光学相干断层扫描血管成像引导光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变
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摘要
目的探讨光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)作为一种新方法引导光动力疗法(photodynamic therapy,PDT)治疗慢性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的疗效。方法非随机病例对照研究。慢性CSC患者60例(60眼),按引导PDT光斑设计方法分为三组,每组各20例,A组由荧光素眼底血管造影设计、B组由吲哚菁绿血管造影设计、C组由OCTA设计,同时选入正常眼36例(36眼)作为对照;患者均采用半剂量维替泊芬PDT进行治疗。比较治疗前后不同时期最佳矫正视力(best corrected visual acuity,BCVA)、视网膜下液(subretinal fluid,SRF)吸收时间、光感受器内外节至Bruch膜厚度(photoreceptor inner/outer segment to bruch member thickness,IOBT)、中央视网膜厚度(central retinal thickness,CRT)、黄斑中心凹下脉络膜厚度(subretinal fovea choridial thickness,SFCT)、后极部6 mm×6 mm区域脉络膜毛细血管血流密度(choriocapillary layer angio-flow density,CFD)以及治疗后并发症情况。结果 PDT光斑大小A组(1500.00±79.47)μm、B组(2800.00±629.95)μm、C组(2700.00±553.46)μm差异有统计学意义(P=0.000),A组明显小于B、C组(均为P=0.000),B、C两组差异无统计学意义(P=0.358)。三组SRF吸收时间差异有统计学意义(P=0.000),其中A组比B、C组时间延长(均为P=0.000),B、C组差异无统计学意义(P=0.151)。SRF吸收后三组BCVA显著提高、IOBT显著增厚,差异均有统计学意义(均为P=0.000),三组间BCVA差异无统计学意义(P=0.176)、IOBT差异有统计学意义(P=0.041)。SRF吸收后三组CRT、SFCT与CFD明显降低,差异均有统计学意义(均为P=0.000),三组间CRT、CFD差异均有统计学意义(均为P=0.000),但SFCT差异无统计学意义(P=0.245)。CSC患者治疗前后BCVA、CRT、SFCT、IOBT以及治疗前CFD与正常眼差异均有统计学意义(均为P<0.05)。治疗后未见与视力相关的眼部及全身并发症。结论适当大小PDT光斑有利于缩短CSC病程,但对最终视力影响不大;OCTA引导与FFA、ICGA引导PDT治疗CSC有相似的效果;因为无创及经济,OCTA引导更优于FFA及ICGA引导。
Objective To explore the effect of optical coherence tomography angiography(OCTA) as a new technique to guide photodynamic therapy(PDT) in the treatment of chronic central serous chorioretinopathy(CSC).Methods A non-randomized case-control study.Sixty patients(60 eyes) with chronic CSC were divided into three groups according to the guiding PDT spot design method,20 patients in each group.Group A was designed by fluorescence angiography,group B was designed by indocyanine green angiography,and group C was designed by OCTA.At the same time,36 normal patients(36 eyes) were selected as the control group.All patients were treated by PDT with half-dose verteporfin.The best corrected visual acuity(BCVA),subretinal fluid(SRF) disappearance time,photoreceptor inner/outer segment to bruch member thickness(IOBT),central retinal thickness(CRT),subretinal fovea choridial thickness(SFCT),choriocapillary layer angi-flow density(CFD) on 6 mm×6 mm region of the posterior pole and postoperative complications were compared and analyzed before and after PDT treatment.Results There were significant differences between group A [(1500.00±79.47)μm],group B [(2800.00±629.95)μm],and group C [(2700.00±553.46)μm] in PDT treatment spot(P=0.000),the treatment spot of group A was significantly smaller than group B and group C(both P=0.000),and there was no significant difference between group B and group C(P=0.358).SRF absorption time of the three groups was significantly different(P=0.000),in which the time of group A was longer than that of group B and group C(both P=0.000),while the time of group B and group C was not significantly different(P=0.151).After SRF absorption,BCVA was significantly increased in the three groups(all P=0.000),IOBT was significantly increased and structure was improved(all P=0.000),there was no significant difference in BCVA(P=0.176) and was significantly different in IOBT between the three groups(P=0.041).After SRF absorption,CRT,SFCT and CFD were significantly reduced in the three groups(all P=0.000),and there were significant differences in CRT and CFD among the three groups(all P=0.000),but no significant differences in SFCT(P=0.245).There were significant differences in BCVA,CRT,SFCT,IOBT and CFD between CSC patients and normal eyes before and after treatment(all P<0.05).No ocular or systemic complications related to visual acuity were observed after treatment.Conclusion PDT with appropriate spot can shorten the course of CSC but has little effect on the final vision.OCTA guidance has similar effect with FFA and ICGA-guided PDT in the treatment of CSC.Because of noninvasive and economical,OCTA guidance is superior to FFA and ICGA guidance.
Objective To explore the effect of optical coherence tomography angiography(OCTA) as a new technique to guide photodynamic therapy(PDT) in the treatment of chronic central serous chorioretinopathy(CSC).Methods A non-randomized case-control study.Sixty patients(60 eyes) with chronic CSC were divided into three groups according to the guiding PDT spot design method,20 patients in each group.Group A was designed by fluorescence angiography,group B was designed by indocyanine green angiography,and group C was designed by OCTA.At the same time,36 normal patients(36 eyes) were selected as the control group.All patients were treated by PDT with half-dose verteporfin.The best corrected visual acuity(BCVA),subretinal fluid(SRF) disappearance time,photoreceptor inner/outer segment to bruch member thickness(IOBT),central retinal thickness(CRT),subretinal fovea choridial thickness(SFCT),choriocapillary layer angi-flow density(CFD) on 6 mm×6 mm region of the posterior pole and postoperative complications were compared and analyzed before and after PDT treatment.Results There were significant differences between group A [(1500.00±79.47)μm],group B [(2800.00±629.95)μm],and group C [(2700.00±553.46)μm] in PDT treatment spot(P=0.000),the treatment spot of group A was significantly smaller than group B and group C(both P=0.000),and there was no significant difference between group B and group C(P=0.358).SRF absorption time of the three groups was significantly different(P=0.000),in which the time of group A was longer than that of group B and group C(both P=0.000),while the time of group B and group C was not significantly different(P=0.151).After SRF absorption,BCVA was significantly increased in the three groups(all P=0.000),IOBT was significantly increased and structure was improved(all P=0.000),there was no significant difference in BCVA(P=0.176) and was significantly different in IOBT between the three groups(P=0.041).After SRF absorption,CRT,SFCT and CFD were significantly reduced in the three groups(all P=0.000),and there were significant differences in CRT and CFD among the three groups(all P=0.000),but no significant differences in SFCT(P=0.245).There were significant differences in BCVA,CRT,SFCT,IOBT and CFD between CSC patients and normal eyes before and after treatment(all P<0.05).No ocular or systemic complications related to visual acuity were observed after treatment.Conclusion PDT with appropriate spot can shorten the course of CSC but has little effect on the final vision.OCTA guidance has similar effect with FFA and ICGA-guided PDT in the treatment of CSC.Because of noninvasive and economical,OCTA guidance is superior to FFA and ICGA guidance.
引文
[1] WANG M,MUNCH I C,HASLER P W,PRUNTE C,LARSEN M.Central serous chorioretinopathy[J].Acta Ophthalmol,2008,86(2):126-145.
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[3] LEE S T,ADELMAN R A.The treatment of recurrent central serous chorioretinopathy with intravitreal bevacizumab[J].J Ocul Pharmacol Ther,2011,27(6):611-614.
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[6] KOYTAK A,EROL K,COSKUN E,ASIK N,OZTURK H,OZERTURK Y.Fluorescein angiography-guided photodynamic therapy with half-dose verteporfin for central serous chorioretinopathy[J].Retina,2010,30(10):1698-1703.
[7] CHAN S Y,WANG Q,WEI W,JONAS J B.Optical coherence tomographic angiography in central serous chorioretinopathy[J].Retina,2016,36(11):2051-2058.
[8] MO B,ZHOU H Y,JIAO X,LIU W.Comparative study of optical coherence tomography angiography and ICGA in central serous chorioretinopathy [J].Int Eye Sci,2017,17(7):1351-1355.莫宾,周海英,焦璇,刘武.中心性浆液性脉络膜视网膜病变的OCTA特点及ICGA的比较分析[J].国际眼科杂志,2017,17(7):1351-1355.
[9] SU W Q,HU L Y,LI X R,LI Z Q.Clinical study of compound anisodine injection in the treatment of chronic central serous chorioretinopathy[J].Rec Adv Ophthalmol,2018,38(12):1137-1140.苏雯琪,胡立影,李筱荣,李志清.复方樟柳碱注射液治疗慢性中心性浆液性脉络膜视网膜病变的临床研究[J].眼科新进展,2018,38(12):1137-1140.
[10] CHAN W M,LAI T Y,LAI R Y,TANG E W,LIU D T,LAM D S.Safety enhanced photodynamic therapy for chronic central serous chorioretinopathy:one-year results of a prospective study[J].Retina,2008,28(1):85-93.
[11] KIM Y K,RYOO N K,WOO S J,PARK K H.Choroidal thickness changes after photodynamic therapy and recurrence of chronic central serous chorioretinopathy[J].Am J Ophthalmol,2015,160(1):72-84.
[12] ZENG J,YAN Y Y,DING X Y,LIU R,LI J Q.Choridal thickness after half-dose verteporfin photodynamic therapy in chronic central serous chorioretinpathy[J].Chin J Ophthalmol,2013,49(6):490-494.曾婧,闫媛媛,丁小燕,刘冉,李加青.半剂量光动力疗法治疗后慢性中心性浆液性脉络膜视网膜病变患者脉络膜厚度变化分析[J].中华眼科杂志,2013,49(6):490-494.
[13] JIAO Y,FU B B,YE B,HUANG Y H,ZHANG H,HE W S,et al.Clinical observation of optical coherence tomography angiography in the macular vascular density after repair of retinal detachment[J].Rec Adv Ophthalmol,2018,38(4):373-377.焦亚,付碧波,叶波,黄银花,章晖,贺文山,等.视网膜脱离复位术后黄斑区血流密度:基于光学相干断层扫描血管成像(OCTA)的观察[J].眼科新进展,2018,38(4):373-377.
[2] GEMENETZI M,SALVO G D,LOTERY A J.Central serous cho-rioretinopathy:an update on pathogenesis and treatment[J].Eye,2010,24(12):1743-1756.
[3] LEE S T,ADELMAN R A.The treatment of recurrent central serous chorioretinopathy with intravitreal bevacizumab[J].J Ocul Pharmacol Ther,2011,27(6):611-614.
[4] LAI F H,NG D S,BAKTHAVATSALAM M,CFAN V C,YOUNG A,OJLUK F,et al.A multicenter study on the long-term outcomes of half-dose photodynamic therapy in chronic central serous chorioretinopathy [J].Am J Ophthalmol,2016,170(10):91-99.
[5] YANNUZZI L A,SLAKTER J S,GROSS N E,SPAIDE R F,COSTA D L,HUANG S J,et al.Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy:a pilot study [J].Retina,2003,23(6):288-298.
[6] KOYTAK A,EROL K,COSKUN E,ASIK N,OZTURK H,OZERTURK Y.Fluorescein angiography-guided photodynamic therapy with half-dose verteporfin for central serous chorioretinopathy[J].Retina,2010,30(10):1698-1703.
[7] CHAN S Y,WANG Q,WEI W,JONAS J B.Optical coherence tomographic angiography in central serous chorioretinopathy[J].Retina,2016,36(11):2051-2058.
[8] MO B,ZHOU H Y,JIAO X,LIU W.Comparative study of optical coherence tomography angiography and ICGA in central serous chorioretinopathy [J].Int Eye Sci,2017,17(7):1351-1355.莫宾,周海英,焦璇,刘武.中心性浆液性脉络膜视网膜病变的OCTA特点及ICGA的比较分析[J].国际眼科杂志,2017,17(7):1351-1355.
[9] SU W Q,HU L Y,LI X R,LI Z Q.Clinical study of compound anisodine injection in the treatment of chronic central serous chorioretinopathy[J].Rec Adv Ophthalmol,2018,38(12):1137-1140.苏雯琪,胡立影,李筱荣,李志清.复方樟柳碱注射液治疗慢性中心性浆液性脉络膜视网膜病变的临床研究[J].眼科新进展,2018,38(12):1137-1140.
[10] CHAN W M,LAI T Y,LAI R Y,TANG E W,LIU D T,LAM D S.Safety enhanced photodynamic therapy for chronic central serous chorioretinopathy:one-year results of a prospective study[J].Retina,2008,28(1):85-93.
[11] KIM Y K,RYOO N K,WOO S J,PARK K H.Choroidal thickness changes after photodynamic therapy and recurrence of chronic central serous chorioretinopathy[J].Am J Ophthalmol,2015,160(1):72-84.
[12] ZENG J,YAN Y Y,DING X Y,LIU R,LI J Q.Choridal thickness after half-dose verteporfin photodynamic therapy in chronic central serous chorioretinpathy[J].Chin J Ophthalmol,2013,49(6):490-494.曾婧,闫媛媛,丁小燕,刘冉,李加青.半剂量光动力疗法治疗后慢性中心性浆液性脉络膜视网膜病变患者脉络膜厚度变化分析[J].中华眼科杂志,2013,49(6):490-494.
[13] JIAO Y,FU B B,YE B,HUANG Y H,ZHANG H,HE W S,et al.Clinical observation of optical coherence tomography angiography in the macular vascular density after repair of retinal detachment[J].Rec Adv Ophthalmol,2018,38(4):373-377.焦亚,付碧波,叶波,黄银花,章晖,贺文山,等.视网膜脱离复位术后黄斑区血流密度:基于光学相干断层扫描血管成像(OCTA)的观察[J].眼科新进展,2018,38(4):373-377.