频域相干光断层扫描比较急性中心性浆液性脉络膜视网膜病变患侧与对侧眼的形态学特征

Change on optical coherence tomography in affected eyes and the fellow eyes of patients with central serous chorioretinopathy

目的比较急性中心性浆液性脉络膜视网膜病变(CSC)的患侧与对侧眼视网膜频域相干光断层扫描(OCT)的图像特征。方法应用频域OCT对30例(60眼)单眼发病急性CSC患者患侧和对侧眼的黄斑部视网膜显微结构进行检测,比较患侧组与对侧组黄斑中心凹外核层厚度、光感受器层(IS/OS层)、视网膜色素上皮(RPE)形态差异。结果所有30例患者患侧眼均有不同程度黄斑部视网膜浆液性脱离,对侧眼中有4眼(13.3%)存在轻度视网膜浆液性脱离;患侧组黄斑中心凹外核层厚度均值为(95.32±24.87)μm,对侧组为(98.80±14.36)μm,两组差异无统计学意义(t=1.627,P=0.110)。患侧组中IS/OS层厚度均匀一致者12眼(40.0%),对侧组20眼(66.7%);患侧组IS/OS层厚度均匀一致伴内外节缺损、不均、凸起增厚者共18眼(60.0%),对侧组共10眼(33.3%),差异有统计学意义(χ2=4.28,P=0.038)。患侧组中出现RPE异常者有24眼(80.0%),对侧组中有8眼(26.7%),差异有统计学意义(χ2=17.143,P=0.000)。结论频域OCT能清晰显示急性CSC患者的细微病理结构改变,单眼发病CSC患者中一部分对侧眼存在IS/OS层和RPE异常,但是其发生率较患侧眼低。

Objective To compare the image morphology in affected eyes and the fellow eyes of acute central serous chofioretinopathy（ ACSC ）by using spectral domain optical coherence tomography （SD-OCT）. Methods Thirty cases（60 eyes） of unilateral involved ACSC imaged with high-resolution optical coherence tomography was concluded in the study. The thickness of the outer nuclear layer was measured and the morphology of retinal pigment epithelial and photoreceptor was observed. The differences of the above parameters between the affected eyes group and the fellow eyes group were compared. Results A varying degrees of retinal detachment was found in all 30 affected eyes of ACSC with SD-OCT, and the thickness of the outer nuclear layer of the affected eyes group was （95.32 ± 24.87 ） μm. While there were 4 eyes（ 13.3% ） having light retinal detachment, and thickness of the outer nuclear layer of the fellow eyes group was（98.80 ± 14.36） p.m. There was no significant difference of the thickness of the outer nuclear layer between the affected eyes group and the fellow eyes group（t = 1. 627 ,P =0. 110）. The thickness of photoreceptors were uniform in 12 eyes（40% ） in affected eyes group,while 20 eyes（66.7% ） in the fellow eyes. The thickness of photoreceptors which were uniform but with defect, uneven, protruding of outer segments was observed in 18 eyes（60.0% ） in affected eyes group,while 10 eyes（33.3% ） in the fellow eyes. There was statistically significant difference of the regularity of the photoreceptors between the affected eyes group and the fellow eyes group （ X2 = 4.28, P = 0. 038 ）. Twenty-four eyes （80.0%） of the affected eyes group showed retinal pigment epithelium morphology,while 8 eyes（26.7% ） of the fellow eyes group did, with statistically significant difference between the two groups （ X2 = 17. 143 ,P =0.000）. Conclusions The SD-OCT could clearly display subtle pathologic structure change of acute central serous chorioretinopathy. A part of the fellow eyes of the unilateral involved ACSC patients present abnormality in the outer nuclear layer and photoreceptors. But the rate of the abnormality was lower in the fellow eyes than that in the affected eyes. （Chin J Ophthalmol and Otorhinolaryngo1,2013,13 ： 165-167 ）