微脉冲激光联合与不联合皂苷类药物治疗急性中心性浆液性视网膜脉络膜病变

Micro-Pulse Laser with or without Aescuvenforte for Treatment of Acute Serous Chorioretinopathy

摘要: 目的：观察微脉冲激光视网膜光凝联合与不联合七叶皂苷素(商品名：迈之灵)治疗急性中心性浆液性视网膜脉络膜病变(Central serous chorioretinopathy, CSC)疗效。方法：临床病例对照研究。选取2014年3月至2015年3月微脉冲激光视网膜光凝治疗的急性CSC患者40例。随机选择单一微脉冲视网膜光凝或与迈之灵联合治疗(以下简称联合治疗)两组，最终完成治疗与随访34例42眼。34例CSC中联合治疗22眼，单一微脉冲激光治疗20眼。比较两组治疗前与治疗后4周，8周最佳矫正视力(BCVA)，FFA及ICGA，黄斑视网膜中心厚度，中心视野的变化。结果：治疗后4周CSC联合治疗组BCVA 0.625 ± 0.15，单一治疗组BCVA 0.455 ± 0.18 (p = 0.032)，8周联合治疗组BCVA 0.770 ± 0.17，单一治疗组BCVA 0.576 ± 0.17 (p = 0.027)，两组比较差异均有显著性意义。治疗后4，8周联合治疗组黄斑中心视网膜厚度(CRT)分别为208.4 ± 75 μm，198.8 ± 67 μm，单一治疗组CRT 315 ± 81 μm，278 ± 77 μm (p = 0.041; p = 0.014)，两组差异有显著性意义。治疗后8周联合治疗组视野指数(VFI) 98.0% ± 30.8%，单一治疗组VFI 96.7% ± 26.8% (p = 0.293)，两组差异没有显著性意义。两组视野平均缺损(MD)，模式标准差(PSD)分别为−1.96 ± −0.21 dB，1.77 ± 0.30 dB；−2.10 ± −0.57 dB，1.53 ± 0.27 dB (P = 0.768, P = 0.493)。两组比较差异没有显著性意义。结论：微脉冲视网膜激光光凝联合迈之灵治疗急性CSC与单一视网膜光凝比较能更有效提高BCVA，降低CRT。而两组视野指数，平均缺损，模式标准差比较没有显著性差异，表明微脉冲激光光凝对CSC患者黄斑区视野没有明显影响。

Abstract: Objective: To observe the efficacy of subthreshold micro-pulse laser and subthreshold micro-pulse laser combined with Aescuven forte in treatment of acute central serous chorioretinopathy (CSC). Methods: It was a clinical case-control study. 40 patients of acute CSC treated by micro-pulse laser were analyzed from March 2014 to March 2015. 34 cases (42 eyes) with acute CSC were analyzed retrospectively, divided into two groups: mono subthreshold micro-pulse laser treatment (SMLT) and SMLT combined with Aescuven forte. 22 eyes among 34 CSC patients were treated by combined therapy and 20 eyes treated by mono SMLT. The best-correct visual acuity (BCVA), FFA, ICGA, central retinal thickness (CRT), and visual field index of the two groups before and 4, 8 weeks after the treatment were compared. Results: At the 4th and 8th week after treatment: the BCVA of com-bined group was 0.625 ± 0.15, 0.77 ± 0.17 and the BCVA of mono SMLT group was 0.455 ± 0.18, 0.576 ± 0.17, there was significant difference between two groups (p = 0.032; 0.027); the central retinal thickness (CRT) of combined group was 208.4 ± 75 μm, 198.8 ± 67 μm and that of the mono SMLT group was 315 ± 81 μm, 278 ± 77 μm, there was significant difference between two groups (p = 0.041; 0.014). VFI of combined group was 98.0 ± 30.8%, and that of mono therapy was 96.7 ± 26.8%. There wasn’t difference between two groups at the 8th week after treatment (p = 0.293). MD and PSD (dB) of two groups were −1.96 ± −0.21, 1.77 ± 0.30; −2.10 ± −0.57, 1.53 ± 0.27, respectively. There wasn’t difference between two groups at the 8th week after treatment (p = 0.768, p = 0.493). Conclusion: Combined group could improve BCVA and decrease CFT significantly than mono SMLT group. For the VFI, MD and PSD, there was no difference between the two groups, which indicated that micro-pulse laser had no significant impact on the vision of the macula region.