慢性中央漿液性脈絡膜視網膜病變之治療：以低劑量傳統黃斑雷射模擬次閾值微脈衝雷射的療效評估

Abstract

目的： 慢性中央漿液性脈絡膜視網膜病變（cCSC）是中年族群中央視力喪失的主要原因之一，特徵為持續超過六週的黃斑下積液。雖然光動力療法（PDT）與次閾值微脈衝雷射（SML）為現行有效治療方式，但受限於費用與設備，臨床應用仍有困難。本研究旨在評估以調整過的低劑量532奈米連續波綠光雷射，是否能模擬微脈衝雷射的治療效果。

方法： 本回溯性世代研究納入黃斑下積液持續超過六週，且螢光血管造影無明顯滲漏點、不適合傳統熱凝雷射治療的cCSC患者。患者接受低劑量傳統雷射治療（設定功率60 mW，持續時間10 ms，光斑直徑50微米），以散點、非重疊的方式覆蓋積液範圍。將最佳矯正視力（VA）與中央黃斑厚度（CMT）於低劑量雷射組、半劑量PDT組與觀察組之間進行比較。

結果： 共37位患者完成47次雷射治療。雷射治療後，CMT由418 ± 118 µm顯著下降至278 ± 76 µm（p < 0.0001），VA由0.41改善至0.62 logMAR（p < 0.0001）。PDT組與觀察組亦顯示類似的解剖與功能改善。亞組分析顯示，症狀持續超過1.5個月的患者，接受雷射治療後獲得更明顯的改善。

結論： 低劑量傳統綠光雷射能有效促進黃斑下積液吸收並改善視力，且不會造成視網膜損傷。此方法為SML或PDT之外，尤其適用於黃斑下積液或螢光血管造影無明確滲漏點的患者，提供一個安全、有效且設備需求較低的替代治療方案。

Purpose: Chronic central serous chorioretinopathy (cCSC) is a common cause of central vision loss in middle-aged adults, with subretinal fluid persisting beyond six weeks leading to significant visual impairment. While photodynamic therapy (PDT) and subthreshold micropulse laser (SML) are established treatments, their accessibility is limited by cost and equipment availability. This study investigates whether modified low-dose conventional 532 nm green laser can mimic the therapeutic effects of micropulse laser in cCSC patients.

Methods: A retrospective cohort study included cCSC patients with subretinal fluid persisting beyond 6 weeks without identifiable leaking points suitable for conventional photocoagulation. Patients received low-dose conventional laser (60 mW, 10 ms, 50 µm spot) in a scattered, non-confluent pattern over the area of subretinal fluid. Best-corrected visual acuity (VA) and central macular thickness (CMT), were compared among three groups: low dose laser, half-dose PDT, and observation.

Results: Among 37 patients (47 sessions), laser treatment significantly reduced CMT (from 418 ± 118 µm to 278 ± 76 µm, p < 0.0001) and improved VA (from 0.41 to 0.62 logMAR, p < 0.0001). Comparable anatomical and functional improvements were observed in the PDT and observation groups. Subgroup analysis revealed greater benefit from laser in patients with symptoms exceeding 1.5 months.

Conclusion: Low-dose conventional laser effectively reduces subretinal fluid and improves vision in cCSC without inducing retinal damage, offering a practical and accessible alternative to SML or PDT, particularly for patients with subfoveal fluid or non-identifiable leakage on angiography.