急性与慢性中心性浆液性脉络膜视网膜病变视网膜微血管改变的对比研究

Comparative study on retinal microvasculature changes between acute and chronic central serous chorioretinopathy

目的:中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)是亚洲中青年男性较为常见的眼底病变。急性和慢性CSC可导致视网膜血流不同程度的损伤。本研究利用光学相干断层扫描血流成像(optical coherence tomography angiography,OCTA)技术,观察并对比急性和慢性CSC患眼各层视网膜毛细血管血流密度。方法:纳入12例急性CSC和8例慢性CSC患者,包括12只急性CSC患眼(急性CSC患眼组)、11只慢性CSC患眼(慢性CSC患眼组)、17只正常眼(正常眼组)。患者均接受3 mm×3 mm、6 mm×6 mm黄斑区OCTA扫描。通过去投影OCTA算法将扫描的视网膜血流分层分割为浅层血管复合体(superficial vascular complexes,SVC)、中间毛细血管层(intermediate capillary plexuses,ICP)和深层毛细血管层(deep capillary plexuses,DCP)。内层视网膜包括SVC、ICP、DCP。计算并比较各层视网膜血流密度。结果:3 mm×3 mm黄斑区OCTA扫描显示:SVC和ICP血流密度3组之间差异均无统计学意义(均P>0.05);慢性CSC患眼组的DCP和内层视网膜血流密度显著低于急性CSC患眼组及正常眼组(均P<0.05);急性CSC患眼组与正常眼组之间各层视网膜血流密度差异均无统计学意义(均P>0.05)。6 mm×6 mm黄斑区OCTA扫描结果显示:慢性CSC患眼组的内层视网膜血流密度显著低于急性CSC患眼组及正常眼组(均P<0.05),而3组之间的SVC血流密度差异无统计学意义(P>0.05)。结论:慢性CSC患眼DCP和内层视网膜血流密度显著降低,可能是患者视功能受损的原因。对于急性期CSC患者,建议积极治疗,以避免迁延成慢性CSC。

Objective:Central serous chorioretinopathy(CSC)is generally a common fundus disease in young and middle-aged Asian men.Acute and chronic CSC can lead to different degrees of injury to the retinal blood flow.This study aims to observe and compare the blood flow density in different retinal capillary layers in patients with acute and chronic CSC using optical coherence tomography angiography(OCTA)technology.Methods:Twelve patients with acute CSC and 8 patients with chronic CSC including 12eyes with acute CSC(acute CSC eye group),11 eyes with chronic CSC(chronic CSC eye group),and 17 normal eyes(normal eye group)were enrolled in this study.All patients underwent 3 mm×3 mm,6 mm×6 mm macular OCTA scanning.The retinal microvasculature was divided into superficial vascular complexes(SVC),intermediate capillary plexuses(ICP),and deep capillary plexuses(DCP)using the projection resolved-OCTA algorithm.Inner retina includes SVC,ICP,and DCP.The vessel density in each retinal layer and the inner retina were calculated and compared.Results:Macular OCTA scanning of 3 mm×3 mm showed that there was no significant difference in blood flow density of SVC and ICP among the 3 groups(both P>0.05);blood flow density of DCP and inner retina in the chronic CSC eye group was significantly lower than that in the acute CSC eye group and the normal eye group(all P<0.05);there was no significant difference in retinal blood flow density of different layer between the acute CSC eye group and the normal eye group(all P>0.05).Macular OCTA scanning of 6 mm×6 mm showed that inner retinal blood flow density of the chronic CSC eye group was significantly lower than that of the acute CSC eye group and the normal eye group(both P<0.05);there was no significant difference in blood flow density of SVC among the 3 groups(P>0.05).Conclusion:The vessel density of DCP and inner retina in the eyes with chronic CSC are significantly reduced,which may result in impaired visual function.Therefore,we recommend that patients with acute CSC should be properly treated to avoid progressing into chronic CSC.