全身使用糖皮质激素继发中心性浆液性脉络膜视网膜病变的临床特征

Clinical features of central serous chorioretinopathy secondary to systemic corticosteroids

目的 探讨全身使用糖皮质激素患者发生中心性浆液性脉络膜视网膜病变(CSCR)的临床特征.设计回顾性比较性病例系列.研究对象2012年10月至2018年10月间在北京同仁医院眼科就诊的全身使用糖皮质激素后继发CSCR患者35例(50眼)作为继发CSCR组;同时连续纳入61例(67眼)既往无全身糖皮质激素使用史的CSCR患者作为对照组.方法 回顾性分析研究对象的病史、视力、彩色眼底照相、荧光眼底素血管造影(FFA)等临床资料,并对两组患者之间的临床特征进行比较.主要指标发病特点、眼底及FFA表现.结果 35例(50眼)继发CSCR患者中,双眼发病15例(42.9%),单眼20例(57.1%);15眼(30.0%)可见黄白色神经上皮下纤维素样物质沉着;8眼(15.7%)下方视网膜可见渗出性脱离;16眼(31.4%)眼底呈弥漫萎缩性视网膜色素上皮改变(DARA);21眼(42.0%)在FFA静脉中、晚期出现单个点状荧光素渗漏点,29眼(58.0%)出现2个或以上渗漏点或呈弥漫性荧光素渗漏.对照组61例(67眼)CSCR患者中,双眼发病6例(9.8%),单眼发病55例(90.2%);9眼(13.4%)可见黄白色神经上皮下纤维素样物质沉着,无患眼(0%)发生下方视网膜渗出性脱离,2眼(3.0%)眼底呈DARA.59眼(88.1%)FFA静脉中、晚期出现单个荧光素渗漏点,8眼(11.9%)出现2个或以上荧光素渗漏点和/或弥漫性荧光素渗漏.上述临床特征,两组间的差异均有统计学意义(P均=0.000).结论 与普通CSC患者相比,全身使用糖皮质激素继发CSCR患者更容易双眼发病,视网膜色素上皮功能受损更为严重.

Objective To investigate the clinical features of central serous chorioretinopathy(CSCR)secondary to systemic corticosteroids.Design Retrospective comparative case series.Participants 35 consecutive CSCR patients(50 eyes)induced by corticosteroid who consulted at the ophthalmic clinic of Beijing Tongren Hospital from October 2012 to October 2018,and 61 consecutive CSCR patients(67 eyes)without a history of systemic corticosteroid.Methods The clinical data including medical history,visual acuity,color fundus photos,fundus fluorescence angiography(FFA)of the secondary CSCR group and control group were collected continuously,the clinical features of the two groups were analyzed and compared retrospectively.Main Outcome Measures Clinical features,ocular fundus and FFA changes.Results In 35 patients(50 eyes)with secondary CSCR,15 cases onset in both eyes(42.9%),20 cases in one eye(57.1%);subretinal yellowish fibrinous deposits were found in 15 eyes(30%);inferior retinal detachment in 8 eyes(15.7%);diffuse atrophic retinal pigment epithelium alterations(DARA)in 16 eyes(31.4%);one fluorescein leakage site in 21 eyes(42.0%)during FFA,more than 1 leakage site in and/or diffuse fluorescein leakage in 29 eyes(58.0%).In the control group of 61 cases(67 eyes),6 cases(9.8%)onset in both eyes,55 case(90.2%)in one eye;subretinal yellowish fibrinous deposits were found in 9 eyes(13.4%);exudative retinal detachment in no eyes;DARA in 2 eyes(3%);one fluorescein leakage site in 59 eyes(88.1%),more than one leakage site or diffuse fluorescein leakage in 8 eyes(11.9%).There were significant statistic differences between the two groups(all P=0.000).Conclusion Compared with idiopathic CSCR,CSCR secondary to systemic corticosteroid was more apt to involve both eyes,and have more severe retinal pigment epithelium damage.