急性中心性浆液性脉络膜视网膜病变的频域光相干断层扫描特征

Features of frequency domain optical coherence tomography in acute central serous chorioretinopathy

目的观察急性中心性浆液性脉络膜视网膜病变（CSC）频域光相干断层扫描（FD-OCT）的图像特征。方法对比分析31例单眼急性CSC患者的FD-OCT以及荧光素眼底血管造影（FFA）检查资料。观察患眼FFA检查发现的渗漏点视网膜色素上皮（RPE）层、视网膜脱离区域以及对侧无症状眼RPE层的FD-OCT图像特征。结果31只患眼中，FFA检查共发现荧光渗漏点34个。其中，RPE层面18个，占52．9％。荧光渗漏点在FD-OCT图像中表现为色素上皮脱离（PED）者17只眼，占54．8％；8只眼8个渗漏点表现为RPE层突起，分别占患眼及渗漏点的25．8％、23．5％；4只眼的6个渗漏点表现为RPE层不规则，分别占患眼及渗漏点的12．9％、17．6％；2只眼2个渗漏点表现为RPE层无明显异常，分别占患眼及渗漏点的6．5％、5．9％。其中，7只眼7个渗漏点可见RPE层缺损，分别占患眼及渗漏点的22．6％、20．6％。所有患眼均可检测到后极部浆液性视网膜脱离以及光感受器内外节（IS／OS）层强反光带的断裂或消失。24只眼可见外节（OS）层厚度不均，占77．4％；10只眼可见外节层剥脱样改变，占32．3％；8只眼可见视网膜神经上皮外层以及RPE表面的颗粒样强反光点，占25．8%。OS层厚度不均的24只眼中，14只眼可见下垂征。31只无症状对侧眼中，11只眼存在RPE异常，占35．5％。其中，2只眼为PED，占无症状对侧眼的6．5％；1只眼为RPE层突起，占无症状对侧眼的3．2％；8只眼表现为RPE层不规则，占无症状对侧眼的25．8％。结论急性CSC患眼渗漏点处RPE层的FD-OCT图像特征为PED、RPE层突起、RPE层不规则、RPE层无明显异常。视网膜脱离区域FD-OCT图像特征为浆液性视网膜脱离、IS／OS层断裂或消失、OS层厚度不均、OS层剥脱样改变、视网膜神经上皮外层以及RPE表面颗粒样强反光点。

Objective To observe the features of frequency domain optical coherence tomography （FD-OCT） in acute central serous chorioretinopathy （CSC）. Methods The data of FD-OCT and fundus fluorescein angiography （FFA） of 31 patients with unilateral acute CSC were retrospectively analyzed. The FD-OCT of retinal pigment epithelial （RPE） layer at leakage points, retinal detachment area and RPE layer in the fellow eyes was documented. Results Thirty-four leakage points were detected in 31 eyes on FFA. At the sites of fluorescein leakage, FD-OCT showed that serous pigment epithelial detachment （PED） in 18 leakage points （52.9%） and 17 eyes （54.8%）, a small RPE protrusion in 8 leakage points （23.5%） and 8 eyes （25.8%）, RPE irregularity in 6 leakage points （17.6%） and 4 eyes （12.9%） and no detectable RPE abnormality in 2 leakage points （5.9%） and 2 eyes （6.5%）. An RPE defect at the edge of or within the PEDwas found in 7 leakage points （20.60%） and 7 eyes （22.6%）. Serous retinal detachment and interruption or complete disappearance of the hyper-reflective inner/outer segment junction （IS/OS） were detected in all diseased eyes. Uneven thickness of the outer segments （OS） was found in 24 eyes （77.4%）, 14 of which had sagging sign. Flaking of the OS was found in 10 eyes （32.3%）, multiple hyper-reflective dots on the posterior surface of the detached neurosensory retina and on the surface of the RPE were found in 8 eyes （25.8%）. Among 31 fellow eyes, FD-OCT also showed RPE abnormalities in 11 eyes （35.5%）, in which PED, RPE protrusion and RPE irregularity were detected in 2 （6.5%）, 1 （3.2%） and 8 eyes （25.8%）, respectively. Conclusions In acute CSC the FD-OCT images at leakage points of are featured byPED, RPE protrusion, RPE irregularity and no detectable RPE abnormality; in retinal detachment area FD-OCT are featured by serous retinal detachment, interruption or disappearance of IS/OS, uneven thickness of OS, flaking of OS and hyper reflective dots on the posterior surface of the detached neurosensory retina and on the surface of the RPE.