Fondazione G. B. Bietti Foundation, IRCCS, Rome, Italy.
Retina. 2019 May;39(5):980-987. doi: 10.1097/IAE.0000000000002040.
To describe early and late morphological and functional changes in subjects receiving photodynamic therapy (PDT) for chronic central serous chorioretinopathy.
Patients with chronic central serous chorioretinopathy were prospectively enrolled and received standard PDT. At the baseline examination, each subject underwent complete ophthalmological examination, including best-corrected visual acuity (BCVA) assessment, fluorescein angiography and indocyanine green angiography, spectral domain optical coherence tomography, and microperimetry. Spectral domain optical coherence tomography, microperimetry, and BCVA assessment were repeated in multiple sections over 7 days after PDT and at 1-, 3-, and 12-month intervals. Main outcome measures were: identification of early changes (1-week examination) in BCVA, retinal sensitivity, and spectral domain optical coherence tomography parameters and their influence on outcomes at the 1-year follow-up.
Three main patterns of early response to PDT were identified during the 1-week examination. The neurosensory retinal detachment most frequently decreased rapidly (12/19 pts), with complete resolution in 50% of cases. An increase in neurosensory retinal detachment height was registered in 16% (3/19) of cases, whereas in 21% (4/19), a large fluctuation in neurosensory retinal detachment was encountered. Best-corrected visual acuity declined significantly in 5/12 patients in the first group and was stable or improved in the remaining cases. Overall, retinal sensitivity diminished in 16/19 subjects, with a mean worsening of 2.56 dB (P = 0.0002). At the 12-month examination, final mean BCVA improved by 14.4 letters (P = 0.001) and a similar progressive recovery in the retinal sensitivity was observed (+2.69 dB, P = 0.0039). The neurosensory retinal detachment completely resolved in 18/19 (95%) cases, with a parallel significant reduction in central foveal choroidal thickness (P < 0.0001).
Three patterns of early response to standard PDT can be identified. Although an early and abrupt reduction in BCVA and retinal sensitivity after treatment is possible, this does not compromise a final improvement in visual functions.
描述接受光动力疗法（PDT）治疗慢性中心性浆液性脉络膜视网膜病变患者的早期和晚期形态和功能变化。
前瞻性纳入慢性中心性浆液性脉络膜视网膜病变患者，并接受标准 PDT 治疗。在基线检查时，每位患者均接受全面的眼科检查，包括最佳矫正视力（BCVA）评估、荧光素血管造影和吲哚青绿血管造影、谱域光学相干断层扫描和微视野检查。PDT 后 7 天内和 1、3 和 12 个月时，对多个节段进行谱域光学相干断层扫描、微视野和 BCVA 评估。主要观察指标：确定 PDT 后 1 周检查时 BCVA、视网膜敏感度和谱域光学相干断层扫描参数的早期变化及其对 1 年随访时结果的影响。
在 1 周检查期间，共确定了 3 种 PDT 早期反应的主要模式。神经感觉性视网膜脱离最常迅速减少（19 例中的 12 例），其中 50%的病例完全消退。神经感觉性视网膜脱离高度增加见于 19 例中的 16%（3 例），而在 21%的病例（4 例）中，神经感觉性视网膜脱离出现较大波动。第 1 组中有 5/12 例患者的 BCVA 显著下降，其余患者的 BCVA 稳定或改善。总体而言，19 例中有 16 例患者的视网膜敏感度下降，平均恶化 2.56dB（P = 0.0002）。在 12 个月检查时，最终平均 BCVA 提高了 14.4 个字母（P = 0.001），视网膜敏感度也观察到类似的逐渐恢复（+2.69dB，P = 0.0039）。19 例（95%）患者的神经感觉性视网膜脱离完全消退，中央凹脉络膜厚度显著减少（P < 0.0001）。
可以确定对标准 PDT 的三种早期反应模式。尽管治疗后 BCVA 和视网膜敏感度可能会出现早期和急剧下降，但这并不影响视觉功能的最终改善。
