目的：对比分析智能精准靶向导航阈值下能量和微脉冲激光治疗慢性中心性浆液性脉络膜视网膜病变(cCSC)的疗效。

方法：回顾性临床研究。2020-01/2021-01于南京医科大学附属眼科医院就诊的cCSC患者36例40眼纳入研究，其中19例23眼接受智能精准靶向导航阈值下能量激光治疗(靶向导航组)，17例17眼接受微脉冲激光(SML)治疗(SML组)。两组患者基线资料比较，差异无统计学意义(P>0.05)。对比两组治疗前和治疗后2wk，1、3、6mo最佳矫正视力(BCVA，LogMAR)、黄斑中心视网膜厚度(CMT)、黄斑中心凹视网膜下积液(SRF)、视网膜浅层毛细血管丛(SCP)、视网膜深层毛细血管丛(DCP)的血流密度和黄斑中心凹无血管区(FAZ)面积。

结果：治疗后3、6mo，两组BCVA均较治疗前明显提高(P<0.05)。靶向导航组CMT在治疗后2wk较治疗前明显降低，SML组在治疗后1mo出现降低(P<0.05)，治疗后3、6mo较治疗前明显降低(P<0.05)，而两组间无明显差异(P>0.05)。两组患者SRF吸收情况有差异(P<0.05)，靶向导航组患者SRF完全吸收率高于SML组患者。两组患者治疗后各时间点SCP、DCP、FAZ较治疗前均无改变(P>0.05)。

结论：智能精准靶向导航阈值下能量激光治疗可迅速改善视网膜形态，缩短cCSC病程以促进视功能恢复，具有显效时间快、费用低、无创、可重复等优点，可成为临床治疗cCSC新方法。

METHODS: A retrospective clinical study. A total of 36 patients(40 eyes)with cCSC were recruited from January 2020 to January 2021 diagnosed at the Affiliated Eye Hospital of Nanjing Medical University. There were 19 patients(23 eyes)treated with subthreshold navigated laser photocoagulation(the Navilas group), and 17 patients(17 eyes)treated with subthreshold micropulse laser(SML)(the SML group). There was no significant difference in baseline data between the two groups(P>0.05). The best corrected visual acuity(BCVA, LogMAR), central macular thickness(CMT), subretinal fluid(SRF)height, vessel densities of the superficial capillary plexus(SCP), the deep capillary plexus(DCP)and area of the foveal avascular zone(FAZ)were collected at 2wk, 1, 3 and 6mo before and after treatment.

RESULTS: The BCVA of the two groups were significantly higher than that before treatment at 3 and 6mo after surgery(P<0.05),which was significantly reduced at 2wk after treatment in the Navilas group and was reduced at 1mo after treatment in the SML group(P<0.05). In both groups, there was significant decrease compared with that before treatment at 3 and 6mo after treatment(P<0.05),but there was no significant difference between the two groups(P>0.05). The difference in SRF absorption between the two groups was statistically significant(P<0.05), and the complete absorption rate of SRF in the Navilas group was higher than that in the SML group. SCP, DCP, the area of the FAZ were not significantly different from each time ofbaseline in the two groups(P >0.05).

CONCLUSION: Subthreshold laser photocoagulation with the NAVILAS^® Laser system can rapidly improve the retinal morphology and shorten the course of cCSC to improve the recovery of visual function with its rapid effect, high cost-effectiveness, non-invasiveness and high repeatability, which can be a new clinical method for patients with cCSC.