目的：研究玻璃体腔注射bevacizumab联合PDT治疗中心性浆液性视网膜脉络膜病变(central serous choroiretinopathy， CSC)患者的临床疗效。

方法：选取2012-02/2015-04于我院就诊的CSC患者82例82眼作为研究对象，所有患者均经OCT、FFA确诊，且均为单眼患病。按治疗方法不同将所有患者分为对照组35例35眼和研究组47例47眼。其中对照组患者采用光动力(PDT)治疗，研究组患者采用PDT联合玻璃体腔内注射bevacizumab治疗。对比两组患者治疗次数、浆液性色素上皮脱离(PED)平伏率和黄斑视网膜下液、黄斑中心区直径的总体积、黄斑中心区直径6mm的平均厚度和黄斑中心区1mm范围的厚度等OCT指标，以及治疗前后不同时间最佳矫正视力和临床疗效。

结果：对照组患者中32眼治疗1次，3眼治疗2次，平均治疗次数为1.25±0.20次； 研究组中9眼治疗3次，10眼治疗2次，28眼治疗1次，平均治疗次数1.48±0.22次。两组患者治疗次数对比差异无统计学意义(t=1.209，P>0.05)。对照组患者PED平伏13眼(37%)，黄斑视网膜神经上皮下浆液吸收22眼(63%)。研究组患者PED平伏30眼(64%)，黄斑视网膜神经上皮下浆液吸收17眼(36%)。两组患者治疗后PED平伏率和黄斑视网膜神经上皮下浆液吸收率对比均差异均有统计学意义(P<0.05)。两组患者治疗前黄斑中心区直径的总体积、黄斑中心区直径6mm的平均厚度和黄斑中心区1mm范围的厚度等OCT指标对比差异无统计学意义(P>0.05)，而治疗后研究组患者在这些OCT指标上均明显低于对照组，且差异均有统计学意义(P<0.05)。两组患者治疗后在这些OCT指标均明显低于各组治疗前，且均有统计学意义(P<0.05)。两组患者治疗前和治疗后1mo最佳矫正视力对比差异无统计学意义(P>0.05)，治疗后3、6mo时研究组患者最佳矫正视力(LogMAR)明显低于对照组，且差异均有统计学意义(P<0.05)。对照组患者中无效6眼，好转15眼，显效8眼，治愈6眼，总有效率为83%； 研究组患者中无效3眼，好转8眼，显效20眼，治愈16眼，总有效率为94%，两组患者总有效率对比差异有统计学意义(P<0.05)。

结论：在慢性CSC合并PED患者治疗中玻璃体注射抗VEGF单克隆抗体bevacizumab联合低剂量PDT在平伏PED，促进黄斑视网膜下浆液吸收，降低黄斑视网膜厚度，改善视力方面优于单一PDT治疗患者。

METHODS:We selected 82 CSC patients treated in the hospital between February 2012 and April 2015, who were diagnosed by optical coherence tomography(OCT)and fundus fluorescein angiography(FFA)and all got the disease monocularly, and divided them into two groups called control group(n=35)and research group(n=47)by different methods, the patients of control group were treated by PDT method, while the patients of research group were treated by vitreous bevacizumab injection combined with PDT. Then compare the number of treatment times, the rate of flat pigment epithelial detachment(PED), macular subretinal fluid absorption, OCT indexes such as volume of the macular central hub, average thickness of central macular with diameter of 6mm and thickness of central macular region below 1mm range, the difference of corrected vision and clinical efficacy of two groups before and after the treatment.

RESULTS: There were 32 eyes which were treated once, and 3 eyes which were treated twice in the control group, the average treatment times was 1.25±0.20; however, there were 9 eyes which were treated three times, 10 eyes twice, 28 eyes once, the average treatment number was 1.48±0.22, the treatment times of two groups had no statistical difference(t=1.209, P>0.05). On the other hand, 13 eyes' PED(37%)was flat in the control group, 22 eyes(63%)which macular retinal subepithelial serous absorption; 30 eyes' PED(64%)was flat in the research group, 17 eyes(36%)which macular retinal subepithelial serous absorption. The rate of flat PED and macular retinal subepithelial serous absorption of two groups had obvious statistical difference(P<0.05). The OCT indexes such as volume of the macular central hub, average thickness of central macular with diameter of 6mm and thickness of central macular region bellow 1mm of two groups had no statistical difference before the treatment(P>0.05), in contrast these OCT indexes were all much lower than control group after the treatment, and the results had obvious statistical difference(P<0.05). Besides, these OCT indexes after treatment were all much lower than that of two groups before treatment respectively, and it also had obvious statistical difference(P<0.05). After 1-month's treatment, the LogMAR corrected vision of two groups had no statistical difference(P>0.05). While the LogMAR corrected vision of research groups had statistical difference with control group after 3mo and 6mo(P<0.05). There were 6 invalid cases, 15 improvement cases, 8 excellence cases and 6 healing cases in the control group; the total effective rate of control group was 83%. While there were 3 invalid cases, 8 improvement cases, 20 excellence cases, 16 healing cases in the research group, the total effective rate of research group was 94%. The effective rate of two groups had obvious statistical difference(P<0.05).

CONCLUSION: In the treatment of chronic CSC with PED patients, the method of vitreous bevacizumab injection combined with low dose PDT has better effect on PED flat, promoting macular subretinal serous absorption, reducing macular thickness and improving visual acuity.