中心性浆液性脉络膜视网膜病变眼底血管造影及脉络膜厚度分析

Analysis of fundus fluorescein angiography, indocyanine green angiography and choroidal thickness incentral serous chorioretinopathy

目的探讨中心性浆液性脉络膜视网膜病变（CSC）患者脉络膜厚度变化特征、脉络膜循环异常特点及其与视网膜色素上皮病变的关系。方法病例对照研究。应用脉络膜深层成像相干光断层扫描（EDI—OCT）仪，测量21例（21只患眼，21只对侧眼）CSC单侧发病患者及24例（24只眼）正常对照者的黄斑中心凹及鼻、颞侧每隔500μm直至3mm的各部位脉络膜厚度。对21例患者行荧光素眼底血管造影（FFA）和吲哚氰绿血管造影（ICGA），并对其图像进行对比分析。对CSC患者的患眼与对侧眼的各部位脉络膜厚度进行比较，采用自身配对t检验；对CSC患者的患眼和对侧眼与正常对照眼的各部位脉络膜厚度进行比较，采用成组设计t检验。结果21例CSC患者的患眼脉络膜厚度在黄斑中心凹处最厚，为（519．04-102．5）μm，对侧眼为（439．3±94．1）μm，患眼较对侧眼明显增厚（t=4．171，P〈0．05）；正常对照眼黄斑中心凹处脉络膜厚度为（332．04-67．3）μm，患眼和对侧眼均较正常对照眼明显增厚（t=7．125，4．441；P〈0．05）。其余测量点间两两比较差异也有统计学意义（患跟与对侧眼配对比较：t=2．544～3．819，P〈0．05；患眼和对侧眼与正常对照眼的成组比较：t=4．797～7．816，2．487—5．236；P〈0．05）。FFA、ICGA检查，显示21只CSC患眼的视网膜色素上皮渗漏点均出现在相对应的脉络膜早期充盈迟缓区内，其中19只眼出现渗漏点周围脉络膜血管扩张，造影晚期所有渗漏点周同均呈现脉络膜局灶性强荧光。有6只对侧眼出现视网膜色素上皮脱离，其相对应的脉络膜部位在ICGA早期呈现脉络膜血管扩张，晚期有强荧光素渗漏。而4只患眼和11只对侧眼的脉络膜在ICGA晚期呈现强荧光素渗漏灶处，经FFA检查未见视网膜色素上皮病变。结论CSC是脉络膜局灶性缺血、继发性脉络膜血管扩张和充血、高通透性的双眼疾患。EDI—OCT检测技术是评估CSC患者脉络膜血管高通透性且引起脉络膜厚度改变的有效手段之一。（中华聪科杂志，2012，48：878-882）

Objective To evaluate the characteristics of choroidal thickness changes and abnormalities in choroidal circulation in cases of central serous ehorioretinopathy （CSC）. Methods This was a case control study, we measured the bilateral ehoroidal thickness in 21 patients with unilateral CSC and 24 eyes of 24 age- and sex-matched normal subjects using enhanced depth imaging optical coherence tomography （EDI-OCT）. The choroid was measured from the posterior edge of the retinal pigment epithelium （RPE） to the choroid-scleral junction at 500 p,m intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea. Paired-samples t-test was conducted to compare mean choroidal thicknesses between symptomatic eyes and fellow eyes of patients. The datum between patients and normal subjects were analyzed by independent-samples t-test. Fundus fluorescein angiography （FFA） and indocyanine green angiography （ICGA） were performed and the digital images were analyzed in CSC patients. Results The 21 CSC patients had a mean age of 45.6 years, and 12 patients （57.1%） were male. The choroid insymptomatic eyes was thickest beneath the fovea （519.0 ± 102. 5） μm. It was significantly thicker than that in the fellow eyes （439.3 ±94. 1 ） μm （t = 4. 171, P 〈 0. 05 ）. Choroidal thickness in both groups was significantly greater than that in the eyes of age- and sex-matched normal subjects （ 332. 0 ±67. 3 ） μm （ t = 7. 125,4. 441 ;P 〈 0. 05 ）. Choroidal thickness at each of the other 12 points showed a similar tendency （ t = 2. 544 to 3. 819,4. 799 to 7. 816,2. 487 to 5. 236; P 〈 O. 05 ）. ICGA showed a choroidal filling delay （ 100% ） , vessels dilation （90. 5% ）, and focal choroidal hyperfluorescence （ 100% ） surrounding leakage from the RPE in symptomatic eyes. Pigment epithelium detachment with abnormal choroidal circulation was observed in 6 fellow eyes. In 4 symptomatic eyes and 11 fellow eyes, ICGA revealed choroidal hyperfluorescence but FFA showed normal appearance. Conclusions CSC seems to be a bilateral eye disease with choroidal focal ischemia followed by vessels congestion and hyperpermeability. EDI OCT is a useful tool for monitoring choroidal thickness changes caused by choroidal vascular hyperpermeability. （Chin J Ophtbalmol, 2012,48：878-882 ）