激素诱发中心性浆液性脉络膜视网膜病变

Steroids induced central serous choroidoretinopathy

本文回顾性分析14例(23眼)因全身或眼病而用糖皮质激素(简称激素)治疗过程中,发生中心性浆液性脉络膜视网膜病变(CSC)或大泡性视网膜脱离的病例。症状为视力下降或视物变形。眼底病变均在后极,分为3类:1个或2个泡状半透明视网膜浅脱离;1个或几个视网膜下黄白色渗出,可伴有下方视网膜脱离;大泡性视网膜脱离伴视网膜下灰白色纤维素渗出。所有病例经荧光素眼底血管造影检查显示,后极均见1个或多个色素上皮渗漏点或斑。相干光断层扫描都显示黄斑区神经视网膜脱离或伴有视网膜下高反射物质。这些都符合CSC体征。停用激素后,视网膜在2～10个月内渐复位。其中,浆液性脱离及视网膜下黄白色渗出病例视力恢复良好,达0.5以上;大泡性视网膜脱离最差,在0.1以下。本文详细描述了激素治疗中出现的视力下降情况,并讨论了如何区分是激素用量不足还是激素诱发了CSC。

Data of 14 patients （23 eyes） with central serous choroidoretinaopathy （CSC） or bullous retinal detachment induced by steroids application were analyzed retrospectively. Deterioration of visual acuity （VA） and metamorphosis were major symptoms. Object findings were located at the posterior pole, which included one or two serous translucent shallow retinal detachment （RD）; one or several subretinal yellowish exudates some accompanied with inferior shallow RD ;bullous RD with subretinalfibrinous exudates. Fluorescein fundus angiography showed one or several retinal pigment epithelium leakage in all cases. Optical coherence tomography found sensory RD with subretinal hyper- reflecting materials in most cases. All these findings were in accordance with the diagnosis of CSC. Cessation of steroids was undertaken . RD gradually reattached within 2 - 10 months. Among them, cases with serous RD or subretinal yellowish exudates recovered well with final VA 〉0.5. The worst VA was found in bullous RD patients with VA 〈0. I. The paper discussed how to distinquish whether inadequate dosage of steroids or steroids caused worse of VA in steroids induced CSC. （Chin J Ophthalmol and Otorhinolaryngo1,2013,13：2-5）