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慢性中心性浆液性脉络膜视网膜病变半剂量维替泊芬光动力疗法治疗一年的结果。

One-year outcomes with half-dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy.

机构信息

Department of Ophthalmology, Surugadai Nihon University Hospital, Tokyo, Japan.

Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, Kanagawa, Japan.

出版信息

Ophthalmology. 2015 Mar;122(3):555-61. doi: 10.1016/j.ophtha.2014.09.034. Epub 2014 Nov 18.

Abstract

PURPOSE

To assess the 1-year outcome of half-dose verteporfin photodynamic therapy (PDT) for patients with chronic central serous chorioretinopathy (CSC).

DESIGN

Retrospective, interventional case series with no controls.

PARTICIPANTS

A total of 204 eyes of 204 patients with chronic CSC were studied.

METHODS

Fluorescein angiography (FA) and indocyanine green angiography (ICGA) were performed before PDT. The best-corrected visual acuities (BCVAs) were measured and optical coherence tomography was performed before and 1, 3, 6, 9, and 12 months after PDT.

MAIN OUTCOME MEASURES

The main outcome measures were the resolution of the serous retinal detachment (SRD), changes in BCVA, and ocular and systemic complications at 12 months.

RESULTS

A total of 182 of 204 eyes (89.2%) had complete resolution of the SRD at 12 months after the PDT. Eleven eyes (5.4%) had a persistent SRD throughout the follow-up period, and 12 eyes (5.9%) had a recurrence of the SRD after an earlier resolution. One of the 12 eyes had a spontaneous resolution of the SRD 6 months after PDT. The mean±standard deviation BCVA in logarithm of the minimum angle of resolution (logMAR) units significantly improved from 0.11±0.25 before to 0.07±0.23 at 1 month, 0.02±0.23 at 3 months, 0.01±0.23 at 6 months, 0.00±0.24 at 9 months, and -0.01±0.22 at 12 months (P<0.0001). The eyes with an SRD at 12 months were more likely to have an intermediate hyperfluorescence on ICGA (chi-square test, P<0.001) and poorer BCVA before the half-dose PDT (Student t test, P=0.04) than those without SRD at 12 months. None of the patients developed any systemic complications or experienced any severe visual reduction after the half-dose PDT. However, polypoidal lesion appeared in 1 eye 8 months after the PDT.

CONCLUSIONS

Half-dose PDT is an effective and safe method to treat eyes with chronic CSC with an SRD. The CSC resolved and the BCVA improved significantly after PDT. Half-dose PDT was less effective for cases without intense hyperpermeability on ICGA and those with lower BCVA before the PDT.

摘要

目的

评估半剂量维替泊芬光动力疗法(PDT)治疗慢性中心性浆液性脉络膜视网膜病变(CSC)患者的 1 年疗效。

设计

回顾性、无对照的干预性病例系列研究。

参与者

共纳入 204 例 204 只眼慢性 CSC 患者。

方法

PDT 前进行荧光素血管造影(FA)和吲哚青绿血管造影(ICGA)。PDT 前及 PDT 后 1、3、6、9 和 12 个月时测量最佳矫正视力(BCVA)并进行光学相干断层扫描(OCT)。

主要观察指标

主要观察指标为 12 个月时视网膜下液(SRD)的消退、BCVA 的变化以及眼部和全身并发症。

结果

PDT 后 12 个月时,204 只眼中共有 182 只眼(89.2%)SRD 完全消退。11 只眼(5.4%)在整个随访期间持续存在 SRD,12 只眼(5.9%)在早期消退后再次出现 SRD。其中 1 只眼在 PDT 后 6 个月 SRD 自发消退。LogMAR 单位平均±标准差 BCVA 从 PDT 前的 0.11±0.25 显著提高至 1 个月时的 0.07±0.23、3 个月时的 0.02±0.23、6 个月时的 0.01±0.23、9 个月时的 0.00±0.24 和 12 个月时的-0.01±0.22(P<0.0001)。12 个月时仍存在 SRD 的眼在 ICGA 上更可能出现中等程度的强荧光(卡方检验,P<0.001),且 PDT 前 BCVA 更差(Student t 检验,P=0.04)。所有患者均未出现任何全身并发症或 PDT 后出现严重视力下降。然而,1 只眼在 PDT 后 8 个月出现息肉样脉络膜血管病变。

结论

半剂量 PDT 是治疗伴有 SRD 的慢性 CSC 患者的有效且安全的方法。CSC 在 PDT 后消退,BCVA 显著提高。在 ICGA 上无明显强通透性和 PDT 前 BCVA 较低的患者,半剂量 PDT 的效果较差。

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