Ket qua lau dai cua benh vong mac trung tam thanh dich sau dieu trj quang dong vong mac biing laser Nd: YAG 532nm
The long-term outcome of central serous retinopathy after treatment by Nd: YAG 532nm laser photocoagulation
Le Thi Dong Phu-cng Benh vien Trung uang Qudn doi 108
Tom tat
Muc tieu: nghien cUu hoi cUu lau dai benh vong mac trung tam thanh djch (VMTTTD) de danh gia ket qua thj luc, xu hudng tai phat va xac djnh nhUng tac dpng lau dai cua laser Nd: YAG 532nm quang dong vong mac. Ooi tUdng va phUdng phap: 78 mat cua 78 benh nhan (BN) bj benh VMTTTD dugc dieu trj laser Nd: YAG 532nm tai khda Mat Benh vien TJQO 108 tU thang 1/2005 den thang 1/2010 khong phan biet tuoi va gidi, theo doi it nhat 1 nam sau laser. Co 60 mat laser true tiep len 16 do va 18 mat laser gian tiep. Ket qua: tuoi trung blnh 41,75± 5,24 tuoi, thdi gian theo doi trung blnh 3,05 + 1,5 nam. Nam ehiem 89,74%. Ket qua thj lUc CO 21 mat thj lUcdat 10/10. Neu mated thj lUe trudc dieu trj Idn hdn hdac bang.5/10 sau dieu trj it bj thay ddi, Cdn neu thj lUe dudi 5/10 sau dieu trj thj lUc tang 2-3 hang vdi bang thj lUe Snellen. Ty le tai phat 5,12% trdng dd Cd 3 mat Cd tien sU tai phat. Ty le tai phat d dieu trj laser gian tiep la 16,67% trdng khi dd laser true tiep la
l,67%sUkhacbietcdy nghTa. Khdng cd bien chUng nad xay ra trdng dieu trj cung nhUqua trinh thed ddi sau dieu trj laser. Ket luan: laser Nd: YAG 532nnm quang ddng la mpt phUdng phap an toan va dat hieu qua trong dieu tri benh VMTTTD. Ty le tai phat cua benh VMTTTD giam sau khi laser quang dong trUe tiep. Cac bien ehUng cua dieu trj la hiem gap.
TCf khoa: laser quang dong, benh vong mac trung tam thanh djch, laser Nd: YAG 532nm.
Summary
Objective: the purpose of our retrospective long-term follow-up study in central serous retinopathy (CSR) patients to evaluate visual acuity outcome, recurrence tendency and attempt to determine the long- term effects of Nd:YAG 532nn laser photocoagulation. Patients and Methods: seventy-eight consecutive eyes with CSR in 78 patients referred to Department of Ophthalmology at 108 Central Military Hospital from 2004 to 2010, the follow-up period lasts at least one year. Sixty eyes underwent laser treatment directed to the site of fluorescein dye leakage. Eighteen eyes underwent an indirect laser photocoagulation. Results: mean age at initial visit was 41.75 ± 5.24 years, ranging of 30 to 53 years, male patients 89.74%, follow-up average time 3.05 ± 1.5 years, with a range of 1 to 5 years. Visual acuity outcomes: Twenty-one eyes had 20/20 visual acuity at follow-up. If the initial visual acuity was greater than or equal to 20/40, there was no significant change in visual acuity. Similarly, if the initial vision was less than 20/40, there was an average improvement of between 2 and 3 Snellen lines. There were 4 eyes (5.12%) with recurrences after laser treatment, including 3 eyes with a history of recurrence. The recurrence rate in the eyes with indirect laser photocoagulation was 16.67%
(3 eyes), whereas recurrence in the eyes with direct photocoagulation was 1.67% (1 eye). The recurrences
Phan bien khoa hoc: PGS.TS. NGUYEN HONG GIANG
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol6-N°4/2011
between the 2 groups was statistically significant (p <0.01). There was no complication from photocoagulation in any of the eyes. Conclusions: laser Nd: YAG 532nnm photocoagulation is a safe and satisfactory method of treatment in those cases with central serous retinopathy. The recurrent rate decreases after direct laser photdcdagulatidn. Cdmplieatidns df treatment were uncdmmdn.
Keywords: laser phdtdcdagulatidn, central serdus retindpathy, laser Nd: YAG 532nm.
1. Dat van de
Benh vdng mac trung t l m thanh djch (VMTTTD) la bong thanh djch vdng mac (VM) tu phlt vijng hoang diem, nguyen nhln la do rd ri djch Idng tU mach m l u hie mac qua Idp bieu md sic td vdng mac (BMSTVM).
Von Graefe md t l dau tien benh VMTTTD vao nam 1866 vdi die diem dien hinh la gilm thj lUc trung t l m , nhln vat bien dang va I m diem trung t l m . Mac du sinh benh hpc, die diem lim sang va dien bien benh VMTTTD d l dugc biet rd hon trong nhUng nam gan dly, nhung ve dieu tri van chUa dUpc thiet lap mdt elch dung d i n [7, 9]. Neu thj lUc tU phuc hdi dUgc tdt, mdt sd nha l i m sing khdng dieu tri gi, trong khi dd mdt sd t i c g i l khIe khuyen elo dieu tri neu phuang phIp dd lam thay ddi hinh t h i i bong thanh djch VM.
Neu bong thanh djch VM tai phlt hole tdn tai dai dang lam Inh hudng den chit lupng cude sdng v l hieu q u i edng viec dd II van de b i n ell ve phuong phIp dieu tri. Cijng vdi sU phlt trien tien bd eua ky thuat quang ddng Wessing n l m 1971 d l dUa ra phuong phIp dieu trj quang ddng cd hieu q u i . NhUng nghien eUu g i n dly cho thl'y laser quang ddng trUe tiep vj trf Id dd chu yeu lim gilm khoing thdi gian bong thanh djch VM xudng cdn khoing 1 thing, nhUng khdng ed hieu q u i ve thj luc. Quang ddng giln tiep khdng hieu q u i vdi khoing thdi gian bong thanh djch, nhung trinh dugc ddng die djch dd dudi VM vung hoang diem [2,8].
Trong nghien cUu hdi eUu l l u dai benh n h l n bj benh VMTTTD, chung tdi nham muc tieu d i n h g i l ket q u i thj lUe v l xu hudng t i l p h l t eua benh. TU dd, dUa ra tien lupng va xle djnh hieu q u i lau d i i cua laser Nd:YAG 532nm quang ddng d benh VMTTTD.
2. Doi tUorng va phUcrng phap nghien cuTu 2.1. Doi tuang nghien edu
Tl't e l benh nhan (BN) bj benh VMTTTD dugc dieu tri laser Nd: YAG 532nm tai khoa M l t Benh vien
TLfQD 108 tU t h i n g 1/2005 den t h i n g 1/2010 khdng p h l n biet tudi va gidi theo cle tieu ehuan sau: 1) chup mach huynh quang (CMHQ) cd Id rd thudc nhudm nam ngoai hd hoing diem; 2) bong thanh djch vijng hoang diem; 3) khdng cd phu hoIng diem dang nang; 4) khdng eli thien trieu chUng sau dieu trj lan dau; 5) khdng cd benh ly VM khIc ve mat cung tdn tai; 6) theo ddi it nhl't 1 n l m sau laser.
2.2. Phuang phap nghien edu
Nghien cUu theo phuong phIp hdi cUu, md ta l i m sang theo ddi, d i n h g i l ket q u i l i m sing trudc va sau dieu trj, khdng cd nhdm ehUng. Trudc khi laser de xle djnh mdt elch chfnh xle vj tri Id dd tat el BN deu dugc chung tdi CMHQ d l y mat.
2.2.1. Phuang tien nghien edu
Sinh hien vi khIm ed den khe va cd gan mIy chup Inh; MIy soi d l y mlt; Kfnh 3 mat gUOng (Goldman), kfnh soi trung t l m (Lens Mainster); MIy chup d l y m l t ; MIy laser Nd: YAG bUde sdng 532nm.
2.2.2. Ky thuat tien hdnh laser
Nhd d i n ddng tU bang Mydrin P d i m bio ddng tCr d i n tdi da ed the quan s i t dugc day mlt. Nh6 thudc te be mat dicain 1% hole l i m eho BN khdng khd chju khi tl-fUc hien dat kfnh soi len gilc mac.
Dung chat gel nhU Methoxel 3% len mat Idm eCia kfnh tiep xue trudc khi dat len tren gilc mac cua BN.
Khi lam laser: benh n h l n ngdi t h o l i m l i trUdc sinh hien vi ed den khe, ed the cd djnh dau bang mdt g i l l b l n g sau g l y . Thu thuat dugc thUe hien trong budng tdi de cd the quan sit rd han. Cd the dung mdt ngudn sing nhd tren sinh hien vi de benh n h l n djnh thj v I o do.
Quang ddng true tiep vao Id dd dupc p h l t hien tren I n h CMHQ nam ngoli hd hoIng diem hole cac mach m l u Idn (ddng tTnh mach t h i i dUdng tren va
dudi) vdi elc thdng sd ban dau nhU sau: Kich thudc ndt b i n 50-200|Lim; Thdi gian g l y bdng 0,1-0,2sec;
Cdng suat ban dau 70mW; Cudng dp cd the t i n g dan dat dugc vet bdng VM cd m l u trIng nhe. Trinh bd gal hoang diem.
Quang ddng g i l n tiep v I o vj tri bd dudi vung bong thanh djch hole v I o mao mach dan den vj tri Id dd each Id dd 500 microns trong trudng hpp Id dd d sit hd hding diem v l bong thanh djch rpng. Dat thdng sd tuong t u nhU vdi quang ddng trUe tiep.
Ban theo hinh tam gilc deu (vdi khoing elch giUa hai vet b i n dung bang dudng kfnh cua vet ban.
D i n h g i l t o l n bd b l n g I n h m l u va CMHQ nhU sau: 1) vj tri v l kfeh thUdc eua bong thanh djch VM;
2) sd lupng, vj trf, hinh thu v l kfeh thude Id dd; 3) vj trf pham vi va mUc dp nang cua l i n g dpng BMSTVM.
Dae diem cua Id dd ri v l bong thanh djch de dugc thdng nhat. D i n h g i l BMSTVM la phUOng p h I p chu quan nhieu hon va vl the khdng ban luan.
Mdi l l n khIm tat e l BN deu dugc do thj lUc (ed chinh kfnh ), do n h l n I p , khIm xet d i n h g i l tinh trang vdng mac qua sinh hien vi vdi kinh tiep xue 3 mat gUOng v l m I y soi d l y m l t . Djnh ky khIm theo thdi gian 1 t u i n , 2 tuan, 1 t h i n g , 3 t h i n g , 6 t h i n g , 1 n l m , 2 n l m v l 3 n l m ghi ket q u i vao phieu theo ddi. Cle sd lieu thu dupe dUa v I o Foxpro 6.0 v l Excel de thdng ke v l xU ly.
3. Ket qua
Bang l.Tudi va gidi
^ v . Tuoi Gidi ^ \ ^ ^
Nam NU T.so
DUdi 20 n
0 0 0
% 0 0 0
20-40 n 26
3 29
% 33,33
3,85 37,18
40-60 n
44 5 49
% 56,41
6,41 62,82
Tren 60 n
0 0 0
% 0 0 0
Tong so n
70 8 78
% 89,74 10,26 100 Dae diem co b i n : tudi trung blnh d l u tien t h i m khIm la 41,75± 5,24 tudi, khoing tU 30-53tudi. Nam ehiem 89,74% gap 6,75 l l n nU. Tl't c l BN deu bj 1 m l t trong dd 36 m l t t r i i v l 42 m l t p h l i .
Thdi gian bj benh: hau het BN deu den khIm d benh vien co sd luc bj g i l m thj lUe. BN den dieu trj d benh vien chung tdi tU luc ed trieu ehUng cho den khi t h i m khIm lan dau trung blnh khoing 4 ± 1,3 tuan;
Dieu trj laser dugc tien hanh d t u i n thU 5 sau hdi ehUng dau tien. Cd 14 m l t bj t i i p h l t sau 2 lan dieu trj ndi khoa. 64 m l t bi benh lan dau.
Vj trf 16 do TM* thai dUdng tren TM*thaidUdngdUdi TM* mi VM
Canh ho trung tam Tong so
Bang 2. P h l n bd vj t r i Id d d tren hinh I n h CMHQ
VM vung hoang diem n
36 13 7 17 73
% 49,31
17,81 9,59 23,29 75,26
VM ngoai vung hoang diem n
18 6 0 0 24
% 75 25 0 0 24,74
Tong so n
54 19 7 17 97
% 55,67 19,59 7,22 17,52
T/W*= tinh mach
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol6-N°4/2011 Vdng mac vung hoIng diem I I mdt vung n l m
trong vdm mach m l u t h i i duong tren va t h i i duong dudi. Kfeh thUde khoing 5,5mm bao gdm dUdng kfnh cua hd hoang diem (Fovera = 1,5mm), hai lan dp rpng cua parafovera (2x0,5=1 mm) v l hai l l n dp rpng cua perifovera (2x1,5 = 3mm).
SU p h l n bd diem rd trudc dieu tri nhU sau: canh hd hoIng diem cd 17 diem dd; n l m trong cung mach t h i i duong tren va dudi nhUng ngoai hd trung t l m cd 49 diem dd; Tfnh mach mi - vdng mac cd 7 diem dd; d bat ky vj trf nao eua vdng mac h l u eUc ed 24 diem dd.
Chung tdi n h l n thay ed 3 kieu rd ri. Mdt ndt trdn ngam huynh quang to dan theo thdi gian b i t dau tU vj tri mdt tTnh mach VM gap 62 m l t . Mdt diem
rd phun len t h i n h hinh "cot khdi hole hinh Idng chim" gap 15 m l t . Diem rd ri tU vj tri bong BMST gap
1 m l t .
Tdng sd cd 62 m l t cd 1 Id dd ehiem 79,49%; 13 m l t ed 2 Id dd ehiem 16,67% v l chi cd 3 m l t ed 3 16 dd ehiem 3,85%.
Dae diem bong thanh djch d lan khIm dau tien eua m l t BN. Kfeh thudc trung blnh eua bong la hai dudng kfnh dfa thj, n l m trong khoing 2/3 den 4 dudng kfnh dia thj. Bong thudng d trung t l m hoang diem nhung thudng bong eao phfa dudi. Ling dpng lipid (cham xul't tiet cUng m l u vang dUdi VM) co cung vdi bong thanh djch d 7 m l t (8,97%). Bong thanh djch rpng la kfeh thude bong tren 3 dUdng kfnh dTa thj cd 17 m l t ehiem 21,79%.
Cdng suit laser trung blnh:
- Cdng suit max: 155,64 ± 126,36mW -Cdng suit min: 166,67± 130,09mW Thdi gian laser trung blnh: 0,13 ± 0,03s Kfeh thudc ndt bdng laser trung blnh:
81,41 ±24,32fam
Sd ndt bdng trung blnh 31,31 ± 30,6 Bang 3. Lien quan tdn thuang VM tren l i m sang va sd lUpng Id dd tren CMHQ
Tmh trang VM So 16 do
1 2 3 Tong so
Bong thanh djch n
37 2 0 39
% 59,68 15,38
0 50
Bong thanh djch rpng n
9 6 2 17
% 14,52 46,15 66.67 21,79
Bong thanh djch va BMSTVM n
11 4 0 15
% 17,74 30,77
0 19,23
Bong thanh djch va lang Lipid n
5 1 1 7
% 8,06 7,69 33,33
8,97 Bang 4. PhUong phIp laser quang ddng va sd Id dd
So 16 do PhUdng phap laser TrUe tiep
Gian tiep
True tiep va gian tiep
1 n 47 15 0
% 75,81 24,19
0
2 n 10
0 3
% 76,92
23,08
3 n 3 0 0
% 100
0 0
Tong so n
60 15 3
% 76,92 19,23 3,84 Chung tdi laser chu yeu true tiep vao dung vj tri Id dd 60 m l t (76,92%)), ed 15 m l t (19,23%)) laser giln tiep trong do 14 m l t ed Id dd n l m canh hd hoang diem va 1 m l t nam bd gai hoIng diem. Cd 3 m l t (3,84%) vUa laser true tiep vCra laser g i l n tiep bdi nhUng m l t nay ed 3 Id dd mdi m l t : laser true tiep Id dd nam ngoai hd hoang diem, edn laser g i l n tiep Id dd nam canh hd hoang diem.
Bang 5. Lien quan t h j lUc trUde va sau laser vdi sd Id d d
Thj luc So 16 do
1
2
3
T.SO
<0,1 Trudc
6 9,68
2 15,38
1 33,33
9 11,54
Sau 1 1,61
1 1,28
> 0,1 - < 0,3 Trude
28 45,16
5 38,46
1 33,33
34 43,59
Sau 5 8,06
1 7,69
1 33,33
7 8,97
>0,3 -<0,5 Trudc
19 30,64
5 38,46
1 33,33
25 32,05
Sau 7 11,29
1 7,69
0
8 10,26
>0,5-<0,8 Trude
9 14,52
1 7,69
10 12,82
Sau 34 54,84
6 46,15
1 33,33
41 52,56
>0,8 TrUdc
0
0
0
0
Sau 15 24,19
5 38,46
1 33,33
21 26,92
Bang 6. Bong thanh djch t i i p h l t lien quan den phUong phIp laser PhUdng
phap laser True tiep Gian tiep True tiep va
gian tiep Tong so
Tai phat n
1 3 0 4
% 1,67
20 0 5,12
Khong tai phat n
59 12 3 74
% 98,33
80 100 94,88 Thdi gian theo ddi trung blnh eho 78 BN dieu trj II 3.05 ± 1.5 n l m (tU 14 t h i n g den 72 thing).
Thj luc: 21 m l t trong sd 78 sau dieu trj ed thj lUc tren 0,8 d thdi diem theo ddi cudi cung. Ddi vdi el nhdm thj lUc ban d l u Idn han hole bang 0,5 thi thay ddi thj luc khdng nhieu, nhUng d nhdm thj lUc dudi 0,5 thi mUc eli thien t i n g nhieu khoing 2-3 hang.
Trong sd 14 m l t ed tien sU t i i p h l t sau dieu trj ndi khoa dugc laser: thj luc dudi 0,1 trude laser ed 2 mlt, sau laser thj lUe lan cudi eijng den khIm (sau 2 nam) 1 m l t dugc 10/10 cdn 1 m l t thj lUc khdng thay ddi. Cdn lai 12 mat thj lUetren 1/10: sau laser thj lUc lan cudi cung den khIm t i n g ft nhat 2 h i n g . Trong sd nay ed 3 m l t bj t i i p h l t deu dugc laser lan 2, 1 mat thj luc khdng thay ddi, edn 2 m l t thj lUe t i n g 8/1 Ova 9/10tuang Ung.
Thdi gian phuc hdi trung blnh 6,2 tuan ± 1,6 tuan. bieu hien dich bong tieu, khdng cdn rd ri d CMHQ, nhung edn l i n g dpng lipid.
Nhln I p tat c l BN trudc khi laser deu n l m trong gidi han blnh thudng. Nhln I p trung blnh trudc laser 17,71 ± l,43mmHg. Nhln I p sau laser khdng ed trUdng hpp nao eao. Nhln I p trung blnh sau dieu tri 17,55± l,34mmHg.
Tinh trang t i i phlt: trong sd 14 m l t ed tien s\i t i i p h l t sau dieu tri ndi khoa 1 n l m , sau dieu trj laser 2 n l m cd 3 m l t bj t i i phlt. Trong sd 64 m l t bj benh l l n dau dugc laser thi ehi ed 1 m l t bj t i i p h l t sau dieu tri laser 2 n l m .
Phuang p h I p laser true tiep len Id dd ty le t i i p h l t I I 1,67% thap hon so vdi phuong phap laser g i l n tiep ty le t i i p h l t 20%, sU khIc biet nay cd y nghTa vdi P<0.01. Trong sd 4 m l t sau dieu trj laser t i i p h l t cd 3 mat trudc khi laser vj trf Id dd canh hd hoIng diem va bong thanh djch rpng nen khdng the laser true tiep len Id dd dugc. Chung tdi d i e biet chu y vj trf Id rd d 4 m l t bj t i i p h l t tren CMHQ xuat hien Id dd d vj tri mdi 3 mat, vj trf mdf eleh vj trf gdc nUa dudng kfnh gai va 1 m l t cd Id dd elch vj gdc 2 dudng kfnh gai.
Bien ehUng: khdng ed bien chUng cua laser quang ddng p h l t hien trong thdi gian theo ddi.
Khdng ed tdn thuong eau true VM sau dieu trj laser tren CMHQ.
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol6-N°4/2011
4. Ban luan 4.1. Thj luc
Dieu trj laser quang ddng trong benh VMTTTD I I laser quang ddng true tiep len vj tri rd ri fluorescein. Ndi chung vdi thdi gian theo ddi BN l l u d i i chung tdi quan s i t thay Ipi ich eua laser dieu tri la thj lUe eli thien tdt, BN khdng bj mat thj lUc vTnh vien. Trong nghien cUu eua chung tdi cd 78 m l t sau dieu trj vdi thdi gian theo ddi trung blnh I I 3 n l m thj luc tdt tren 0,5 I I 62 m l t (79,48%), thj lUc xau nhl't dudi 0,1 ehl cd 1 mat (1,28%). Dieu n i y eho thl'y b i t chap bong thanh djch VM rpng, l i n g dpng nhieu lipid v l bong BMSTVM, nhUng thj lUc BN van khdng bj mat hoan toan.
Lai feh rd ring cua lieu phIp laser la khi n i n g l i m g i l m thdi gian bong thanh djch cua Idp nhay e l m than kinh VM. Dieu n i y d l dugc elc t i c g i l b i o elo trong nhieu nghien eUu. N l m 1974, Watzke va cdng sU d l trinh b i y thdi gian trung blnh g i l m tU 23 t u i n neu khdng dieu trj xudng cdn 5 tuan neu dieu tri. Trong nghien cUu eua chung tdi thdi gian trung blnh het bong thanh djch sau dieu trj II 6,2 ± 1,6 tuan. CM Gilbert v l edng sU [1] cung thUa nhln ket q u i thj lUc l l u d i i I I tdt v l khdng g l y mat thj lUe trong h l u het cle trudng hpp. SU khIc biet khdng ed y nghTa thdng ke trong nhdm dieu tri so sinh vdi nhdm khdng dieu tri. Tuy nhien, ed nhUng trUdng hpp djch dudi VM tieu di nhUng mdt sd BN van than phien ve nhUng trieu ehUng nhln mau thay ddi nhe keo d i i hon so m l t linh.
4.2. Ky thuat laser quang dong
Laser quang ddng dugc sU dung trong nghien cUu cua chung tdi la laser Nd: YAG 532nn tao nen seo t r I n g phu tren Id rd ri. Chung tdi sU dung cdng s u i t 75-200mW, kich thudc 50-1 OO^m thdi gian 0,1 - 0,2s va sd ndt bdng 5-170 ndt. Nghien eUu thUe nghiem eho thay bien ddi vTnh vien BMSTVM g l y nen d vj tri seo laser. Seo lam eho hap thu djch dudi VM qua h i e mac, nhung cung p h i huy mdt vung te bao BMSTVM tang tiet mpt eleh bat thudng. Khdng cd bat cU hieu q u i nao khi seo laser khdng de len Id rd ri [1, 3, 5]. ThUe sU quang
ddng true tiep lam g i l m thdi gian bong so vdi gian tiep, CO che van cdn tranh e l i . Hau het BN dUpc dieu trj laser cd the an toan, tuy nhien cd mdt ty le nhd khi Id dd n l m s i t hd hoang diem hole mach m l u chinh thi viec can thiep laser trUe tiep I I nguy hiem v l dieu tri laser g i l n tiep khdng the thay the b l n g de Id dd t u lien. Trong nghien eUu eua chung tdi nhUng trUdng hpp t i i p h l t d dieu trj laser true tiep hay g i l n tiep deu x u l t hien Id dd mdi elch diem dd khoing hon mdt dudng kinh gai. Tuy nhien, ty le t i i p h l t d hai phUPng p h I p dieu trj la khIc biet cd y nghTa.
4.3. Tmh trang tai phat
Lieu dieu trj laser cd g i l m nguy co t i i phlt hay khdng, mdt van de van edn ehUa dugc giii dip.
NhUng nghien cUu ve benh VMTTTD trUde dly xle n h l n ty le t i i p h l t va I n h hUdng cua dieu tri laser len ty le niy. Rat khd so sinh vdi cle b i i bio trUdc d l y cung nhU hien tai bdi vl sU khIc biet hole ve khoing thdi gian theo ddi hole khIe nhau ve tieu ehuan t i l phlt.
Ty le t i l p h l t dugc thdng b i o trong cle bio cao cung khIe nhau Yap va Robertson khdng gap trudng hop nao t i i p h l t sau dieu trj, khIc vdi Robertson DM, llstrup D [8] vdi thdi gian theo ddi 18 t h i n g d 2 nhdm laser g i l n tiep va dieu trj g i l gap ty
le t i i p h l t 34%, cdn laser trUe tiep khdng gap trUdng hpp nIo.Cle t i e g i l eho ring hai ly do de cd the lam thay ddi ty le t i i p h l t dd I I : (1) khoing thdi gian theo ddi khIe nhau; (2) ky thuat dieu trj khIc nhau (laser trUe tiep, g i l n tiep va dieu trj gil). L Picker va cdng sU [3] theo ddi trung blnh 9,5 n l m gap 28% tai p h l t d nhdm dieu tri laser va 37% d nhdm khdng dieu trj laser. Cle t i e g i l quan sit d 17BN bj t i i phlt cd 15 m l t xuat hien Id dd mdi cle xa vj ban dau, chi ed 2 m l t x i y ra d vj tri ban dau d m l t khdng dieu trj laser. VI vay t i e g i l ket luan laser khdng l i m gilm ty le tai p h l t ma ehi de g i l m nhanh bong thanh djch.
CM. Gilbert [1] thdi gian theo ddi trung blnh 4,9 nam gap 19%) d nhdm dieu trj v l 28% d nhdm khdng dieu trj. Verma L [6] thdi gian theo ddi 1 nam khdng gap trudng hop n i o t i i p h l t vdi dieu trj laser argon hole diod.
Trong nghien eUu eua chung tdi gap ty le t i i p h l t I I 5,12% trong dd 3,85% laser g i l n tiep va 1,28% laser true tiep. Mdt han che trong nghien cUu eua chung tdi khdng cd nhdm chUng, tuy nhien trong nghien cUu cd 14 m l t bj t i i p h l t lan 2 sau dieu trj ndi khoa trong vdng 1 nam, chung tdi chuyen sang dieu trj laser sau 2 n l m cd 3 m l t bj t i i p h l t v l Id dd d vj tri mdi elch xa vj tri ban d l u . Do dd chung tdi ung hd y kien cua L.Ficker la laser khdng ngan c l n dugc benh t i i p h l t , bdi vl b i n chat benh c l n cua benh VMTTTD I I tdn thuong thanh mao mach, laser ehi ed t i c dung bjt lai Id dd ri.
Theo A. Caccavale v l cdng sU [9] nghien cUu ve benh hpc cho rang benh VMTTTD I I thay ddi cP b i n trong mach m l u lien quan vdi Idp bieu md sic td vdng mac. NhUng ddi tUPng de bj cang t h i n g vdi thay ddi tuyen yen dudi ddi g l y p h l n Ung (HPA) v l hp cd mUc huyet thanh, Cortisol vi the va catecholamin cao hon ddi tuong blnh thudng. VI vay, elc t i e g i l deu ddng y cle phuong p h I p dieu tri khIc nhau, bao gom t i e n h l n g l y g i l m tiet adrenalin, chat Uc che anhydrase khf cic-bd-nfch, laser quang ddng, tiem ndi n h l n bevacizumab v l dieu tri quang ddng vdi verteporfin deu dat dugc hieu q u i tren l i m sang.
5. Ket luan
TU nghien eUu chung tdi ket luan rang, laser Nd:
YAG 532nm quang ddng VM I I mdt phuong phIp dieu trj an toan hieu q u i eho nhUng trudng hop ed Id dd mach m l u tren CMHQ v l khi thj luc I n h hudng den ehl't lupng cude sdng va kha n i n g lam viec. Ddi vdi nhdm thj lUe ban dau Idn hon hole bang 0,5 thi thi luc ft thay ddi sau dieu tri. Tuy nhien, nhdm thj luc dudi 0,5 thi mUe eli thien thj lUe nam trong khoing giUa 2-3 dUdng. SU khIe biet ed y nghTa ve ty le t i i p h l t giUa m l t laser true tiep len Id dd va laser g i l n tiep. Khdng ed bien chUng n i o quan trpng khi dieu trj laser quang ddng b l n g Nd: YAG 532nm.
Do dd laser Nd: YAG 532nm quang ddng VM la phuang p h I p lUa chpn cho BN. Tuy nhien nghien cUu nay eua chung tdi can ed nhdm chUng de viec ket l u i n duac chfnh xle hon.
Tai lieu tham khao
1. Gilbert CM, Owens SL, Smith PD, and Fine SL (1984), Long-term follow-up of central serous chorioretinopathy. British Journal of Ophthalmology, 1984,68,815-820.
2. Leaver P, Williams C (1979), Argon laser photocoagulation in the treatment of central serous retinopathy. Br J Ophthalmol 1979,63:674-677.
3. Ficker L, Vafidis G, While A, Leaver P (1988), Long- term follow-up of a prospective trial of argon laser photocoagulation in the treatment of central serous retinopathy. British Journal of Ophthalmology, 1988, 72, 829-834.
4. Marmor MF (1997), On the cause of serous detachments and acute central serous chorioretinopathy.British Journal of Ophthalmoldgy 1997;81:812-813.
5. Murthy KR et all (1983), Management df central serdus retindpathy. Indian J Ophthalmdl 1983;
31:135-6.
6. Verma L, Sinha R, Venkatesh P (2004), Research article.Cdmparative evaluatidn df didde laser versus argdn laser phdtdcdagulatidn in patients with central serdus retindpathy: A pildt, randdmized Cdntrdlled trial. BMC Ophthalmdiogy 2004,4:15.
7. Wirostko WJ., Pulido JS. (2004), Chapter 127 - Central Serous Chorioretinopathy Yanoff: Ophthalmology, 2nd ed.. Copyright © 2004 Mosby, Ine: 938-941.
8. Robertson DM, llstrup D. (1983), Direct, indirect, and sham laser photocoagulation in the management of central serous chorioretinopathy. Am J Ophthalmol.
1983 Apr; 95(4):457-66.
9. Caccavale A, Romanazzi F, Imparato M, Negri A, Morano A, Ferentini F. (2011), Central serous ehdridretindpathy: a pathdgenetie mddel. Clin Ophthalmdl. 2011; 5:239-43. Epub 2011 Feb 20.
