相干光断层扫描与荧光素眼底血管造影在中心性浆液性脉络膜视网膜病变诊断中的对比观察

Comparison of optical coherence tomography and fundus fluorescein angiography on central serous chorioretinopathy

目的观察对比相干光断层扫描(OCT)和荧光素眼底血管造影(FFA)在中心性浆液性脉络膜视网膜病变(CSC)诊断中的特点。设计回顾性病例系列。研究对象临床诊断为CSC的58例(62眼)患者。方法对临床诊断为CSC且均行FFA及OCT检查的58例(62眼)患者的临床资料进行对比观察,分析其影像特征。随访中每月行OCT检查,每3个月行FFA检查,对比两种影像学检查观察疾病演变过程的特点。主要指标FFA及OCT影像学表现。结果 58例(62眼)患者OCT检查中,60眼(96.8%)有神经上皮脱离,其中55眼(88.7%)FFA表现为荧光渗漏,且均在OCT神经上皮脱离范围内,另5眼未见异常荧光;5眼(8.1%)伴色素上皮脱离,而FFA未见特殊表现;2眼(3.2%)OCT仅见色素上皮脱离,其中1眼FFA见黄斑鼻侧透见荧光,另1眼无异常荧光。治疗后3个月,OCT检查62眼中16眼(24.2%)见神经上皮脱离,16眼中FFA仅5眼(8.1%)有荧光渗漏;2眼伴色素上皮脱离,而FFA未有特殊表现。对FFA检查及随诊中发现渗漏点在中心凹500μm外者(57眼)行激光光凝治疗。结论 OCT和FFA在对CSC的诊断上各具优势,OCT可观察到视网膜病变的形态改变,FFA可定位血管渗漏,利于激光治疗。两者结合是CSC最有效的影像诊断技术。

Objective To investigate the diagnosis value of optical coherence tomography （OCT） and fundus fluorescein anglograph （FFA） in central serous chorioretinopathy （CSC）. Design Retrospective case series. Participants 58 cases （62 eyes） with CSC. Methods FFA and OCT were performed in all patients. OCT was performed every month and FFA was performed every 3 months. The characters of FFA and OCT images were observed and analyzed. Main Outcome Measures OCT and FFA images. Results OCT showed retinal detachment（RD） in 60 eyes （96. 8% ） in which FFA showed fluorescent leakage in 55 eyes （88.7%） and no abnormal fluorescence in other 5 eyes; RD accompanied with pigment epithelium detachment（PED） was found in 5 eyes （8.1%）, in which no abnormal fluorescence was demonstrated. PED without RD was demonstrated in 2 eyes （3.2%）, in which FFA showed abnormal fluorescence at nasal macular in 1 eye and no abnormal fluorescence in another eye. Three months after treatment, OCT showed RD in 16 eyes （24.2%） in which FFA showed fluorescent leakage in 5 eyes （8.1%）. OCT showed PED in 2 eyes, in which no abnormal fluorescence was demonstrated in FFA. Laser treatment was performed in 57 eyes in which FFA showed leakage point no less than 500 Ixm from macular fovea （first visit and follow-up）. Conclusions OCT and FFA have different advantages in diagnosis of CSC. OCT shows morphological change of retinopathy while FFA shows vascular leakage for laser treatment. The combination of OCT and FFA is valuable for the diagnosis of CSC and guidance of treatment.