Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Retinal Degeneration Research Laboratory, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
PLoS One. 2018 Aug 27;13(8):e0202930. doi: 10.1371/journal.pone.0202930. eCollection 2018.
This study evaluated changes in choroidal vascularity after half-fluence photodynamic therapy (HF-PDT) in patients with central serous chorioretinopathy (CSC) using swept-source optical coherence tomography (SS-OCT) en face imaging.
This retrospective comparative case series included 50 eyes of 25 patients with unilateral CSC who underwent HF-PDT and 50 age-and sex-matched normal healthy control eyes. En face SS-OCT images of the choriocapillaris, Sattler's layer, and Haller's layer were converted into binary images. The vascular proportions were defined as the percentage of the area of vascular lumen against the area of the 3.0-mm-diameter circular area. The main outcome measures were the vascular proportions before HF-PDT and at 6 weeks, 6 months, and 12 months after HF-PDT.
At baseline, the vascular proportions in the CSC eyes were significantly greater than those in the control eyes in all layers (choriocapillaris: 51.8% ± 15.5% vs. 41.3 ± 18.7%, P = 0.018; Sattler's: 58.6% ± 13.4% vs. 49.7% ± 15.7%, P = 0.017; Haller's: 65.3% ± 15.3% vs. 53.0% ± 13.4%, P = 0.001). In the CSC eyes, the vascular proportion in the choriocapillaris significantly decreased at 6 weeks (36.6% ± 16.9%, P < 0.001), 6 months (34.0% ± 12.3%, P < 0.001), and 12 months (34.8% ± 17.6%, P < 0.001) after HF-PDT compared with baseline. The vascular proportions in Sattler's and Haller's layers did not show a significant decrease at 6 weeks (Sattler's: 49.7% ± 17.3%, P = 0.052 and Haller's: 58.3% ± 12.9%, P = 0.558) but decreased significantly at 6 months (Sattler's: 48.9% ± 12.4%, P < 0.001 and Haller's: 57.7% ± 15.7%, P = 0.027) and 12 months after HF-PDT from the baseline values (Sattler's: 45.8% ± 10.4%, P < 0.001 and Haller's: 56.8% ± 15.7%, P < 0.001).
After HF-PDT, the choriocapillaris showed the earliest decrease in vascular proportion of en face images, Sattler's and Haller's layers showed later decreases. The temporal differences in the response of each layer may reflect the pathophysiology of CSC and the therapeutic mechanism of HF-PDT.
本研究采用扫频源光学相干断层扫描（SS-OCT）眼底像评估中心性浆液性脉络膜视网膜病变（CSC）患者行半剂量光动力疗法（HF-PDT）后脉络膜血管密度的变化。
本回顾性病例系列研究纳入了 25 例单侧 CSC 患者的 50 只眼，所有患者均行 HF-PDT，同时纳入 50 只年龄和性别匹配的正常健康对照眼。将脉络膜毛细血管层、Sattler 层和 Haller 层的 SS-OCT 眼底像转换为二值图像。血管比例定义为脉管腔面积与 3.0mm 直径圆形区域面积的百分比。主要观察指标为 HF-PDT 前和 HF-PDT 后 6 周、6 个月和 12 个月的血管比例。
在基线时，CSC 眼各层的血管比例均明显大于对照组（脉络膜毛细血管层：51.8%±15.5%比 41.3%±18.7%，P=0.018；Sattler 层：58.6%±13.4%比 49.7%±15.7%，P=0.017；Haller 层：65.3%±15.3%比 53.0%±13.4%，P=0.001）。CSC 眼脉络膜毛细血管层的血管比例在 HF-PDT 后 6 周（36.6%±16.9%，P<0.001）、6 个月（34.0%±12.3%，P<0.001）和 12 个月（34.8%±17.6%，P<0.001）时较基线显著下降。Sattler 层和 Haller 层的血管比例在 HF-PDT 后 6 周时无明显下降（Sattler 层：49.7%±17.3%，P=0.052；Haller 层：58.3%±12.9%，P=0.558），但在 6 个月（Sattler 层：48.9%±12.4%，P<0.001；Haller 层：57.7%±15.7%，P=0.027）和 12 个月（Sattler 层：45.8%±10.4%，P<0.001；Haller 层：56.8%±15.7%，P<0.001）时较基线显著下降。
HF-PDT 后，脉络膜毛细血管层的眼底像最早出现血管比例下降，Sattler 层和 Haller 层较晚出现下降。各层之间反应的时间差异可能反映了 CSC 的病理生理学和 HF-PDT 的治疗机制。
