局限性脉络膜凹陷患者的EDI-OCT特征及并发症观察

Enhanced depth imaging optical coherence tomography findings and complications in patients with focal choroidal excavation

目的观察局限性脉络膜凹陷(FCE)患者的增强深部成像光学相干断层扫描(EDI-OCT)的影像学特征及并发症发生情况。方法将2014年12月至2020年12月在佛山市第二人民医院眼科中心首诊并经EDI-OCT检查确诊的47例47眼FCE患者纳入研究。记录患者的性别、年龄、屈光度、logMAR最佳矫正视力及凹陷的数量、位置、类型、形态,测量中心凹下脉络膜厚度、凹陷下脉络膜厚度、最大凹陷宽度和凹陷深度,观察FCE发生的并发症及危险因素。结果47例FCE患者中男25例,女22例;年龄(48.30±15.20)岁,logMAR视力为0.27±0.36,等效球镜度数为(-2.23±3.00)D,近视患者34例(72.34%);患眼黄斑区有54个凹陷。凹陷位置33个位于中心凹下,21个位于中心凹外;凹陷类型紧密型44个,分离型10个;凹陷形态碗形37个,锥形17个。FCE患者中心凹下脉络膜厚度为(219.36±105.80)μm,凹陷下脉络膜厚度为(166.28±101.45)μm,凹陷宽度为(703.26±317.61)μm,凹陷深度为(72.57±35.52)μm。22例FCE患者出现了并发症,包含脉络膜新生血管(CNV)10例(21.28%)、中心性浆液性脉络膜视网膜病变(CSC)7例(14.89%)、息肉状脉络膜血管病变2例、视网膜色素上皮脱离3例。FCE有并发症组患者的logMAR视力、中心凹下脉络膜厚度、凹陷下脉络膜厚度及凹陷宽度均大于FCE无并发症组患者(均为P<0.05)。Logistic回归分析显示,凹陷下脉络膜厚度(P=0.009)、凹陷宽度(P=0.007)是FCE发生并发症的危险因素。结论FCE好发于中青年患者的黄斑中心凹下,以紧密型、碗形多见。FCE易出现RPE功能障碍相关并发症,以CNV、CSC多见,导致患者视力明显下降。凹陷下脉络膜厚度增加、凹陷宽度增大可能与并发症的发生相关。

Objective To observe the findings of enhanced depth imaging optical coherence tomography(EDI-OCT)and the occurring of complications in patients with focal choroidal excavation(FCE).Methods Forty-seven patients(47 eyes),who were first diagnosed with FCE by EDI-OCT in the Second People’s Hospital of Foshan from December 2014 to December 2020,were included in the study.The gender,age,refraction,and logMAR best corrective visual acuity of the patients,and the amount,location,pattern,and shape of all excavations were recorded.The subfoveal choroidal thickness,subexcavation choroidal thickness,maximum excavation width and depth were measured.The complications of FCE and related risk factors were analyzed.Results There were 25 males and 22 females in 47 FCE patients.The age was(48.30±15.20)years,the logMAR visual acuity was 0.27±0.36,and the spherical equivalent was(-2.23±3.00)diopters,and there were 34 patients(72.34%)with myopia.Fifty-four excavations were identified in the macula of 47 affacted eyes.As to the location of excavations,33 were subfoveal and 21 were extrafoveal.As to the pattern of excavations,44 were conforming and 10 were non-conforming.As to the shape of excavations,37 were bowl-shaped and 17 were cone-shaped.The subfoveal choroidal thickness of FCE patients was(219.36±105.80)μm,the subexcavation choroidal thickness was(166.28±101.45)μm,the excavation width was(703.26±317.61)μm,and the excavation depth was(72.57±35.52)μm.Twenty-two FCE patients developed complications,including 10 patients(21.28%)with choroidal neovascularization(CNV),7 patients(14.89%)with central serous choroidal lesions(CSC),2 patients with polypoid choroidal vasculopathy,and 3 patients with retinal pigment epithelium detachment.The logMAR visual acuity,subfoveal choroidal thickness,subexcavation choroidal thicknessand excavation width of FCE patients with complications were significantly higher than those of FCE patients without complications(all P<0.05).Logistic regression analysis showed the subexcavation choroidal thickness(P=0.009)and excavation width(P=0.007)were the risk factors for complications of FCE.Conclusion FCE usually occurs under the fovea of macula in young and middle-aged patients,frequently with the conforming pattern or bowl shape.FCE is prone to complications related to RPE dysfunction,especially CNV or CSC,which will cause a significant decline of vision.The increase of subexcavation choroidal thickness and excavation width may be related to the occurrence of complications.