光学相干断层扫描成像对急性中心性浆液性脉络膜视网膜病变渗漏点的前瞻性观察研究  

Observation on the leakage point of acute central serous chorioretinopathy through optical coherence tomography:A prospective study

作　　者：吉宇莹 张雄泽 李妙玲 甘雨虹 苏永悦 米兰[1] 文峰[1] JI Yuying;ZHANG Xiongze;LI Miaoling;GAN Yuhong;SU Yongyue;MI Lan;WEN Feng(Department of Medical Retina,Zhongshan Ophthalmic Center,Sun Yat-sen University,State Key Laboratory of Ophthalmology Guangzhou 510060,China)

机构地区：[1]中山大学中山眼科中心眼底内科,眼科学国家重点实验室,广州510060

出　　处：《眼科学报》2021年第2期115-121,共7页Eye Science

基　　金：广东省自然科学基金(2018A030313116);广东省自然科学基金博士启动纵向协同项目(2017A030310282)。

摘　　要：目的:观察急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的自然病程中渗漏点的形态及变化。方法:本研究为前瞻性研究,使用光学相干断层扫描(optical coherence tomography,OCT)观察从发病到发病后5~13个月的CSC患者的渗漏点的OCT形态,测量并计算Hal l层、脉络膜全层各自厚度及比值,并进行比较。结果:共20例患者[男14例,女6例,年龄33~59(中位数41)岁]纳入研究。随访时间为5~13个月。在19例患者中观察到微小视网膜色素上皮脱离(pigment epithelium detachment,PED)。1例患者可见视网膜色素上皮(retinal pigment epithelium,RPE)小凸起。在随访期间,仅1例患者的PED完全恢复,其他19例患者在视网膜下液被完全吸收时,RPE和Bruch膜之间仍存在微小分离。渗漏点处的Haller层/脉络膜厚度显著高于中央凹处(初诊时0.806±0.08 vs 0.863±0.06,P=0.003;最后1次随访时为0.801±0.07 vs 0.851±0.06,P=0.004)。结论:本研究观察到在急性CSC患者自然病程中,即使视网膜下液吸收,OCT显示渗漏点处仍存在持续的PED,更厚的Haller层及更薄的内层脉络膜,这些发现为CSC的发病机制提供了更多线索。Objective:To observe the morphology and changes of leakage points in the natural course of acute central serous chorioretinopathy(CSC).Methods:This study was a prospective study,using optical coherence tomography to observe the OCT morphology of leakage points in CSC patients from onset to 5 to 13 months after onset,measuring the thickness and ratio of Hall layer and the whole choroid,and then compare them.Results:A total of 20 patients were included in the study,including 14 males and 6 females,aged from 33 to 59,with the median being 41 years old.The follow-up time ranged from 5 months to 13 months.Minute retinal pigment epithelial detachments(PED)were observed in 19 patients.A small bulge of retinal pigment epithelium(RPE)was observed in 1 patient.During the follow-up,only one patient totally recovered.Small separation between RPE and Bruch membrane still exit even subretinal fluid were absorbed completely in the other 19 patients.The thickness of Haller layer or choroid at the leakage point was significantly higher than that of the fovea(0.806±0.08 vs 0.863±0.06,P=0.003,at the first visit;0.801±0.07 vs 0.851±0.06,P=0.004,at the last follow-up).Conclusion:This study observed that in the natural course of acute CSC patients,even if the subretinal fluid was absorbed,OCT still showed that there was persistent PED at the leakage point,thicker Haller layer and thinner inner choroid layer.These findings provided more clues to the pathogenesis of CSC.

关 键 词：中心性浆液性脉络膜视网膜病变 渗漏点 光学相干断层扫描 色素上皮脱离 Haller层厚度 

分 类 号：R774.1[医药卫生—眼科] R773.4[医药卫生—临床医学]