Retrospective study of 30％ and 50％ dose verteporfin photodynamic therapy versus anti-vascular endothelial growth factor for chronic central serous chorioretinopathy

目的 对比观察30％、50％剂量维替泊芬光动力疗法(PDT)和抗血管内皮生长因子(VEGF)药物治疗慢性中心性浆液性脉络膜视网膜病变(CSC)的疗效.方法 回顾性队列病例研究.临床确诊为慢性CSC的125例患者138只眼纳入研究.所有患者均行最佳矫正视力(BCVA)及频域光相干断层扫描(SD-OCT)检查.BCVA转换为最小分辨角对数视力记录.根据所接受的治疗方法和药物剂量不同,分为30％剂量维替泊芬PDT治疗组(30％剂量组)、50％剂量维替泊芬PDT治疗组(50％剂量组)及抗VEGF药物治疗组(抗VEGF组).3组分别为39例42只眼、67例77只眼、19例19只眼.3组患者年龄、性别、病程、BCVA及黄斑中心凹视网膜厚度(CMT)比较,差异均无统计学意义(P＞0.05).PDT及抗VEGF药物治疗均按常规方法进行.治疗后随访6～60个月.以SD-OCT检查可见视网膜下液完全消失并未再出现为治愈;视网膜下液完全消失后再次出现为复发;视网膜下液未完全消失为无效.对比分析3组患眼治疗后1、3、6个月的治愈率、复发率及BCVA、CMT的变化情况.Logistic回归模型分析治愈率的影响因素.结果 治疗后1个月,3组间治愈率比较,差异有统计学意义(x2＝6.926,P=0.031).治疗后3、6个月,50％剂量组的治愈率较30％剂量组更高,但差异无统计学意义(x2=2.218、1.682,P=0.136、0.195).治疗后3、6个月,30％剂量组与50％剂量组复发率比较,差异均无统计学意义(x2=2.133、3.366,P=0.144、0.067).治疗后50％剂量组患眼视力改善情况最好,但与30％剂量组和抗VEGF组患眼视力改善情况比较,差异均无统计学意义(P＞0.05).治疗后50％剂量组患眼CMT改善情况最好,与抗VEGF组患眼CMT改善情况比较,差异有统计学意义(P＜0.05);与30％剂量组患眼CMT改善情况比较,差异无统计学意义(P＞0.05).Logistic回归模型分析结果显示,治疗后1、6个月,年龄与治愈率呈负相关[回归系数=-0.942、-0.979,比值比(OR) =0.390、0.375,P＜0.05].治疗后3个月,维替泊芬剂量与治愈率呈正相关(回归系数=0.855,OR=2.351,P＜0.05).结论 50％剂量维替泊芬PDT治疗慢性CSC疗效更优.Objective To compare the efficacy among 30％ and 50％ dose of verteporfin photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) in the treatment of chronic central serous chorioretinopathy (CSC).Methods 138 eyes of 125 patients with chronic CSC,who were treated in our hospital from March 2006 to May 2014,were enrolled in this retrospective study.All patients were confirmed by spectral domain optical coherence tomography (SD-OCT) and best corrected visual acuity (BCVA),which was recorded with logMAR BCVA.And all the patients were divided into three groups by different treatments:30％ dose group (42 eyes of 39 patients) ; 50％ dose group (77 eyes of 67 patients); anti-VEGF group (19 eyes of 19 patients).The differences of age,gender,eyes,courses,mean logMAR BCVA among three groups were not significant.Disappearing of fluid under retina in SD-OCT was considered to be cured and fluid remaining was not cured.If fluid appeared again the eyes were relapsed.We comparatively analyzed the cure rate,relapse rate and changing of BCVA,central macular thickness (CMT) among 3 groups of patients after 1,3,6 months.Results The cure rate among 3 groups after 1 month was statistically different (x2=6.926,P =0.031).The cure rates of 50％ dose PDT treatment group after 3 months and 6 months were better than 30％ dose PDT treatment group,but the differences were not significant (x2 =2.218,1.682; P=0.136,0.195).The relapse rate between 30％ dose and 50％ dose PDT treatment groups after 3 months and 6 months were not significant (x2 =2.133,3.366; P=0.144,0.067).The improvement of BCVA in 50 ％ dose PDT treatment group was the best,but comparing with the other two groups,the differences were not significant in statistics (P＞0.05).The improvement of CMT in 50％ dose PDT treatment group was the best.Comparing with anti-VEGF group,the differences was significant (P＜0.05).But comparing with 30％ dose PDT treatment group,the differences was not significant (P＞0.05).Logistic regression analysis showed that after treatment,the cure rates after 1 month and 6 months were negatively correlated with the age (regression coefficient=-0.942,-0.979; odds ratio=0.390,0.375; P＜0.05) and the cure rates after 3 months was positively correlated with the dose of verteporfin (regression coefficient =0.855,odds ratio =2.351,P＜ 0.05).Conclusion 50％ dose verteporfin PDT is recommend for chronic CSC treatment.中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)3221-2253