中心性浆液性脉络膜视网膜病变的两种眼底自发荧光特征观察

Lipofuscin- and melanin-related fundus auto-fluorescence in patients with central serous chorioretinopathy

背景眼底自发荧光（AF）成像是一种新的非侵入性眼底荧光检测技术，可利用共焦激光扫描检眼镜获得两种眼底AF，包括脂褐素相关的AF（FAF）和黑色素相关的近红外AF（NIA）。目的探讨中心性浆液性脉络膜视网膜病变（CSC）患者眼底FAF和NIA两种AF特征。方法对CSC患者23例28眼进行FAF、NIA和荧光素眼底血管造影（FFA）检查，其中急性期CSC15例17眼，慢性迁延性CSC8例11眼。结果急性期CSC患者FFA荧光素渗漏点AF改变有3种特征：（1）AF增强，包括FAF增强2眼，占11．76％；NIA增强4眼，占23．53％。（2）无AF，包括FAF10眼，占58．82％；NIA13眼，占76．47％。（3）AF正常，包括FAF5眼，占29．42％；NIA0眼。视网膜浆液性脱离区AF改变有2种特征：（1）AF减弱，包括FAF减弱12眼，占70．59％；NIA减弱10眼，占58．82％。（2）AF增强，包括FAF增强5眼，占29．41％；NIA增强7眼，占41．18％。慢性迁延性CSC患者AF像中，FFA检查视网膜色素上皮（RPE）渗漏点位置表现为无AF，部分无AF点在相应位置的FFA像未见RPE渗漏点，而NIA像中所见的无AF点常常多于FAF。慢性CSC视网膜浆液性脱离区常表现为颗粒样无AF、AF增强及AF减弱等多种AF改变并存的复合病灶，并且AF像显示的异常荧光范围常常大于对应的FFA显示的异常荧光区。结论AF技术为研究CSC提供了一种活体观察RPE细胞代谢和功能改变的手段。

Background Auto-fluorescence （AF）imaging is a new non-invasive fundus examining technology. It is now playing an increasingly important role in the diagnosis of retinal diseases. Using a eonfocal Scanning Laser Ophthalmoscope microscope （eSLO） , two types of AF can be obtained ： melanin-related near-infrared fundus auto-fluorescence （NIA） and lipofuscin-related fundus auto-fluorescence（FAF）. Objective The purpose of this study was to compare the outcome between NIA and FAF in patients with central serous ehorioretinopathy （CSC）. Methods FAF,NIA imaging and fundus fluoreseein angiography（FFA） were performed on 28 eyes of 23 subjects using a cLSO. AF images were evaluated and compared with angiographie findings. Written informed consent was obtained before the initiation of this study. Results In 17 eyes of 15 cases with acute CSC,the leakage points on the FFA image showed three kinds of AF patterns ： （ 1 ） hyper-AF, including FAF hyper-AF in 2 eyes（ 11.76% ） and NIA hyper-AF in 4 eyes（23.53% ）. （2） Non-AF,ineluding FAF non-AF in 10 eyes（58.82% ）and NIA non-AF in 13 eyes（76.47% ）. （3）Normal AF, including normal AF of FAF in 5 eyes （29.42%）. The AF in the retinal serous detachment area showed two kinds of characteristics ： （ 1 ） hypo-AF, including 12 eyes （ 70. 59% ） with FAF hypo-AF and 10 eyes （ 58.82% ） with NIA hypo-AF. （ 2 ） hyper-AF, including 5 eyes （ 29.41% ） with FAF hyper-AF and 7 eyes （41.18%）with NIA hyper-AF. In 11 eyes of 8 cases with chronic CSC, the leakage on the FFA also showed an absence of AF. However,AF-absent areas also partly appeared in the non-leakage area of FFA. In NIA, the non-AF areas were often more visible than that in FAF. Serous detachment areas in chronic CSC usually displayed multiple AF forms, including granular-like non-AF, hyper-AF and hypo-AF, and the abnormal AF areas were often greater than that of the corresponding abnormal fluorescent area in FFA. Conclusions AF can be used to detect the functional status and metabolic activity of RPE in CSC eves.