中心性浆液性脉络膜视网膜病变转换为PCV和PNV的多模式影像学特征  

Multimodal imaging characteristics of central serous chorioretinopathy converted to polypoidal choroidal vasculopathy and pachychoroidal neovascularization

作　　者：陈青山[1] 赵霞 李志[1] 程晓容 Chen Qingshan;Zhao Xia;Li Zhi;Cheng Xiaorong(Shenzhen Key Laboratory of Ophthalmology,Shenzhen Eye Hospital,Jinan University,Shenzhen 518023,China;Shenzhen Aier Eye Hospital,Shenzhen 518001,China)

机构地区：[1]暨南大学附属深圳眼科医院,深圳市眼科学重点实验室,深圳518023 [2]深圳爱尔眼科医院,518001

出　　处：《中华实验眼科杂志》2019年第1期30-34,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：深圳市科技创新委知识创新计划项目(JCYJ20150402152130699).

摘　　要：目的观察中心性浆液性脉络膜视网膜病变(CSC)转换为息肉样脉络膜血管性病变(PCV)和增厚型脉络膜新生血管病变(PNV)的影像学特征。方法对2009年6月至2017年9月在暨南大学深圳眼科医院初诊为CSC且经微脉冲激光光凝或半剂量光动力疗法(PDT)治疗的79例91眼病历资料进行回顾性分析,所有患眼均经彩色眼底照相、荧光素眼底血管造影(FFA)、频域光相干断层扫描(SD-OCT)、吲哚青绿血管造影(ICGA)检查,其中治疗后仍存在视网膜色素上皮(RPE)脱离或复发的CSC者行FFA、OCT、ICGA、光相干断层扫描血管成像(OCTA)检查。对16例20眼CSC确诊转归为PCV和PNV眼进行分析并行增强深度成像OCT测量黄斑中心凹下脉络膜厚度(SFCT)。结果治疗的91眼CSC中9例11眼转换为PNV,FFA显示黄斑区多发性斑点状高荧光,ICGA显示黄斑区异常脉络膜毛细血管团状扩张,OCT显示RPE波浪状浅脱离伴浆液性神经上皮脱离,OCTA分层显示脉络膜毛细血管层团状新生血管位于RPE与Bruch膜之间。共有7例9眼转换为PCV,FFA显示浆液或浆液血性色素上皮脱离(PED)及黄斑多灶性斑点高荧光,ICGA显示异常扩张脉络膜血管网(BVN)伴典型息肉样病灶,OCT示拇指状PED与双层征并伴浆液性神经上皮脱离,OCTAen-face分层示脉络膜毛细血管层BVN与细小息肉样表现。PCV组和PNV组基线平均最佳矫正视力(BCVA,LogMAR视力)分别为0.282±0.220和0.413±0.190,差异有统计学意义(t=0.037,P<0.05)。CSC组、PCV组和PNV组SFCT分别为(373.61±65.11)、(296.22±30.24)和(328.63±76.18)μm,差异均有统计学意义(F=3.48,P<0.05)。与PCV比较,PNV患者SFCT显著增厚,差异有统计学意义(t=2.91,P<0.05)。结论慢性或反复发作的具有脉络膜增厚特征CSC可转换为PNV,具有浆液性或出血性PED的PNV可转换为PCV。多模式影像检查有助于CSC转换为PNV和PCV眼的诊断。Objective To investigate the multimodal imaging characteristics of central serous chorioretinopathy (CSC) converted to polypoidal choroidal vasculopathy (PCV) and pachychoroidal neovascularization(PNV).Methods A retrospective case series study was adopted.The clinical data of 91 eyes from 79 patients with CSC who received treatment from June 2009 to September 2017 in Shenzhen Eye Hospital were analyzed.Color fundus photography,fundus fluorescein angiography (FFA),spectral domain optical coherence tomography (SD-OCT) and indocyanine angiography (ICGA) were performed in the patients.The eyes with recurrence or maintained serous retinal pigment epithelium(RPE) after treatment were examined once more.Results In 91 eyes,11 eyes of 9 patients converted to PNV.Late stage of FFA showed multifocal hyperfluorecnece in macular area.ICGA showed plaque hyperflurorescence overlying dilated choroidal vessel.OCT revealed irregular flap shallow RPE detachment with retinal neurosensory detachment.OCTA revealed mass-like enlarged choroidal vessel between RPE and Bruch membrane.Nine eyes of 7 patients with CSC converted to PCV,and late stage of FFA showed serous-hemorrhage pigment epithelium detachment(PED) and multifocal enlargement hyperfluorecnece.ICGA showed branch vessels network (BVN) with small polyps.OCT revealed PED like thumb with double-layer sign and retinal neurosensory detachment.OCTA en-face revealed BVN with small polyps at choroidal capillaries layer.The baselines BCVA of PCV and PNV(LogMAR) was 0.282±0.220 and 0.413±0.190,respectively with a significant difference between them (t=0.037,P<0.05).Subfoveal choroidal thickness (SFCT) of CSC,PCV and PNV patients was (373.61±65.11),(296.22±30.24) and (328.63±76.18)μm,with siginificant differences among them (F=3.48,both at P<0.05).SFCT of PNV patients was thicker than that of PCV patients,with a significant difference between the two groups (t=2.91,P<0.05).Conclusions Chronic or recurrence CSC is probably to develop to PNV,and the PNV with serous or hemorrhage PED

关 键 词：中心性浆液性脉络膜视网膜病变 息肉状脉络膜血管病变 增厚型脉络膜新生血管病变 眼底多模式影像 

分 类 号：R774.1[医药卫生—眼科]