不同类型中心性浆液性脉络膜视网膜病变患者RPE-Bruch膜-脉络膜毛细血管复合体的特征差异  

Characteristics differences of the retinal pigment epithelium-Bruch’s membrane-choroidal capillary complex in different subtype of central serous chorioretinopathy

作　　者：周容 孙祖华 林冰 金子兵 刘晓玲 Zhou Rong;Sun Zuhual;Lin Bing;Jin Zibing;Liu Xiaoling(Eye Hospital and School of Ophthalmology and Optomery,Wenzhou Medical Unirersily,Wenzhou 325000,Chine;Beijing Instirute of Ophthalmolog,Beijing Tongren Eiye Center,Beijing Tongren Hospital,Capial Medical Unirersiy,Beijing Key Laboratory of Ophthalmology and Visul Sciences,Beiing 100730,China)

机构地区：[1]温州医科大学附属眼视光医院,325000 [2]首都医科大学附属北京同仁医院,北京同仁眼科中心,北京市眼科研究所眼科学与视觉科学北京市重点实验室,100730

出　　处：《眼科》2022年第4期266-271,共6页Ophthalmology in China

基　　金：国家重点研发计划(2017YFA0105300,2020YFC2008200)。

摘　　要：目的利用OCTA的Dense ART(DART)扫描模式评估急性和慢性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)中RPE-Bruch膜-脉络膜毛细血管复合体的影像学特征差异。设计回顾性病例系列。研究对象43例(43眼)CSC患者,包括急性CSC12例、慢性CSC16例及新生血管性CSC15例。方法回顾患者的病历资料。所有患者均接受眼底多模影像包括眼底照相、OCT、FFA、ICGA及OCTA的DART模式检查。主要指标Bruch膜下的暗区、平坦不规则的RPE脱离(pigment epithelial detachment,PED)、交叉征。结果OCTA结构和血流信号叠加图像上,10/12例(83.3%)急性CSC患者存在Bruch膜下的暗区,而慢性CSC患者中仅10/31例(32.3%)存在Bruch膜下的暗区(P=0.0052)。15/15例(100%)新生血管性CSC伴有平坦不规则的PED,而7/16例(43.8%)非新生血管性CSC伴有平坦不规则的PED(P=0.0008)。14/15例(93.3%)新生血管性CSC存在交叉征,所有(16/16例)非新生血管性CSC者均无交叉征(P<0.0001)。结论急性CSC黄斑区脉络膜毛细血管层的血流减弱,慢性CSC黄斑区脉络膜毛细血管血流减弱不明显,提示其不同的病理生理改变。在平坦不规则的PED区域同时伴有交叉征时,有助于慢性CSC患者中CNV的早期判定。Objective To evaluate the imaging characteristics of retinal pigment epithelium-Bruch’s membrane complex in acute and chronic central serous chorioretinopathy(CSC)using high-definition B-scan optical coherence tomography angiography(OCTA)Dense ART(DART)scan modality.Design Retrospective case series.Participants 43 patients that presented with acute(12 cases),chronic(16 cases)or neovascular(15 cases)CSC were reviewed.Methods Patients’medical records were reviewed.All of the patient underwent multimodal fundus imaging including B-scan optical coherence tomography(OCT),fluorescein angiography,indocyanine green angiography,and OCTA.The Dense DART scan modality,an updated software feature of Heidelberg SPECTRALIS OCT2,was used to assess the cross-sectional retinal pigment epithelium-Bruch’s membrane complex and acquire high-definition B-scan OCTA images.Main Outcome Measures Dark zone under Bruch’s membrane,flat irregular retinal pigment epithelial detachments(PED),crossing-sign.Results Hyporeflective signals,also referred as dark zone under Bruch’s membrane,was observed in 10 of 12(83.3%)acute CSC,and 10 of 31(32.3%)chronic CSC(P=0.0052).Of 15 cases with neovascular CSC,15 cases(15/15,100%)were accompanied by flat irregular PED(fiPEDs),while only 7 of the 16 cases(7/16,43.8%)with non-neovascular CSC were accompanied by fiPEDs(P=0.0008).14 cases with neovascular CSC(14/15,93.3%)exhibited the crossing-sign,but none of 16 cases with non-neovascular CSC had the crossing-sign(P<0.0001).Conclusion OCTA-DART enables accurate overlay between high-resolution structural B-scan and blood flow signal,which can be applied to the observation of alterations in choroidal capillary blood flow beneath the retinal pigment epithelium-Bruch’s membrane-choroidal capillary complex in eyes with CSC.The blood flow of choroidal capillaries was decreased in acute CSC,but not in chronic choroidal capillaries.The presence of flat irregular PED with concomitant crossing signs contributes to the early diagnosis of CNV in patients with

关 键 词：中心性浆液性脉络膜视网膜病变 相干光断层扫描血管成像 

分 类 号：R774.1[医药卫生—眼科]