中心性浆液性脉络膜视网膜病变色素上皮功能状态分析

Analysis of the retinal pigment epithelium＇s function in central serous chorioretinopathy

目的分析中心性浆液性脉络膜视网膜病变（CSC）视网膜色素上皮（RPE）损害性质。方法应用海德堡眼底造影系统对67例（67只眼主检）临床确诊CSC患者进行绿色激光眼底照相、荧光素眼底血管造影（FFA）、吲哚青绿血管造影（ICGA）检查。对18例适于光凝治疗的患者直接光凝封闭RPE渗漏点，并观察视网膜下液吸收速度。结果64只眼绿色激光眼底像显示浆液性视网膜脱离（盘脱）同时FFA显示RPE渗漏点，3例绿色激光眼底像显示明显盘脱而FFA未显示RPE渗漏点。所有FFA显示RPE渗漏点相对应的ICGA处均显示脉络膜循环异常。43／54（67．19％）患眼在与RPE渗漏点相对应之外其他部位脉络膜也出现了循环异常。盘脱平均面积为（12．91±8．84）mm^2，视网膜下液平均吸收时间为（23．38±9．70）d。结论CSC患者为弥漫性脉络膜循环异常、弥漫性RPE功能损害，且功能损害先于结构破坏。

Objective To analyze the damage characteristics of retinal pigment epithelium （RPE）in central serous choroids retinopathy（ CSC）.Methods The simultaneous fundus fluorescein angiography（ FFA ）and indocyanine green angiography （ICGA）and fundus picture were performed on 67 eyes of 67 consecutive patients, diagnosed for CSC in clinic,with Heidelberg Retina Angiography.For 18 cases which could be treated by laser, leaking spots of RPE were closed by direct photocoagnlation,in order to observe the subrefinal fluid absorption speed.Result The fundus image of 64 cases appeared serous retinal detachments （disciform detachments）, furthermore,the leaks of RPE were showed in FFA.And 3 ftmdus images appeared disciform detachment without the leaks of RPE.All the RPE leaks in FFA,which were relative areas in ICGA, showed choroidal abnormalities.43 cases of 64 （67.19%）eyes occurred areas ofchoroidal hyperpermeability outside ofrelative areas of RPE leaks.The disciform detachment area was （12.91 ± 8.84）mm^2 and the average time ofsubretinal fluid absorption was（23.38± 9.70）days.Conclusion patients with CSC are occurred diffuse choroidal abnormalities and diffuse dysfunction of RPE, furthermore, the damage of function happens earlier than the structure.