单眼急性中心性浆液性脉络膜视网膜病变患者双眼脉络膜血管光相干断层扫描血管成像观察

The characteristics of optical coherence tomography angiography on choroidal vessels in eyes of unilateral acute central serous chorioretinopathy

目的观察单眼急性中心性浆液性脉络膜视网膜病变(CSC)患者双眼黄斑区视网膜结构及脉络膜毛细血管层血流密度变化。方法前瞻性横断面研究。2018年1~3月在山西省眼科医院检查确诊的单眼急性CSC患者24例48只眼(病例组)纳入研究。将病例组患者的患眼、对侧眼分别设为CSC组、对侧眼组,均为24只眼。选取同期年龄、性别匹配的健康志愿者21名21只眼作为正常对照组。采用OCT及OCT血管成像(OCTA)观察受检眼黄斑区结构,并测量黄斑区半径1mm圆形范围内脉络膜毛细血管层血流密度。采用配对t检验比较三组受检眼之间脉络膜毛细血管层血流密度的差异。结果OCT检查结果显示,CSC组患眼均可见黄斑区神经上皮层浆液性脱离,伴或不伴RPE脱离分别为20、4只眼。对侧眼组24只眼中,厚脉络膜性RPE病变(PPE)13只眼(54.2%)。正常对照组受检眼黄斑区未见视网膜、脉络膜结构异常。OCTA检查结果显示,CSC组、对侧眼组、正常对照组受检眼脉络膜毛细血管层血流密度分别为1.759±0.132、1.924±0.463、1.940±0.033。与对侧眼组、正常对照组受检眼比较,CSC组患眼脉络膜毛细血管层血流密度明显降低,差异有统计学意义(t=6.611、6.474,P=0.000、0.000);对侧眼组、正常对照组受检眼脉络膜毛细血管层血流密度比较,差异无统计学意义(t=1.328,P>0.05);对侧眼组中PPE眼与无RPE改变眼脉络膜毛细血管层血流密度比较,差异无统计学意义(t=0.806,P>0.05)。结论单眼急性CSC患者54.2%的对侧眼存在PPE;患眼脉络膜毛细血管层血流密度较对侧眼及正常眼降低。

Objective To observe the changes of macular structure and choroidal capillary blood flow density in patients with acute central serous chorioretinopathy (CSC). Methods Prospective cross-sectional study. A total of 24 eyes of 24 patients with monocular acute CSC (case group) diagnosed by clinical examination from Shanxi Eye Hospital during January and March 2018 were included in the study. The eyes (24 eyes) and contralateral eyes (24 eyes) of the patients in the case group were set to CSC group and contralateral eye group, respectively. Twenty-one eyes of 21 healthy volunteers with age and gender matching were selected as normal control group. The macular structure of the eyes were observed by OCT and OCT angiography (OCTA), and the blood vessel density of choroidal capillary layer in the circular area of the macular area with a radius of 1 mm was measured. The paired t-test was used to compare the differences in blood flow density in the choroidal capillaries between the three groups. Results The results of OCT showed that the serous neuroepithelial detachment in the macular area was observed in all eyes of the CSC group, with or without RPE detachment being 20 or 4 eyes, respectively. Of the 24 eyes in the contralateral eye group, 13 eyes (54.2%) had thick choroidal RPE lesions (PPE). There was no abnormality in the retina and choroidal structure in the macular area of the normal control group. The results of OCTA showed that the blood flow density of choroidal capillaries in the CSC group, the contralateral eye group and the normal control group were 1.759±0.132, 1.924±0.463, and 1.940±0.033, respectively. Compared with the eyes of the contralateral eye group and the normal control group, the blood flow density of choroidal capillaries in the CSC group was significantly lower (t=6.611, 6.474;P=0.000, 0.000). There was no significant difference in the blood flow density of choroidal capillary layer between the contralateral eye group and the normal control group (t=1.328, P>0.05). In the contralateral eye group, there was no significant difference in the blood flow density of choroidal capillary layer between PPE eyes and no RPE eyes (t=0.806, P>0.05). Conclusions There is 54.2% of the contralateral eyes in the monocular acute CSC patients with PPE. The choroidal capillary layer blood flow density is lower than that of the contralateral and normal eyes.