中心性浆液性脉络膜视网膜病变患者眼底影像学特征

Fundus image in central serous chorioretinopathy cases

目的探究治疗和未治疗的中心性浆液性脉络膜视网膜病变（CSC）患者的眼底自发荧光（FAF）~其他影像学特征。方法回顾性病例对照研究。2009年至2010年在眼科确诊为CSC后经光动力疗法（PDT）治疗或未经治疗且随访记录完整的患者各18例（18眼）。治疗组为病程少于3个月的急性CSC患者18例，并应用50％维替泊芬PDT治疗；未治疗组为病程超过3个月且未经治疗病情反复发作的CSC患者18例。治疗前后两组患者均进行频域光学相干断层扫描（Spectralis OCT）和FAF的检查，同时治疗组中所有患者及未治疗组中视力降低较严重的9名患者在治疗前后进行了荧光素眼底血管造影（FFA）和吲哚青绿血管造影（CGA）检查，观察两组患者FAF和其他影像学结果的异同。结果治疗组18例患者在治疗前眼底均出现程度不等的异常自发荧光，SpectrMis OCT显示黄斑区出现神经上皮层脱离．视网膜下间隙积液，FFA中表现为典型的墨迹样或炊烟样荧光渗漏，ICGA中表现为在渗漏点附近出现异常扭曲扩张的脉络膜血管；PDT治疗后1个月时有16例视网膜下间隙积液吸收，其余2例在3个月时视网膜下间隙积液吸收，且3个月时所有患眼均未见异常自发荧光，同时FFA和ICGA检查也未见原始病灶部位的荧光渗漏和扭曲扩张的脉络膜血管。然而，未治疗组患者在发病后3个月检查眼底时仍有16例可见眼底异常白发荧光，表现为原始病灶处或其周围出现斑驳状、片状、葫芦状或椭圆形的高荧光区．其中有2例表现为与原发病灶相连接的竖条状或斜条状带拖尾的异常高荧光；9例患者因长期视物模糊、精细辨物能力差进行了FFA和ICGA检查，发现造影早中期未见明显异常荧光渗漏，但在造影晚期却可见程度不等的脉络膜大片损害区，有些损害区范围可达5视盘直径以上。结论未及时治疗的CSC患者在疾病缓慢愈合过程中可能因长期视网膜下积液的存在导致RPE细胞损害，出现异常自发荧光．最终导致RPE细胞功能紊乱，故对部分CSC患者早期进行干预治疗是安全而必要的。

Objective To investigate the characteristics of the fundus image in central serous chorioretinopathy （CSC） patients who undergo or not undergo treatment. Methods This was a retrospective case control study. The fundus images of 36 patients who were diagnosed with CSC from Jan. 2009 to Dec. 2010 were analyzed. Eighteen of 36 cases （group A） with less than 3 months since onset were treated with photodynamic therapy （PDT） with a half-dose （3 mg/m2） of verteporfin and 18 of 36 patients （group B） with more than a 3-month period since onset were not treated. All eyes were imaged by spectral domain optical coherence tomography （Spectralis OCT） and fundus autofluoreseenee （FAF） at each follow-up visit. Eighteen cases in group A were imaged by fundus fluorescein angiography （FFA） and indocyanine green angiography （ICGA） each time and 9 of 18 patients with a severe decrease in visual acuity in group B were imaged by FFA and ICGA. The differences between Group A and B were observed. Results Group A patients presented with an abnormal increase in FAF before treatment and normal FAF after treatment. In the meantime, Spectralis OCT imaging showedserous neuroepithelial detachment with subretinal fluid （SRF）, FFA showed ink-dot diffusion or a smokestack phenomenon, and ICGA revealed dilated and tortuous choroidal vessels with diffuse hyperpermeability. After i month, Spectralis OCT imaging showed a resolution of SRF in 16 of 18 patients who had undergone PDT treatment （group A）. Fundus images of the other 2 patients showed that their conditions did not revert to normal until 3 months after treatment. Three months after treatment, Spectralis OCT clearly showed that there was a resolution of SRF in all patients, and FFA and ICGA showed an absence of fluorescence leakage and a recovery of dilated choroidal vessels. However, 16 of 18 patients in group B showed an abnormal FAF. There were mainly four phenotypic patterns in the FAF shapes such as pachy, variegated, round and short-lagenated. Two of 16 patients showed a descending tract with a downward-leading swathe of decreased autofluorescence originating from the posterior pole and extending below the inferior arcade. We called this the RPE track. There were 9 patients in group B who were imaged with FFA and ICGA due to persistent blurred vision and several recurrences, and the ICGA images showed late-stage obviously damaged areas. The size of the damaged areas in the partial patients was greater than 5 disc diameter. Conclusion Abnormal FAF could be seen in CSC without treatment due to SRF damaging the retinal pigment epithelium （RPE） ceils and thrther leading to permanent RPE cellular dysfunction and poor visual acuity. Therefore, treatment intervention in the early stages is safe and necessary for partial CSC patients to avoid long-term damage and visual function loss.