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目的 观察577 nm阈下微脉冲激光治疗慢性中心性浆液性脉络膜视网膜病变(CSC)疗效及对黄斑色素密度的影响.设计回顾性病例系列.研究对象2015年8月至2016年2月在南方医科大学武汉临床医学院确诊为慢性CSC行577 nm阈下微脉冲激光治疗的患者32例(32眼).方法 患者均行最佳矫正视力(BCVA)、全视网膜镜、眼底彩色照相及黄斑色素密度(MPOD)、荧光素眼底血管造影(FFA)和吲哚菁绿血管造影(ICGA)、相干光断层扫描(OCT)及对比敏感度检查.577 nm阈下微脉冲激光治疗光斑直径100 μm,曝光时间0.2 s,负载系数5％,治疗能量为50％P,根据检查结果对渗漏点及其周围(跨出渗漏点约50～100 μm)进行覆盖性光凝.治疗后1、3、6个月复查相关检查.主要指标BCVA、视网膜中心凹厚度(CFT)和对比敏感度、视网膜下液(SRF)吸收率、预后相关因素及黄斑色素密度.结果 治疗1、3、6个月后BCVA分别为0.36±0.15、0.35±0.16、0.32±.021,均较前好转(P均＜0.05);CFT分别为(305.56±62.53) μm、(298.29±46.42) μm、(253.81±57.18)μm,均较前下降(P均＜0.05);对比敏感度分别为14.32±1.02、15.68±0.98、17.53 ±1.32,均较前提高(P均＜0.05).阈下微脉冲治疗慢性CSC疗效与病变类型和年龄相关,当病变为点状渗漏其SRF吸收率最高为100％,病变为局限性渗漏伴RPE萎缩时SRF吸收率为72.73％,当病变为弥漫性病变及RPE萎缩时SRF吸收率最低为64.25％.阈下微脉冲治疗慢性CSC无反应组平均年龄高于有反应组(t=-9.23,P=0.001).随访6个月,所有患者所有检查上均未在治疗部位观察到可见光斑.阈下微脉冲激光治疗后1、3、6个月MPOD平均值分别为0.15±0.18、0.16±0.05、0.16±0.21 (P均＞0.05).结论 577 nm阈下微脉冲激光治疗慢性CSC安全有效,对MPOD水平无影响.“,”Objective To observe the efficacy of the subthreshold micropulse yellow laser (577 nm)for chronic central serous chorioretinopathy (CSC) and its effects on macular pigment.Design Retrospective cases series.Participants 32 eyes of 32 patients with chronic CSC treated with subthreshold micropulse yellow laser photocoagulation were enrolled.Methord All patients were examined with best corrected visual acuity (BCVA),color fundus photography,fundus fluorescein angiography (FFA) combined with indocyanine green angiography(ICGA),optical cohenrence tomography (OCT) and contrast sensitivity.Subthreshold micropulse yellow laser was performed in the micropulse mode,using 100 μm spot diameter and 0.2 s duration with 5％ duty cycle,and power reduced 50％ from the power of a single threshold burn.Micropulse yellow laser was applied on the leaking point on fluorescein angiogram and normal retina around the borderline area of serous retinal detachmen (50～100 μm).Retreatment was considered in clinic examination which was the same with that of baseline.Main outcome measures BCVA,centrel fovea thickness (CFT),contrast sensitivity,the rate of resolution of subretinal fluid (SRF),MPOD,and the factors associated with prognosis.Results The average BCVA was 0.36±0.15,0.35±0.16,0.32±.021 at lth,3th,6th month respectively,significantly better than at baseline (all P＜0.05).The average CFT was (305.56±62.53)μm,(298.29±46.42) μm,(253.81±57.18) μm reapectively,significantly decreased than at baseline (all P＜0.05).The average contrast sensitivity was 14.32±1.02,15.68±0.98,17.53±1.32 respectively,significantly better than at baseline (all P＜0.05).The rate of resolution of SRF was 100％ in chronic CSC patients with point source leakage.The rate of resolution of SRF was 72.73％ in chronic CSC patients with point source leakage and associated RPE atrophy.The rate of resolution of SRF was 64.25％ in chronic CSC patients with diffuse RPE decompensation.Ages in nonresponder group was higher than that in responder group (t=-9.23,P=0.001).At 6 months,any structural laser damage were not showed.The average MPOD after treatment remained at the baseline level (all P＞0.05).Conclusion Subthreshold micropulse yellow laser (577 nm) photocoagulation treatment is an effective and safe treatment option for patients with chronic CSC.The MPOD did not increased after subthreshold micropulse yellow laser (577 nm) photocoagulation.