妊娠期中心性浆液性脉络膜视网膜病变的分析研究

Central serous chorioretinopathy in pregnant women

目的分析妊娠期中心性浆液性脉络膜视网膜病变(CSC)的发病率和临床特点。方法随机招募2014年10月至2015年10月在南方医科大学南方医院妇产科进行孕检的832例健康孕妇自愿者,先对所有孕妇进行常规询问关于视觉症状(视力下降、视物变形、暗点和色觉异常),如出现视觉障碍再进行免费的全面眼科评估,包括最佳矫正视力、Amsler方格、裂隙灯显微镜检查、直接检眼底和及相干光断层扫描(OCT)检查,并在整个孕期及产后进行跟踪随访。结果研究调查发现832例受访孕妇在孕期过程中37例曾有出现视觉障碍,通过全面眼科检查,其中4例(4只眼)确诊为CSC,其发病率为0.48%。症状主要为主诉视力减退或视物变形,均出现在妊娠晚期。所有病例在分娩后视力完全恢复,并通过OCT观察视网膜神经上皮层复位情况。结论妊娠是CSC的一个危险因素,妊娠期有较大精神压力,妊娠期女性发病率提高。由于血管造影的潜在危害限制了怀孕和哺乳妇女在眼底病中的诊断使用,OCT是妊娠期CSC的安全可靠检查方式。

Objective To report the incidence and clinical features of central serous chorioretinopathy in pregnant women. Methods A total of 832 patients were voluntarily recruited from Southern Hospital,Southern Medical University between Oct 2014 and Oct 2015. Patients with visual complaints underwent comprehensive ophthalmic examinations,including best corrected visual acuity（ BCVA）,slit lamp biomicroscopy,direct funduscopy,Amsler grid screening and optical coherence tomography OCT. Medical records of patients with central serous chorioretinopathy were reviewed. All patients were observed throughout the course of pregnancy and 3 months after delivery. Results Among the 832 pregnant women,4 patients had central serous chorioretinopathy,with an incidence of 0. 48%. Main symptoms are blurred vision and metamorphopsia during third trimester. Symptoms were completely resolved within 3 months after delivery. OCT showed serous retinal detachment. Conclusion Central serous chorioretinopathy typically affects males from 20 to 50 years old,but a few reports have documented its occurrence in women. Pregnancy is a unique association with central serous chorioretinopathy in women. OCT may show the progress of neuro-retinal recovery. Further studies with a larger sample size are warranted to investigate the risk factors in pregnant women.