Karim Shaheen P, Adelman Ron A
Department of Ophthalmology and Visual Science, Yale University, New Haven, CT, USA.
Clin Ophthalmol. 2013;7:1867-75. doi: 10.2147/OPTH.S32177. Epub 2013 Sep 19.
Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterized by serous retinal detachments associated with focal leakage on fluorescein angiography and pigment epithelial detachments. While the majority of cases improve spontaneously over several months, a significant subset of patients advance to a chronic recurrent form of the disease with diffuse pigment epitheliopathy, foveal atrophy, scarring, and permanent visual loss. Photodynamic therapy (PDT) with verteporfn has been extensively studied as a potential therapeutic option for chronic cases. Multiple prospective interventional studies have demonstrated the efficacy of PDT for CSCR with significant functional and anatomic improvements achieved. Refinement of the PDT protocol has subsequently been performed in an effort to minimize adverse effects. Anti-vascular endothelial growth factor (anti-VEGF) agents, such as bevacizumab, have been utilized in the treatment of CSCR. Recent advances in imaging and functional testing have shed further light on possible pathophysiologic mechanisms of disease and post treatment changes induced by PDT. While the body of evidence supports PDT as an efficacious and relatively safe treatment for CSCR, further evaluation of the long-term efficacy and safety of PDT, as well as protocol improvements are required.
中心性浆液性脉络膜视网膜病变(CSCR)是一种特发性疾病,其特征为浆液性视网膜脱离,伴有荧光素血管造影显示的局灶性渗漏和色素上皮脱离。虽然大多数病例在数月内可自发改善,但有相当一部分患者会发展为慢性复发性疾病,伴有弥漫性色素上皮病变、黄斑萎缩、瘢痕形成和永久性视力丧失。使用维替泊芬的光动力疗法(PDT)已被广泛研究作为慢性病例的一种潜在治疗选择。多项前瞻性干预研究已证明PDT对CSCR有效,实现了显著的功能和解剖学改善。随后对PDT方案进行了优化,以尽量减少不良反应。抗血管内皮生长因子(抗VEGF)药物,如贝伐单抗,已被用于治疗CSCR。成像和功能测试的最新进展进一步揭示了疾病可能的病理生理机制以及PDT诱导的治疗后变化。虽然现有证据支持PDT作为CSCR的一种有效且相对安全的治疗方法,但仍需要进一步评估PDT的长期疗效和安全性,以及改进方案。