局限性脉络膜凹陷患眼多模式影像特征观察及发生并发症的危险因素分析

Multimodal imaging characteristics of focal choroidal excavation and risk factors analysis of its complications

目的观察局限性脉络膜凹陷(FCE)患眼的多模式影像特征,初步分析FCE发生RPE相关并发症的危险因素。方法回顾性病例研究。2014年12月至2018年12月在佛山市第二人民医院眼科中心首诊并经频域OCT检查确诊的FCE患者31例31只眼纳入研究。其中,男性14例,女性17例;均为单眼发病。平均年龄(45.84±13.57)岁。均行BCVA、医学验光、频域OCT检査;行FFA联合ICGA检查3只眼,均为合并RPE并发症者。采用频域OCT深度增强成像技术测量黄斑中心凹下脉络膜厚度(SFCT)和最大凹陷宽度。根据是否伴RPE并发症将患眼分为FCE单纯组和FCE并发症组,分别为17、14只眼。FCE并发症组14只眼中,伴脉络膜新生血管、中心性浆液性脉络膜视网膜病变、息肉样脉络膜血管病变、RPE脱离分别为7 ( 22.6%).4 ( 12.9%).1( 3.2%).2( 6.5%)只眼。两组患者平均年龄(t=0.87 )、性别构成(χ^2=0.06 )、眼别(χ^2=2.58).等效球镜度数(t=-0.81 )比较,差异无统计学意义(P>0.05 );BCVA比较,差异有统计学意义(戶-2.11, PV0.05)。观察所有患眼的SFCT、最大凹陷宽度以及FCE并发症组患眼的ICGA特征。Logistic回归模型分析FCE发生RPE相关并发症的危险因素。结果31只眼共发现33个凹陷。FCE单纯组、FCE并发症组患眼SFCT分别为(167.00±85.18 )、( 228.36±67.95 ) pm;凹陷宽度分别为(645.00 + 231.93 ).( 901.00±420.55 ) gm;两组患眼SFCT、凹陷宽度比较,差异均有统计学意义(PV0.05)。Logistic回归分析结果显示,SFCT ( OE1.016, P=0.026)、凹陷宽度(O&1.004, P=0.034)是FCE发生RPE相关并发症的危险因素。频域OCT检查发现,FCE单纯组患眼均有不同程度RPE结构受损、变薄,以凹陷边缘处RPE受损最为明显。FCE并发症组14只眼中,RPE病损位于凹陷边缘10只眼(71.4%)。行ICGA检查的3只眼,可见凹陷下脉络膜呈持续弱荧光、充盈缺损。结论SFCT、凹陷宽度是FCE患眼发生RPE相关并发症的可能危险因素;凹陷边缘RPE结构受损及凹陷下脉络膜局部缺血或循环障碍,可能与FCE并发症的发生密切相关。

Objective To observe multimodal imaging characteristics in eyes with focal choroidal excavation (FCE) and preliminarily analyze the risk factors in FCE with complications correlated with RPE. Methods A retrospective case series. Thirty-one patients (31 eyes) with monocular FCE, first identified by spectral-domain (SD)-OCT in the Eye Center of The Second People's Hospital of Foshan from December 2014 to December 2018, were involved in this study. There were 14 males and 17 females, with the mean age of 45.84± 13.57 years. All patients underwent BCVA, optometry, and SD-OCT examinations. FFA and ICGA were simultaneously performed in 3 FCE patients with RPE complications. The subfoveal choroidal thickness (SFCT) and excavation width were measured with enhanced depth imaging OCT (EDI-OCT). The eyes with FCE were divided into two groups (FCE alone group 17 eyes vs. FCE complication group 14 eyes), based on whether complicated by RPE dysfunction. Among 14 eyes of FCE complication group, 7 (22.6%) with choroidal neovascularization, 4 (12.9%) with central serous chorioretinopathy, 1 (3.2%) with polypoidal choroidal vasculopathy, and 2 (6.5%) with RPE detachment. No significant difference was found in the mean age (/=0.87), gender composition (/2=0.06), ocular laterality (/2=2.58), and spherical equivalent (^=-0.81) between two groups, respectively (P>0.05), except that the BCVA was significantly different (/=-2.11, PV0.05). The SFCT and excavation width of eyes in both groups and the ICGA imaging characteristics of eyes in FCE complication group were analyzed. Risk factors of FCE with RPE complications were analyzed by logistic regression analysis. Results Thirty-three excavations were identified in 31 eyes with FCE. The mean SFCT was 167.00土 85.18 pm in FCE alone group vs. 228.36±67.95 gm in FCE complication group, while the excavation width was 645.00土231.93 pm vs. 901.00±420.55 pm and they were both significantly different (P<0.05). Logistic regression analysis showed the SFCT (O2?=1.016, P=0.026) and excavation width (O7?= 1.004, P=0.034) were risk factors for RPE complications of FCE. EDI-OCT showed the RPE at the excavation was impaired or vulnerable in all eyes of the FCE alone group, especially at the boundary area of excavation. The RPE damages were located at the boundary area of excavation in 10 eyes (71.4%) of FCE complication group. Constant choroidal hypofluorescence and filling defect were observed under the excavation in 3 eyes with ICGA imaging. Conclusions SFCT and excavation width may be risk factors for RPE complications of FCE. Impairment of RPE at boundary area of excavation and focal choroidal ischemia or aberrant circulation under the excavation may correlate with the development of FCE complications.