郑建龙 林洪杰 张安琳 陈适蓉 刘昕宇

【摘要】 目的：探討577 nm阈值下微脉冲激光（SML）治疗中心性浆液性脉络膜视网膜病变（CSC）的效果与黄斑结构变化。方法：回顾性分析2017年5月-2020年5月在本院确诊的80例CSC患者。按照治疗方案的不同将患者分为微脉冲激光治疗组（观察组，n=40）和传统黄色激光治疗组（对照组，n=40）。观察组采用577 nm SML治疗，对照组采用传统黄色激光治疗。治疗前后采用统一主观视觉质量问卷评价两组患眼视物变暗情况，观察最佳矫正视力（BCVA），SD-OCT检测黄斑中心凹结构参数：视网膜厚度（CRT）、上皮层厚度（CNT）、外核层厚度（ONT）、脉络膜厚度（SFCT）、椭圆体带（EZ）、嵌合体带（IZ）;相关性分析视力情况与黄斑区结构变化关系。结果：治疗后，两组急性期患者视物变暗均消失，慢性期患者视物变暗有所改善，两组间比较，差异均无统计学意义（P>0.05）。治疗后，两组BCVA较治疗前均有显著改善，差异均有统计学意义（P<0.05）。治疗后，两组CRT、SFCT较治疗前均有改善，差异均有统计学意义（P<0.05）。治疗后，观察组急性期和慢性期的CRT均显著低于对照组，差异均有统计学意义（P<0.05）。治疗后，观察组急性期和慢性期EZ与IZ与治疗前结构变化比较，差异均有统计学意义（P<0.05）。对照组急性期治疗后EZ和IZ与治疗前比较，差异均有统计学意义（P<0.05）;对照组慢性期治疗后IZ与治疗前比较，差异有统计学意义（P<0.05）。Pearson相关性分析显示BCVA（logMAR）与CRT、SFCT参数均呈正相关（P<0.05）。Spearman相关性分析显示，BCVA（logMAR）与EZ、IZ完整程度均呈负相关（P<0.05）。结论：对于急性期CSC患者，577 nm SML与传统黄色激光均使患眼视物变暗消失，而对慢性期CSC患者视物变暗有所改善，577 nm SML可快速改善BCVA，改善黄斑区结构和视觉症状，疗效显著且安全。

【关键词】 阈值下微脉冲激光 黄色激光 中心性浆液性脉络膜视网膜病变 黄斑结构

Clinical Observation on the Effect and Macular Structure Changes of Central Serous Chorioretinopathy Treated with Subthreshold Micropulse Laser at 577 nm/ZHENG Jianlong， LIN Hongjie， ZHANG Anlin， CHEN Shirong， LIU Xinyu. //Medical Innovation of China， 2021， 18（14）： -167

[Abstract] Objective： To investigate the clinical efficacy and macular structure changes of central serous chorioretinopathy （CSC） treated with subthreshold micropulse laser （SML） at 577 nm. Method： Retrospective analysis was performed on 80 patients with CSC who were diagnosed in our hospital from May 2017 to May 2020. Patients were divided into two groups according to different treatment regimen： micropulsed laser treatment group （observation group， n=40） and traditional yellow laser treatment group （control group， n=40）. The observation group was treated with 577 nm SML， while the control group was treated with traditional yellow laser. Before and after treatment， the unified subjective visual quality questionnaire was used to evaluate the darkening situation of the two groups， and the best corrected visual acuity （BCVA） was observed. SD-OCT was used to detect the fovea structural parameters of macular area： central retinal thickness （CRT）， central neuroepithelial thickness （CNT）， outer nuclear thickness （ONT）， subfoveal choroidal thickness （SFCT）， ellipsoid zone （EZ）， interdigitation zone （IZ）. Correlation analysis was used to analyze the relationship between visual acuity and macular structure changes. Result： After treatment， the vision darkening disappeared in acute phase patients of both groups， while the vision darkening improved in chronic phase patients， there were no statistically significant differences between the two groups （P>0.05）. After treatment， BCVA in both groups were significantly improved compared with before treatment， the differences were statistically significant （P<0.05）. After treatment， CRT and SFCT in both groups were improved compared with those before treatment， the differences were statistically significant （P<0.05）. After treatment， the CRT of the observation group were significantly lower than those of the control group in both acute and chronic phases， the differences were statistically significant （P<0.05）. After treatment， there were statistically significant differences in the structural changes of EZ and IZ in the acute and chronic stages of the observation group compared with those before treatment （P<0.05）. EZ and IZ after treatment were compared with those before treatment in the control group， the differences were statistically significant （P<0.05）. The comparison of IZ after treatment and before treatment in the chronic phase of the control group， the difference was statistically significant （P<0.05）. Pearson correlation analysis showed that BCVA （logMAR） was positively correlated with CRT and SFCT parameters （P<0.05）. Spearman correlation analysis showed that BCVA （logMAR） was negatively correlated with EZ and IZ integrity （P<0.05）. Conclusion： For patients with acute stage CSC， both 577 nm SML and traditional yellow laser can make the vision darkening disappear， while for patients with chronic stage CSC， the vision darkening can be improved. 577 nm SML can quickly improve BCVA， improve macular structure and visual symptoms， and the effect is significant and safe.

[Key words] Subthreshold micropulse laser Yellow laser Central serous chorioretinopathy Macular structure

First-authors address： Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong， Shantou 515041， China

doi：10.3969/j.issn.1674-4985.2021.14.039

中心性浆液性脉络膜视网膜病变（central serous chorioretinopathy， CSC）是由于视网膜色素上皮屏障功能受损导致液体进入神经上皮下引发神经上皮层脱离为特征的眼底疾病，临床表现为视力下降、视物变暗等，好发于青壮年男性，若迁延反复发作可能会造成视功能不可逆损害[1-2]。传统激光光凝治疗均采用超阈值激光，可能对正常组织产生一定损害，造成患者中心视觉敏感度下降、脉络膜新生血管等[3]。而阈下微脉冲激光（subthreshold micropulse laser， SML）治疗是一种低强度的光凝治疗手段，其既可以达到有效治疗的目的，又能在最大程度上保护组织[4-5]。故本……