点状内层脉络膜病变研究进展

Current advances in punctate inner choroidopathy

点状内层脉络膜病变（PIC）是一种罕见的炎症性多灶性脉络膜病变，归类于白点综合征。目前病因不清．可能与免疫遗传易感性和异常的免疫反应相关。主要发生于中度近视青年女性，以眼底后极部多发的黄白色小点状病灶为特征，缺乏前葡萄膜炎和玻璃体炎体征。大多数患者视力预后较好，无需治疗，但其主要并发症——脉络膜新生血管可引起永久、严重的视力损害。PIC的治疗方法主要有皮质类固醇类药物，其他的有免疫抑制剂、光动力疗法、黄斑下手术及最近兴起的抗血管内皮生长因子疗法。现就点状内层脉络膜病变的定义、研究背景、病因及发病机制、病理、临床表现、诊断和鉴别诊断、治疗以及预后做一综述。

Punctate inner choroidopathy （PIC） is a rare inflammatory muhifocal choroidopathy, which belongs to the white dot syndrome. The pathogenesis of PIC is still not clear. It may result from an immunogenetic predisposition and the development of an inappropriately directed immune response. PIC affects predominantly young moderately myopic women and is characterized by the presence of multiple, small, yellow-white fundus lesions frequently limited to the posterior pole in the absence of signs for anterior uveitis or hyalitis. Most patients with PIC do not require treatment because of its favorable prognosis. However, choroidal ueovaseularization （CNV）, the primary complication of PIC, sometimes causes permanent severe vision loss. Treatment modalities that have been used to manage patients with PIC and CNV include corticosteroids, other immunosuppressant agents, photodynamic therapy, submacular surgery and, most recently, anti-vascular endothelial growth factor therapy. In this article, the definition, historical background, pathogenesis, pathology, clinical features, diagnosis and differential diagnosis, management and prognosis of PIC are reviewed.