慢性中心性浆液性脉络膜视网膜病变口服药物治疗研究现状

The status the oral drugs for chronic central serous chorioretinopathy

慢性中心性浆液性脉络膜视网膜病变（CSC）病情反复、迁延，因视网膜下液长期无法吸收导致光感受器受到损害，视力预后差。由于慢性CSC的发生与皮质醇激素密切相关，因此临床尝试利用皮质醇激素受体拮抗剂抑制皮质醇激素治疗慢性CSC；发现其可提高患者视力，促使视网膜下液吸收，降低黄斑中心视网膜厚度。此外，5α-还原酶的特异性抑制剂非那雄胺、色素P450-3A4诱导剂利福平、调节节律药物褪黑素、系统性抗炎药物甲氨喋呤也已应用于慢性CSC治疗的临床试验，并取得一定疗效。但目前与之相关的临床研究大多为系列病例报告，缺乏多中心随机临床试验结果，有关口服药物治疗慢性CSC的方案选择及其疗效需要进一步观察和研究。

Chronic central serous chorioretinopathy （CSC） usually demonstrates frequent recurrence, diffuse leakage and persistent subretinal fluid, which cannot be absorbed, thus lead to photoreceptor damage and poor visual acuity. As glucocorticoids have been implicated in the pathogenesis of chronic CSC, various anti-glucocorticoids oral drugs were used in the clinic to promote retinal fluid absorption and reduce the central retinal thickness of the macula and improve the vision outcomes. In addition, the 5α-reductase-specific inhibitor finasteride, the P450-3A4 inducer rifampicin, circadian rhythmic regulator melatonin, and systemic anti-inflammatory drug methotrexate have also been put into clinical trials for chronic CSC, and achieved certain effects. However, most of the clinical studies on these oral drugs were case reports, but not multi-center randomized clinical trials. The long-term effects of these oral drugs need to be observed and studied further.