| Objective:To study the influence factors of the prognosis of patients with central serous chorioretinopathy(CSC)treated by half-dose of verteporfin photodynamic therapy(PDT),and to observe the clinical effect of Chinese medicine intervention at different times,In order to improve the understanding of half-dose PDT in the treatment of CSC and the influence of traditional Chinese medicine in adjuvant therapy,and provide reference for clinical diagnosis and treatment.Methods:The general conditions,FFA characteristics,OCT characteristics and TCM treatment of CSC patients receiving only half-dose PDT in 92 cases were reviewed retrospectively to establish a database.Based on the best corrected visual acuity(BCVA)and subretinal fluid height(HPSF)before operation,BCVA and HPSF were followed up for 6 months as the final observation indexes.The risk of eyes were divided into(A)good prognosis group(BCVA increased ? 0.2 logmar or reached the standard level and HPSF=0),poor prognosis(B)(BCVA increased<0.2 logmar or(and)HPSF>0).The affected eyes were divided into preoperative intervention group,postoperative intervention group and non-intervention group according to the different time of TCM intervention,and the curative effect of the three groups was compared.Data results using SPSS24.0 statistical software for data processing and evaluate the influencing factors of prognosis of CSC eyes treated with half-dose PDT,and discusses the influence of intervention on prognosis.Results:(1)The 92 patients ranged in age from 29 to 71 years,with an average age of(48.93±8.192)years.The ratio of male to female was 18:5.The average course of eye disease was(14.21±14.834)months,with 49 recurrent eyes(41.9%).Chronic persistent CSC was more than acute CSC.Patients generally sleep less than 8 hours at night.The prevalence ratio of one eye to two eyes was 67:25.There was no significant difference between left and right eyes.The number of rural patients was 49:43 slightly higher than that of urban patients.Patients with a history of smoking accounted for 54.3%.(2)There was no statistical difference between group A and group B in terms of average age,gender,average sleep time at night,eye type,residence and smoking history(P>0.05).Most of them were middle-aged rural men with smoking history.The average course of disease was statistically significant between the two groups(P<0.01),and the course of disease was significantly longer in group B.The proportion of recurrent eyes in group B before treatment was greater than that in group A,and the difference between groups was statistically significant.In terms of FFA characteristics,the differences between the two groups were statistically significant(P<0.01)by comparing the positions,areas and types of leakage points.In terms of OCT characteristics,preoperative central neuroepithelial thickness and outer reflectance integrity were compared between the two groups,and the differences were statistically significant(P<0.01).The number of eyes in group B combined with RPE detachment was greater than that in group A,but the difference(P>0.05)was not statistically significant.The number of eyes in group B combined with RPE detachment was greater than that in group A,but the difference(P>0.05)was not statistically significant.The number of eyes affected in group A was higher than that in group B(P<0.05),which was statistically significant.After single factor screening of the independent variables,the binary logistic regression analysis showed that recurrent eyes have little independent influence on prognosis(P>0.05),course of diseases,leakage area,types of leakage,center neuroepithelial thickness and outer reflection incomplete positively correlated with poor prognosis,leakage point location,oral medicine and negatively correlated with poor prognosis.(3)In terms of visual function,the vision of the preoperative TCM intervention group was significantly improved in each postoperative period,and the difference was statistically significant compared with that before treatment.The visual acuity of the postoperative TCM intervention group improved with time,and the difference was statistically significant 1 month after operation compared with that before treatment.The visual acuity of the non-intervention group improved significantly after 1 month and slowly after 3 months.Although there was no statistically significant difference in visual acuity between the three groups in each time period,after 6 months of treatment,visual acuity in the intervention group was higher than that in the non-intervention group,with a good upward trend.(4)In terms of Subretinal fluid:SRF in the intervention group at each time period was significantly absorbed.The absorption of SRF in the non-intervention group was significant in the first 3 months and a small amount in the later period,but the difference was not statistically significant.The comparison between the groups showed that HPSF of the preoperative intervention group was lower than that of the postoperative intervention group and significantly lower than that of the non-intervention group 3 months after treatment,with statistically significant difference.After 6 months of treatment,HPSF in the intervention group was significantly lower than that in the non-intervention group,with statistically significant differences.Conclusion:(1)CSC occurred mostly in middle-aged rural men with smoking history.The incidence rate of monocular eyes was higher than that of eyes,and there was no difference between left and right eyes.(2)The course of the disease,the location of the leakage point,the leakage area,the leakage type,the thickness of the neuroepithelial layer,the incomplete reflection of the outer layer,and the oral administration of traditional Chinese medicine were all independent factors affecting the prognosis.Long course of disease,leakage point near the center of macula,multiple lesions,thin neuroepithelial layer and incomplete outer reflection are the main factors of poor prognosis in the treatment of CSC with half-dose PDT.Oral treatment of traditional Chinese medicine can affect the prognosis.(3)The course of the disease,the location of the leakage point,the area of the leakage,the type of leakage,the thickness of central neuroepithelium,the incomplete outer reflexion and the oral administration of TCM were all independent factors affecting the prognosis.The long course of the disease,the leakage point close to the center of the macula,the multiple lesions,the thinning of the neurocortical layer and the incomplete outer reflection are the main factors for the poor prognosis of CSC treated by half-dose PDT,and the oral treatment of TCM can affect the prognosis.(4)In clinical treatment,we may not be able to completely prevent the disease before it occurs,assist patients to eliminate the risk factors of the disease;However,we should try our best to do both disease prevention and disease recovery,in the early stage of the disease for the corresponding treatment measures,such as Chinese medicine decoction oral intervention.It is recommended that patients be followed up regularly after treatment to monitor the changes of their condition in real time and prevent irreversible damage caused by repeated diseases. |
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