眼底伴有灰色病灶的急性中心性浆液性脉络膜视网膜病变的光学影像学特征

The optical imaging features of the acute central serous chorioretinopathy with gray exudation focus

目的观察眼底伴有灰色病灶的急性中心性浆液性脉络膜视网膜病变（CSC）的光学影像学特征。方法回顾分析经直接和间接检眼镜、眼底照相、荧光素眼底血管造影（FFA）、吲哚青绿血管造影（ICGA）、频域光相干断层扫描（FD—OCT）检查确诊的23例眼底伴有灰色病灶的急性CSC患者26只眼的临床资料，对比观察彩色眼底像、FFA、ICGA、FD—OCT检查结果，重点观察灰色病灶在各种检查中的光学影像表现。结果FFA早期所有患眼的灰色病灶处均有1-3个不等的活动性视网膜色素上皮（retinalpigmentepithelium，RPE）渗漏点出现，后期病灶均呈强荧光着色；ICGA早期所有患眼的灰色病灶及其周围的脉络膜血管区域性充盈迟缓，呈斑片状弱荧光，且弱荧光灶内也有强荧光漏点出现，与FFA中RPE渗漏点相对应。其中，23只眼弱荧光灶内还有脉络膜血管扩张，呈条带状强荧光，占88．46％；5只眼伴有小叶状脉络膜毛细血管扩张，呈斑片状强荧光，占15．39％。ICGA后期，灰色病灶处亦均呈强荧光着色。FD—OCT检查，所有患眼灰色病灶对应处神经上皮下脱离腔内有柱状、环形中高等光反射物质连接于神经上皮和色素上皮脱离（PED）灶之间。其中，5只眼有RPE局部断裂，占15．39％。结论眼底伴有灰色病灶的急性CSC有其独自的光学影像学特征，表现为：（1）FFA早期灰色病灶处有活动性RPE渗漏点出现，而后期呈强荧光染色；（2）ICGA早期灰色病灶处脉络膜血管表现为灌注不良或高灌注，后期亦呈强荧光染色；（3）FD—OCT显示灰色病灶处神经上皮下脱离腔内有中高等光反射物质分布，可伴有RPE局部断裂。

Objective T9 observe the optical imaging features of the acute central serous chorioretinopathy （CSC） with grayish lesion. Methods The data of 23 patients （26 eyes） diagnosed as acute CSC by direct/indirect ophthalmoscope, color ftmdus photograph, fluorescence fundus angiogra- phy （FFA）, indocyanine green angiography （1CGA） and fourier-domain optical coherence tomography （FD-OCT） were retrospectively analyzed. The appearances of the grayish lesions in the color fundus photograph, FFA, ICGA and FD-OCT were mainly observed by contrast to analyze their relations. Results One to three retinal pigment epithelium （RPE） active leakage sites presented at the site of the grayish lesion of 26 eyes （100.00%） in the early and the lesions showed strong staining in the later during the FFA. The location of the grayish lesion showed plaque hypofluorescence in which the chorioidal artery delayed filling and there also had ICG dye leakage which were accord with the RPE active leakage sites in the FFA in 26 eyes （100.00%） in the early during the ICGA. Within the lesions,there were strip hyperfluorescence focus appearing in 23 eyes （88.46%） and plaque hyper- fluorescence focus in 5 eyes （15.39%） because of the choroidal vein dilated and the choriocapillary dilated in the site of the grayish lesion respectively. The grayish lesion also showed hyperfluores- cence due to the tissue stained in the later during the ICGA. In the FD-OCT,there were moderate or high reflective masses bridging the neurosensory retina and the pigment epithelial detachment （PED） which showed pillar or circle shape in the site of grayish lesion in 26 eyes （100.00%）,and the RPE of PED were broken partly in 5 eyes （15.39%）. Conclusions The acute CSC with grayish lesion has its own optical imaging characteristics. There are RPE active leakage sites appearing in the location of the grayish lesions in the early and the tissue strong staining in the late during the FFA. The choroidal vessels perfuse poorly or high in the early and the tissue also strong staining in the late during the ICGA. There are moderate or high reflective masses bridging the neurosensory retina and the PED beneath the detached neurosensory retina at the area of grayish lesion,the PED may be associated with RPE broken partialy in the FD-OCT.