急性中心性浆液性脉络膜视网膜病变多波长炫彩图像特征观察

Characteristics of multicolor imaging in the acute central serous chorioretinopathy

目的采用多波长炫彩成像技术对急性中心性浆液性脉络膜视网膜病变(CSC)患者的黄斑区进行扫描,观察其图像特征。方法采用横断面研究,纳入2017年8月至2018年1月在武汉大学人民医院眼科中心确诊的急性CSC患者34例34眼。其中男21例21眼,女13例13眼;年龄26~61岁,平均(37.41±9.35)岁;发病时间5~45 d,平均(12.00±2.29)d。采集患眼彩色眼底照相、荧光素眼底血管造影(FFA)联合吲哚菁绿血管造影(ICGA)、多波长炫彩成像、光相干断层扫描(SD-OCT)图像。分析同一患眼各眼底成像的特征,并比较多波长炫彩成像图像和彩色眼底照相图像上渗漏点和浆液性视网膜神经上皮脱离与FFA/ICGA和SD-OCT诊断的符合率。结果关于浆液性视网膜神经上皮脱离区在标准多波长炫彩成像图像和蓝绿加强图像上表现为边界清晰的绿色反光区者33眼,占97.06%,表现为浆液性神经上皮脱离但边界不清者1眼,占2.94%;在蓝光反射图像上呈弱反光区者17眼,占50%;在绿光反射图像上呈边界清晰的弱反光区32眼,占94.11%;在红外光图像上呈边界清晰的弱反光区者33眼,占97.06%。FFA荧光素渗漏点对应处SD-OCT检查显示,19眼表现为微小视网膜色素上皮层脱离(PED),占55.88%,12眼表现为视网膜色素上皮(RPE)光带粗糙,占35.29%,3眼表现为较大PED,占8.82%。关于RPE渗漏部位,在标准多波长炫彩成像图像和蓝绿加强图像上表现为神经上皮脱离区内的红色斑驳样改变者29眼,占85.29%;在蓝光反射图像上呈强反光斑点者2眼,占5.88%;在绿光反射上表现为强反光斑点者5眼,占14.70%;在红外光反射图像上表现为弱反光区中夹杂强反光斑点者33眼,占97.06%。标准多波长炫彩成像图像、蓝绿加强图像和红外光反射图像用于发现浆液性视网膜神经上皮脱离和渗漏点征象的符合率均明显高于彩色眼底照相图像,差异均有统计学意义(均P<0.05)。结论标准多波长炫彩成像图像、蓝绿加强图像和红外光反射图像均能较好地显示急性CSC病灶的渗漏点和视网膜神经上皮层脱离,绿色反射图像能较好地显示急性CSC视网膜神经上皮脱离。基于共聚焦激光扫描检眼镜技术的多波长炫彩成像可作为急性CSC的辅助诊断手段。

Objective To investigate the features of multicolor imaging in the macular region of central serous chorioretinopathy(CSC)patients.Methods A cross-sectional study was conducted.Thirty-four acute CSC patients(34 eyes)treated in Renmin Hospital of Wuhan University from August 2017 to January 2018 were enrolled.Among the 34 subjects,there were 21 males(21 eyes)and 13 females(13 eyes).The subjects were 26 to 61 years old,with an average age of(37.41±9.35)years.The course of the disease was 5 to 45 days,with an average course of(12.00±2.29)days.All the subjects were examined by color fundus photography,fluorescein angiography(FFA),indocyanine green angiography(ICGA),multicolor imaging,spectral-domain optical coherence tomography(SD-OCT).The image features of each patient were compared and analyzed.The diagnostic accordance rate for leakage point and serous retinal neuroepithelial detachment of multicolor imaging and color fundus photography was calculated according to FFA/ICGA and OCT.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Renmin Hospital of Wuhan University(No.WDRY2019-K037).Results The serous retinal detachment region showed green light reflection area with clear boundary in 33 eyes(97.06%)in the standard as well as blue and green enhanced multicolor image,with not clear boundary in 1 ey e(2.94%).The serous retinal detachment region showed weakly reflective area in 17 eyes(50%)in blue reflectance image,showed weak reflection with clear boundary in 32 eyes(94.11%)in green reflectance image,showed weakly reflection with clear boundary in 33 eyes(97.06%)in infrared reflectance image.The fluorescein leakage point in FFA image was found micro retinal pigment epithelium detachment(PED)in 19 eyes(55.88%),rough light band of retinal pigment epithelium(RPE)in 12 eyes(35.29%),and large PED in 3 eyes(8.82%)in SD-OCT image.The RPE leakage showed red mottled changes in the area of neuroepithelial detachment in 29 eyes(85.29%)in the standard as well as blue and green enhanced multicolor images,presented strong reflection spots in blue reflectance images in 2 eyes(5.88%),showed strong reflective spots in green reflectance in 5 eyes(14.70%),showed strong reflection spot in the weakly reflective area in 33 eyes(97.06%)in infrared reflectance images.Taking FFA/ICGA and OCT as the gold standard,the diagnostic accordance rate of standard multicolor,blue and green enhanced multicolor and infrared reflectance images for serous retinal neuroepithelial detachment and leakage points was higher than that of color fundus photography,and the differences were statistically significant(all at P<0.05).Conclusions Standard multicolor,blue and green enhanced multicolor and infrared reflectance images can reflect the leakage point and retinal neuroepithelial detachment of acute CSC.Green reflectance image can show serous retinal neuroepithelial detachment of acute CSC.Multicolor imaging can be used as the auxiliary diagnosis method of acute CSC.