本文選題：中心性漿液性脈絡膜視網膜病變 + 光動力療法�。� 參考：《中南大學》2010年碩士論文

【摘要】： 目的：觀察三分之一劑量維替泊芬聯(lián)合光動力療法(PDT)治療中心性漿液性脈絡膜視網膜病變(CSC)的臨床療效。 方法：確診為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,男女之比約9.5：1；年齡26-52歲,平均42.1歲�；颊呔邮苋种怀Ｒ�(guī)劑量維替泊芬(2mg/m2)注射,注藥15min后接受波長為689nm激光照射83s。治療后1周、1月、3月和6月隨訪,比較最佳矯正視力(BCVA)、眼底熒光血管造影(FFA)、吲哚青綠血管造影(ICGA)、光學相干斷層掃描(OCT),觀察不良反應。 結果：42例47眼中,PDT治療6月后患者眼前黑影明顯減輕或消失38眼(80.9%)；視力提高≥兩行23眼(48.9%),視力提高一行14眼(29.8%),視力無變化10眼(21.3%)。1月后OCT顯示網膜下液完全吸收44眼(93.6%),FFA和ICGA示滲漏消失的44眼(93.6%)；6月后OCT顯示網膜下液完全吸收47眼(100%),FFA和ICGA示滲漏消失47眼(100%)。視力和OCT均顯示治療前至1月明顯好轉,1月至6月基本穩(wěn)定。 急性CSC治療1月后BCVA好于慢性CSC(P0.01)；急性初發(fā)CSC治療1月后BCVA均≥1.0,較急性復發(fā)視力佳(P0.05)。急性和慢性CSC治療前黃斑區(qū)視網膜神經上皮層(RNEL)厚度的最小值均明顯大于治療后(P0.01)；治療1月后慢性CSC黃斑區(qū)RNEL的厚度明顯小于急性CSC(P0.01)。PDT治療1月后的BCVA (logMAR)與黃斑區(qū)RNEL厚度最小值兩者顯著相關(r=-0.808,P0.01)。 隨訪期間,復發(fā)2例,重復治療5例,全身及眼底均未見明顯并發(fā)癥。 結論：1.三分之一劑量維替泊芬為光敏劑的PDT治療急性和慢性CSC均能改善癥狀,提高和穩(wěn)定視力,停止或減輕脈絡膜血管滲漏,促進視網膜解剖復位,無明顯不良反應。 2.慢性CSC,建議盡早激光治療,對于滲漏點位于黃斑中心和旁中心的患者,建議首選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.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R774.1

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