探讨半剂量维替泊芬光动力疗法治疗复发性中心性浆液性脉络膜视网膜病变的临床效果。

选取2016年6月至2017年5月于内蒙古自治区赤峰市第二医院眼科确诊为复发性中心性浆液性脉络膜视网膜病变的患者8例(10只眼)。全部患者均采用维替泊芬光动力进行治疗，按照1999年北美和欧洲发表的多中心光动力疗法治疗老年性黄斑变性的药剂使用标准确定患者药剂用量。给予患者常规光动力治疗标准剂量的一半，即根据患者体表面积，静脉注射维替泊芬3 mg/m²，注药结束15 min后，采用光照能量为50 J/cm²、功率密度为600 mW/cm²及体激光波长为689 nm的激光裂隙灯照射83 s。采用单因素重复测量方差分析的方法比较患者治疗前后各时间点的最佳矫正视力(BCVA)及黄斑部视网膜厚度(CMT)的变化。

治疗前，患者的BCVA为0.2～0.5，平均为0.34±0.12，治疗3个月后，经复查，患者的BCVA为0.4～1.2，平均为0.78±0.24，患者视力显著提高，差异有统计学意义(t＝－5.18，P<0.05)。治疗3个月后，全部患者均接受光学相干断层扫描检查。检查结果显示，8例(10只眼)患者中，9只患眼完全治愈，即中心凹处视网膜下液完全吸收，占全部患者的90%。1只患眼未完全治愈，占全部患者的10%，患者再次接受治疗后痊愈。治疗后6个月时再次进行复查，经光学相干断层扫描检查，8例(10只眼)患者完全治愈。患者治疗前的CMT为(349±91)μm，治疗后1个月时为(192±60)μm，治疗后3个月时为(184±64)μm，治疗后6个月时为(177±56)μm。经单因素重复测量方差分析，患者各时间点的CMT差异有统计学意义(F＝78.22，P<0.05)。与治疗前相比，治疗后1个月、3个月及6个月的结果均显著优于治疗前，差异有统计学意义(t＝4.32，4.45，4.83；P<0.05)。且治疗后患者的CMT呈现出持续下降的趋势。全部患者于术后1个月、3个月及6个月接受随访。至最后一次随访，中心凹处视网膜下液及CMT均未发现复发情况，也未出现任何并发症。

采用光学相干断层扫描技术，使用半剂量维替泊芬光动力治疗复发性中心性浆液性脉络视网膜病变，可以有效改善患者的脉络膜微循环，缩短患者的病程时间，治疗效果显著。

To investigate the clinical effect of photodynamic therapy with half dose of vepofin in the treatment of recurrent central serous choroidal retinopathy.

From June 2016 to May 2017, 8 patients (10 eyes) were diagnosed as recurrent central serous choroidal retinopathy in the second ophthalmology hospital of Chifeng, Inner Mongolia. All patients were treated with ventpophen photodynamic. According to the drug use standard of polycentric photodynamic therapy published in North America and Europe in 1999 for the treatment of age-related macular degeneration, the patient was determined. The patients were given half of the standard dose of routine photodynamic therapy, namely, according to the surface area of the patient, intravenous injection of venipofinn3 mg/m^2, after the injection of 15 min, the light energy was 50 J/cm^2, the power density was 600 mW/cm², the laser wavelength of body laser was 689 nm, and the laser slit lamp irradiated 83 s. The changes of the best corrected visual acuity (BCVA) and retinal thickness (CMT) of the macular region were compared with the method of single factor repeated measurement of variance analysis.

Before treatment, the BCVA of the patient was 0.2~0.5, the average was 0.34±0.12. After 3 months of treatment, the patient′s BCVA was 0.4~1.2, the average was 0.78±0.24. The visual acuity of the patients was significantly improved. The difference was statistically significant (t= -5.18, P<0.05). After3 months of treatment, all patients underwent optical coherence tomography. The results showed that 9 eyes of 8 patients (10 eyes) were completely cured, that is, the subretinal fluid of the fovea was completely absorbed, accounting for 90% of all patients. 1 eye was not completely cured, accounting for 10% of all patients. At 6 months after treatment, 8 patients (10 eyes) were completely cured after re examination by optical coherence tomography. The CMT before treatment was (349±91)μm, 1 month after treatment (192±60)μm, 3 months after treatment (184±64)μm, and 6 months after the treatment was (177±56)μm. Single factor repeated analysis of variance showed that there was a significant difference in CMT between patients at different time points (F=78.22, P<0.05). Compared with before treatment, the results of 1 month, 3 months and 6 months after treatment were significantly better than those before treatment, and the difference was statistically significant (t=4.32, 4.45, 4.83; P<0.05). After treatment, the CMT of patients showed a continuous decline. All patients were followed up for 1 month, 3 months and 6 months. At the last follow-up, no recurrence was found in the subretinal fluid and CMT of the fovea and no complications occurred.

The treatment of recurrent central serous choroidal retinopathy by using optical coherence tomography technique and half dose of veentfin photodynamic therapy can effectively improve the choroidal microcirculation and shorten the duration of the patient's course of disease, and the therapeutic effect is remarkable.