu)辄c狀滲漏其SRF吸收率最高為100%,病變?yōu)榫窒扌詽B漏伴RPE萎縮時SRF吸收率為72.73%,當病變?yōu)閺浡圆∽兗癛PE萎縮時SRF吸收率最低為64.25%。閾下微脈沖治療慢性CSC無反應組平均年齡高于有反應組(t=-9.23,P=0.001)。隨訪6個月,所有患者所有檢查上均未在治療部位觀察到可見光斑。閾下微脈沖激光治療后1、3、6個月MPOD平均值分別為0.15±0.18、0.16±0.05、0.16±0.21(P均0.05)。結論 577 nm閾下微脈沖激光治療慢性CSC安全有效,對MPOD水平無影響。
[Abstract]:Objective to observe the effect of 577 nm subthreshold micropulse laser on chronic central serous chorioretinopathy (CSC) and its effect on macular pigment density. Design retrospective case series. Participants from August 2015 to February 2016, 32 patients (32 eyes) with chronic CSC were treated with 577 nm subthreshold micro-pulse laser in Wuhan College of Clinical Medicine, Southern Medical University. Methods all patients were treated with best corrected visual acuity (BCVA),). Fundus color photography and macular pigment density (MPOD), fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA), coherence tomography (OCT) and contrast sensitivity. 577 nm subthreshold micropulse laser treatment of spot diameter 100 渭 m, exposure time 0.2 s, load coefficient 5 and the therapeutic energy 50 g / P, the percolation point and its surroundings (about 50 ~ 100 渭 m across the leakage point) were covered with photocoagulation according to the results of the examination. At 1: 3 and 6 months after treatment, the related examinations were re-examined. Main outcome measures BCVA, retinal foveal thickness (CFT) contrast sensitivity (SRF) absorptivity of subretinal fluid prognostic factors and macular pigment density. Results BCVA was 0.36 鹵0.15 鹵0.35 鹵0.16 鹵0.32 鹵0.21, respectively, which was better than that before treatment (P 0.05); CFT was (305.56 鹵62.53) 渭 m, (298.29 鹵46.42) 渭 m, (253.81 鹵57.18) 渭 m, respectively, and the contrast sensitivity was 14.32 鹵1.02 鹵15.68 鹵0.9817.53 鹵1.32, respectively). The effect of subthreshold micropulse therapy on chronic CSC was correlated with the type of lesion and age. The SRF absorptivity was 100 when the lesion was point leakage, 72.73 when the lesion was localized leakage with RPE atrophy, and the lowest SRF absorptivity was 64.25when the lesion was diffuse and RPE atrophy. The average age of chronic CSC patients treated with subthreshold micropulse was higher than that of patients with chronic CSC (tr-9. 23 P0. 001). All the patients were followed up for 6 months. No visible spot was observed on all examinations. The mean value of MPOD was 0.15 鹵0.18 鹵0.05 鹵0.16 鹵0.16 鹵0.21 at 3 and 6 months after subthreshold micro-pulse laser treatment respectively (P 0.05). Conclusion 577 nm subthreshold micropulse laser is safe and effective in the treatment of chronic CSC, and has no effect on the level of MPOD.
【作者單位】： 南方醫(yī)科大學武漢臨床醫(yī)學院;
【基金】：國家自然科學基金(61378084)
【分類號】：R774.1

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