577 nm阈下微脉冲激光联合抗VEGF治疗慢性中心性浆液性脉络膜视网膜病变OA

Objective To evaluate the safety and efficacy of 577 nm subthreshold micropulse laser(SML)combined with intravitreal injection of anti-vascular endothelial growth factor(anti-VEGF)agents in the treatment of chronic central serous chorioretinopathy(cCSC).Methods In this prospective randomized controlled study,40 patients(40 eyes)diag-nosed with cCSC at the Ophthalmology Hospital of Nanchang University between February 2022 and February 2024 were en-rolled and randomly assigned to either the SML monotherapy group or the combination therapy group,with 20 patients in each group.Patients in the SML monotherapy group received 577 nm SML treatment alone,whereas patients in the combina-tion therapy group received intravitreal injection of anti-VEGF agents one week prior to SML treatment.The best corrected visual acuity(BCVA),mean retinal sensitivity within 12°(MS12),central macular thickness(CMT),and subfoveal choroi-dal thickness(SFCT)were assessed at baseline and at 1,3,and 6 months post-treatment.Patients were followed up for 6-12 months.If subretinal fluid(SRF)persisted at 3 months post-treatment,the initial treatment was repeated.Results There were no statistically significant differences in BCVA,MS12,CMT,and SFCT between the two groups at baseline(all P>0.05).In the SML monotherapy group,BCVA and SFCT at 3 and 6 months post-treatment,as well as MS12 and CMT at 1,3,and 6 months post-treatment,showed significant improvement compared to baseline(all P<0.05).In the combination ther-apy group,BCVA,MS12,CMT,and SFCT at 1,3,and 6 months post-treatment significantly improved from baseline(all P<0.05).BCVA at 3 and 6 months post-treatment and MS12 at 1,3,and 6 months post-treatment in the combination therapy group were significantly better than those in the SML monotherapy group(all P<0.05).Additionally,CMT and SFCT at 1,3,and 6 months post-treatment in the combination therapy group were significantly lower than those in the SML monothera-py group(all P<0.05).At 6 months post-treatment,the high SRF response rate in the combination therapy group was sig-nificantly higher than that in the SML monotherapy group(P<0.05).The recurrence rate was 10％in the SML monotherapy group and 5％in the combination therapy group,with no statistically significant difference(P>0.05).Conclusion Com-pared with SML monotherapy,SML combined with anti-VEGF treatment shows better clinical efficacy in cCSC patients with-out increasing the risk of complications or recurrence.This combined approach may be considered a promising therapeutic strategy for cCSC.