Department of Ophthalmology, Korea University Anam Hospital, Seoul, Korea.
Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
Korean J Ophthalmol. 2021 Feb;35(1):51-63. doi: 10.3341/kjo.2020.0112. Epub 2020 Dec 11.
To assess the safety and efficacy of selective retina therapy (SRT) using a Q-switched neodymium-doped yttrium lithium fluoride laser with feedback systems in patients with idiopathic central serous chorioretinopathy (CSC).
This randomized clinical trial enrolled patients having at least 3-month symptom of CSC. From month 3 visit, all subjects in both groups were eligible for SRT retreatment if they showed persistent or recurrent subretinal fluid (SRF). The primary outcome was complete resolution of SRF by optical coherence tomography at 3 months after treatment. The secondary outcomes were changes in SRF, central macular thickness (CMT) and best-corrected visual acuity at the 1-, 3-, and 6-month examinations.
Sixty-eight CSC patients were included (SRT, 31; control, 37). After 1 and 3 months, complete resolution of SRF was achieved in 25.8% and 54.8% of SRT group and 17.6% and 35.1% of controls. The differences were not statistically significant (p = 0.424 and p = 0.142, respectively). However, mixed model for repeated measures analyses showed that the reduction of SRF and CMT were observed earlier in SRT group than in the sham group (least squares mean difference, -59.7 µm; 95% confidence interval, -98.2 to -21.2; p = 0.0029; least squares mean difference -67.0 µm; 95% confidence interval, -104.8 to -29.2; p = 0.0007, respectively). Significant reduction of SRF (≥50% reduction from baseline) was more frequently observed in SRT group (80.6%) than the sham group (44.1%) at month 1 (p = 0.007). Early reduction of SRF and CMT was more abundant in SRT group with symptom duration less than 6 months. Treatment related serious adverse events were not observed.
SRT using a Q-switched neodymium-doped yttrium lithium fluoride laser with feedback system was safe in this trial and effective for early resolution of SRF in the CSC patients. Early intervention with SRT can be a safe alternative for patients with acute symptomatic CSC.
评估使用带反馈系统的 Q 开关掺钕氟化锂钇（Nd:YLF）激光进行选择性视网膜光凝术（SRT）治疗特发性中心性浆液性脉络膜视网膜病变（CSC）患者的安全性和疗效。
本随机临床试验纳入了至少有 3 个月 CSC 症状的患者。从第 3 个月就诊开始，如果两组患者均存在持续性或复发性视网膜下液（SRF），则所有患者均有资格接受 SRT 重复治疗。主要结局是治疗后 3 个月时光学相干断层扫描（OCT）显示 SRF 完全消退。次要结局是在 1、3 和 6 个月的检查中 SRF、中心黄斑厚度（CMT）和最佳矫正视力的变化。
共有 68 例 CSC 患者入组（SRT 组 31 例，对照组 37 例）。在第 1 和第 3 个月，SRT 组分别有 25.8%和 54.8%的患者 SRF 完全消退，对照组分别为 17.6%和 35.1%。差异无统计学意义（分别为 p = 0.424 和 p = 0.142）。然而，重复测量混合模型分析显示，SRT 组 SRF 和 CMT 的减少早于对照组（最小二乘均数差，-59.7µm；95%置信区间，-98.2 至-21.2；p = 0.0029；最小二乘均数差，-67.0µm；95%置信区间，-104.8 至-29.2；p = 0.0007）。SRT 组（治疗后 1 个月）SRF 显著减少（较基线减少≥50%）的比例明显高于对照组（80.6%比 44.1%）（p = 0.007）。在症状持续时间小于 6 个月的患者中，SRT 组更常出现早期 SRF 和 CMT 减少。未观察到与治疗相关的严重不良事件。
本试验中，使用带反馈系统的 Q 开关掺钕氟化锂钇激光进行 SRT 是安全的，可有效促进 CSC 患者 SRF 的早期消退。对于急性有症状的 CSC 患者，早期 SRT 干预可能是一种安全的替代方法。
