中心性浆液性脉络膜视网膜病变患眼激光光凝治疗后视网膜微结构变化及其与视力的相关性研究

The change of retinal microstructure and the correlation with visual outcome in central serous chorioretinopathy after laser treatment

目的观察中心性浆液性脉络膜视网膜病变(CSC)患眼激光光凝治疗后视网膜微结构变化,初步分析其与视力的相关性。方法回顾性病例分析。2016年4月至2017年2月于温州医科大学附属眼视光医院眼底内科检査确诊且行激光光凝治疗后视网膜下液(SRF)完全吸收的连续CSC患者52例52只眼纳入研究。其中,男性46例46只眼,女性6例6只眼;平均年龄(43.92±8.62)岁。行传统激光、阈值下微脉冲激光光凝治疗分别为27、25只眼。将健康对侧眼49只作为对照眼。患者均行BCVA、频域OCT检査。测量患眼、对照眼中心凹视网膜厚度(CFT)、外核层(ONL)、内节(IS)、外节(OS)厚度,并观察黄斑中心凹椭圆体带(EZ)、嵌合体带(IZ)的完整性和RPE平滑性。观察SRF完全吸收后的首次随访以及末次随访时视网膜微结构变化。ONL、IS、OS与BCVA的相关性行Spearman相关性分析。结果首次随访时.患眼CFT、ONL, IS, OS厚度分别为(182.55土24.14)、( 72.86+17.39 ).( 41.23土5.14 )、( 18.52+10.26) gm,平均BCVA为(81.27±6.39)个字母,均较对照眼降低,差异有统计学意义(PV0.001 );末次随访时,患眼CFT、ONL、IS、OS 平均厚度分别为(195.19 ±22.10 )、( 75.44+ 16.33 ).( 44.56 ± 4.09 )、( 26.60+11.39 ) gm,平均BCVA为(85.50±5.65 )个字母。均较首次随访时提高,差异均有统计学意义(PC0.05)。首次随访时,EZ完整、不完整患眼平均BCVA分别为(83.38±5.78 )、( 77.90±5.97)个字母;两者比较,差异有统计学意义(*0.003 )。RPE平滑、粗糙患眼平均BCVA分别为(82.72±5.95 )、( 78.00±6.31)个字母;两者比较,差异有统计学意义(P=0.020 )。Spearman相关性分析结果显示,首次、末次随访时OS厚度与BCVA均呈正相关(r= 0.423、0.416,*0.002、0.002 )?结论 CSC患眼视网膜ONL、IS、OS厚度均有降低,EZ, IZ完整性及RPE平滑性均有不同程度破坏;SRF吸收后,ONL、IS、OS厚度,EZ、IZ完整性均可部分恢复。OS厚度、EZ完整性、RPE平滑性与视力均有相关性。

Objective To observe the change of retinal microstructures and the association between visual outcome with these microstructures in central serous chorioretinopathy (CSC) after laser treatment. Methods This is a retrospective study. From April 2016 to February 2017, a total of 52 eyes from 52 patients who underwent conventional laser treatment (27 eyes) or subthreshold laser treatment (25 eyes) for CSC and the sub-retinal fluid (SRF) absorbed completely were included in this study. The were 46 patients (46 eyes) and 6 males (6 eyes), with the mean age of 43.92 + 8.62 years. The healthy fellow eyes (49 eyes) were selected as control. All patients were underwent BCVA and SD-OCT examination. According to the OCT images for all patients, the thickness of central foveal (CFT), outer nuclear (ONL), inner segment (IS), outer segment (OS) were measured. The status of ellipsoid zone (EZ), interdigitation zone (IZ) and RPE were also evaluated at fovea. Comparing the change of SD-OCT microstructures in two time points, the first visit after SRF absorbed and the last visit respectively. Spearman correlation analysis was used to analyze the relation between BCVA and ONL, IS, OS. Results At the first visit after SRF absorbed, compared with control eyes, the thickness of CFT (182.55+24.14 gm), ONL (72.86± 17.39 gm), IS (41.23±5.14 pm), OS (18.52± 10.26 gm) in CSC eyes were decreased (PV0.001). Meanwhile, the mean BCVA of CSC eyes was 81.27 + 6.39 letters, which was also significantly decreased comparing with control eyes (PV0.001). At last visit, the thickness of CFT, ONL, IS, OS were 195.19±22.10, 75.44± 16.33, 44.56土4.09, 26.60± 11.39 gm, and the mean BCVA was 85.50±5.95 letters. All recovered significantly comparing with first visit (PV0.05). At first visit, the BCVA of patients with integrate EZ (83.38 ±5.78 letters) was significantly better than the BCVA of patients with unintegrated EZ (77.90±5.97 letters)(P=0.003). And the BCVA of patients with smooth RPE (82.72±5.95 letter) was also significantly better than the BCVA of patients with rough RPE (78.00 + 6.31 letter's)(P=0.020). The result of Spearman correlation analysis showed that the thickness of OS was positively correlated to BCVA at two time points (尸0.423, 0.416;P=0.002, 0.002). Conclusions In CSC, the thickness of ONL, IS, OS were decreased, and the integrality of EZ, IZ, the smooth of RPE were disrupted in different extent. After laser treatment, with retinal reattachment, those microstructures including ONL, IS, OS, EZ, IZ recovered slowly. The thickness of OS, the integrality of EZ and the smooth of RPE were associated with visual acuity.