局灶性脉络膜凹陷临床特征

Clinical Characteristics of Focal Choroidal Excavation

目的:观察局灶性脉络膜凹陷(FCE)的临床特征。方法:回顾性系列病例研究。收集2016年10月至2017年11月在金华眼科医院就诊的FCE患者12例(22眼)。所有患者行最佳矫正视力、裂隙灯显微镜、间接眼底镜、光学相干断层扫描(OCT)及超广角激光扫描检眼镜等检查,部分患者行荧光素钠眼底血管造影检查。结果:12例患者中,双眼FCE10例,单眼FCE2例。22眼中,正视10眼,近视12眼。患眼初诊BCVA(LogMAR)为0~0.5(0.18±0.11)。眼底检查FCE处17眼表现为大致正常,2眼有不同程度脱色素或黄白色病灶,2眼黄斑区见盘状水肿,1眼黄斑区见出血、渗出灶。OCT检查示22眼均呈单一FCE;16眼(16/22)为偏中心凹型FCE,6眼(6/22)为中心凹下型FCE。2眼(2/22)合并中心性浆液性脉络膜视网膜病变,经治疗后神经上皮层下积液吸收,FCE处无明显改变。1眼(1/22)合并脉络膜新生血管,经多次抗血管内皮生长因子治疗后病情反复。结论:FCE多双眼发病,也可单眼发病;可合并中心性浆液性脉络膜视网膜病变,也可合并脉络膜新生血管,与屈光状态有一定的相关性;视力可正常或不同程度下降;FCE处眼底表现大部分完全正常,当出现合并症时可出现相对应症状。

Objective:To evaluate the clinical characteristics of focal choroidal excavation(FCE).Methods:This was a retrospective observational case series study.The medical records of 12 patients(22 eyes)with FCE were reviewed from October 2016 to November 2017 in Jinhua Eye Hospital.All patients underwent the following examinations:Slit lamp biomicroscopy,indirect ophthalmoscopy,best corrected visual acuity(BCVA),optic coherence tomography(OCT)and ultra-wide angle laser fundus scans(Daytona).Fundus fluorescein angiography(FFA)was also performed on some patients.Results:The 12 patients included 3 females(3/12)and 9 males(9/12).The average age was 45.3±14.2 years(range from 25 to 59 years).Ten patients had bilateral involvement.Ten eyes(10/22)were emmetropic,and the others were myopic.The mean BCVA(LogMAR)was 0.18±0.11(range from 0 to 0.5).Clinical examination and color photography showed that 17 eyes(17/22)were normal.Two eyes(2/22)had varying degrees of foveal pigment alterations or a yellowish spot at the edge of the fovea.Two eyes(2/22)showed macular edema seen as a disc and 1 eye had both macular hemorrhage and exudation.OCT scans showed that 22 eyes(22/22)had a single FCE.It was located in the subfovea in 6 eyes(6/22)and was eccentric in the other 16 eyes(16/22).In 2 eyes(2/22)with central serous choroidal retinopathy,there was no obvious change in the local choroidal depression after treatment of the hydroepithelia.Choroidal neovascularization was also present in 1 eye(1/22),after repeated anti-vascular endothelial growth factor treatment,the disease reoccured.Conclusions:Most patients have bilateral involvement and secondly,unilateral involvement.Visual acuity is normal or only moderately impaired to different degrees.FCE is related to refraction.Clinical examination shows that the fundus of most patients showed normal.When complications occur,corresponding symptoms appear.