中心性浆液性脉络膜视网膜病变转化为新生血管性肥厚型脉络膜病变的临床特征分析

Clinical research of central serous chorioretinopathy evolution to neovascular pachychoroid disease

目的比较中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)转化为肥厚型脉络膜新生血管病变(pachychoroid neovasculopathy,PNV)和息肉样脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)的转化时间及转化过程中的影像学变化。方法回顾性分析2020年1月至2022年12月在郑州市第二人民医院治的50例(50眼)CSC转化为PNV和PCV患者。将所有患者分为2组,A组为CSC转化为PNV组,共25例。B组为CSC转化为PCV组,共25例。比较两组患者的临床特征及影像学特征。结果B组患者较A组患者的平均年龄大(t=6.014,P=0.000),视力低(t=3.703,P=0.001)。A组患者转化病程为(5.54±3.14)年,B组患者转化病程(10.88±4.51)年,较A组患者长(t=4.862,P=0.000)。A组OCT示视网膜色素上皮层(RPE)由小的或规则的圆顶状转变为不规则浅脱离,OCTA示有脉络膜新生血管(CNV)形成。B组OCT示由小的或规则的圆顶状转变为不规则浅脱离,OCTA示新生血管团及脉络膜息肉(polyp),FFA/ICGA示有polyp,伴或不伴脉络膜伞样的分支血管网(BVN)。结论CSC随着病程的进展,RPE脱离形态的变化,由小的或规则的圆顶状的脱离转化为不规则浅脱离,即可转化为肥厚型脉络膜疾病中的血管性疾病,PNV和PCV,并且转化为PCV的患者年龄较大,病程较长,视力较差。

Objective To compare the conversion time and multimodal imaging changes during transformation in central serous chorioretinopathy(CSC)evolution to pachychoroid neovasculopathy(PNV)and polypoidal choroidal vasculopathy(PCV).Methods A total of 50 CSC patients who envolved to PNV and PCV between Jan.2020 and Dec.2022 were included in the retrospective study.All the patients were divided into two groups.25 PNV and 25 PCV patients transformed from CSC were included in group A and B respectively.The clinical and multimodal imaging characteristics were compared.Results Compared with group A,the average age of patients was older(t=6.014,P=0.000),the best corrected visual acuity was lower(t=3.703,P=0.001)in group B,and the conversion course of group A was(5.54±3.14)years,and group B was(10.88±4.51)years,group B was longer than that of group A(t=4.862,P=0.000).In group A,OCT showed the transformation of retinal pigment epithelium(RPE)from small or regular domed to irregular shallow detachment,and OCTA showed the formation of choroidal neovascularization(CNV).In group B,OCT showed a change from small or regular domed shape to rregular shallow detachment,OCTA showed neovascular mass and choroid polyp(polyp),FFA/ICGA showed polyp with or without branch vascular network(BVN).Conclusion As the course of CSC progresses,the form of RPE detachment changes from small or regular dome-shaped detachment to irregular shallow detachment,which can be transformed into vascular disease,PNV and PCV in hypertrophy choroidal disease.Patients who become PCV are older,have longer duration and worse visual acuity.