慢性中心性浆液性脉络膜视网膜病变眼底自发荧光特点

Fundus autofluorescence in patients with chronic central serous chorioretinopathy

目的观察22例慢性中心性浆液性脉络膜视网膜病变(简称中浆,central serous chorioretinopathy,CSC)患者眼底的自发荧光,探究中浆患者在恢复期眼底自发荧光的特点。方法回顾性随访临床病程超过3个月且曾经眼底荧光血管造影确诊为中心性浆液性脉络膜视网膜病变的患者16例22眼,单眼10例,双眼6例,发病后半年22眼均经海德堡共焦激光扫描镜HRA2-cSLO拍摄眼底自发荧光(fundus autofluorescence,FAF),观察其影像学特点。结果22眼中仅有2眼表现为正常FAF,其余20眼均表现为异常FAF。异常FAF可分为3类:第一类,原发病灶渗漏点处呈不规则形状的低荧光,周围环绕0.5-2DD大小的高荧光区,有8眼占36.3%;第二类,在原发病灶处几乎看不到异常荧光,而在其下方或侧下方可见竖椭圆型,葫芦状或斜条状的高荧光区,中央夹杂有点片状的低荧光有7眼占31.8%;第三类,原发病灶处呈明暗相间的斑驳状的异常荧光有5眼占22.7%。这些不同类型的异常FAF说明自行愈合的中浆患者即使黄斑区视网膜下渗液已经消失但在病灶的原始渗漏部位或病灶周围及下方却出现了RPE细胞功能和代谢的损害。结论未经治疗的中浆患者眼底可出现异常FAF,说明RPE细胞出现了永久损害,故对中浆病人应早期进行干预性治疗。

Objective To investigate the characteristics of fundus autofluorescenee （FAF） in 22 patients with chronic central serous chorioretinopathy （ CSC ）. Methods FAF images by a confocal scanning laser ophthalmoscopy （cSLO）were analyzed retrospectively in 22 eyes of 16 patients with CSC for more than three months, confirmed by fundus fluorescein angiography. The images were obtained at the sixth month or more from the onset of the disease. Results Only two eyes showed a normal FAF, and the other 20 manifested the abnormal FAF, which was classified into three phenotypic patterns. Eight eyes （36.3 % ） showed a irregular-shaped decreased FAF signal over the primary lesion, surrounded by increased FAF with the size of 0.5 -2 DD. In 7 eyes （31.8% ）, abnormal FAF was hardly seen in the leakage point, however they could be found below the leakage point which were defined by the presence of vertical oval, grapeshaped or striped areas of increased FAF, mixed with decreased spots. Five eyes （22.7%）were characterized by light and dark mottled abnormal FAF signal in the lesion. Conclusion Abnormal FAF images can be observed in un-treated CSC patients, indicating that these RPE cells are permanently damaged. Therefore early intervention is quite essential for treating CSC patients.