频域OCT在急性Vogt-小柳原田病和急性中心性浆液性脉络膜视网膜病变鉴别诊断中的应用

目的 评价频域光学相干断层扫描(optical coherence tomography,OCT)鉴别急性Vogt-小柳原田病(Vogt-Koyanagi-Harada,VKH)和急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSCR)的诊断能力.方法 收集急性VKH和急性CSCR病例,所有病例均接受详细的病史采集以及视力、裂隙灯显微镜、散瞳眼底检查、频域OCT和眼底荧光血管造影检查.运用频域OCT(SD-OCT)的5线光栅扫描和黄斑三维扫描进行SD-OCT黄斑区扫描,计算各种OCT形态特征对鉴别诊断两种疾病的敏感性、特异性、漏诊率和误诊率.结果 入选急性VKH患者40例(40眼),急性CSCR患者32例(32眼);急性VKH组的最佳矫正视力较急性CSCR组差(P＜0.001);急性VKH组的黄斑中心凹视网膜厚度为(771.6±419.2) μm,而急性CSCR组为(451.7±157.9)μm,两组差异有统计学意义(P＜0.001);两组所有患者均有视网膜神经上皮层脱离,而膜样结构、视网膜色素上皮层皱褶和内界膜波浪样改变仅见于急性VKH组,它们对鉴别急性CSCR的敏感性分别是85.0％、62.5％和55.0％,膜样结构对鉴别两种疾病的敏感性最高,且其特异性为100.0％,假阳性率(误诊率)为0,假阴性率(漏诊率)为15.0％.结论 SD-OCT可以有效区分急性VKH和急性CSCR,膜样结构是鉴别两者敏感性最高的OCT形态特征.     

The Association between Choroidal Thickness Variations and Response to Intravitreal Bevacizumab in Central Serous Chorioretinopathy

PurposeTo analyze differences in the subfoveal choroidal thickness (SFChT) between bevacizumab responders (BevRs) and nonresponders (BevNRs) in patients with idiopathic central serous chorioretinopathy (CSC).MethodsThe medical records of 30 unilateral chronic CSC patients who were treated with intravitreal bevacizumab (IVB) as a first line treatment were reviewed. Patients were categorized as BevNRs when CSC did not completely resolve after a minimum of 3 IVB treatments. Enhanced depth imaging-optical coherence tomography was used and SFChT was measured before and after treatment. Choroidal hyperpermeability was also evaluated using indocyanine angiography.ResultsTwenty and 10 eyes were classified as BevRs or BevNRs, respectively. The mean number of IVB treatments was 2.22 ± 0.89 in BevRs, and 4.80 ± 1.03 in BevNRs. Compared with BevNRs, BevRs demonstrated significantly greater pretreatment SFChT (441.25 ± 88.09 vs. 364.10 ± 61.97 µm); SFChT reduction following IVB was significantly greater in BevRs than BevNRs. SFChT in the unaffected eyes was also greater in BevRs than BevNRs. Choroidal hyperpermeability was detected less frequently in BevNRs (hypofluorescence on late-phase, 0.0% and 33.3% in BevNRs and BevRs, respectively; p= 0.049).ConclusionsCompared with CSC eyes that did not respond well to IVB, BevRs demonstrated significantly thicker SFChT at baseline, greater reduction in SFChT after IVB treatment, and hyperfluorescence on late-phase indocyanine green angiography. We recommend IVB injection as the first-line therapy for CSC eyes with relatively high SFChT and hyperfluorescence on late-phase indocyanine green angiography.     

中心性浆液性脉络膜视网膜病变眼底自发荧光影像的特点

目的：研究急性和慢性特发性中心性浆液性脉络膜视网膜病变眼底自发荧光影像模式及眼底荧光血管造影相关性发现。

方法：观察性研究案例。回顾性分析中心性浆液性脉络膜视网膜病变患者临床数据,眼底荧光血管造影及眼底自发荧光影像,并对其调查结果进行比较。

结果：该研究共纳入17例25眼。确诊为急性中心性浆液性脉络膜视网膜病变5眼,慢性疾病或复发性慢性疾病20眼。急性病例眼底自发荧光影像显示低荧光点与荧光血管造影检测出的荧光渗漏点位置相同。慢性特发性中心性浆液性脉络膜视网膜病变眼底荧光血管造影为视网膜色素上皮弥漫性萎缩区域,可透视荧光。眼底自发荧光影像的低荧光区域的形态和位置与眼底荧光血管造影的高荧光区域相对应,然而眼底荧光血管造影的低荧光区域与眼底自发荧光影像的高荧光区域相对应。在急性病例中,低自发荧光点不能准确指出视网膜色素上皮的渗漏点。

结论：中心性浆液性脉络膜视网膜病变眼底自发荧光影像模式能够描述疾病不同阶段的特征,具有无风险和可再生性,可替代荧光素血管造影术治疗中心性浆液性脉络膜视网膜病变。     

脉络膜厚度与CSCR的病例对照研究与Meta分析

目的：定量分析中心性浆液性脉络膜视网膜病变( central serous chorioretinopathy,CSCR)患者黄斑中心凹下脉络膜厚度( subfoveal choroidal thickness,SFCT)改变。
　　方法：采用病例对照研究及Meta分析。连续的CSCR患者46例纳入研究,CSCR患者散瞳后前置镜眼底检查,荧光素眼底血管造影和吲哚菁绿血管造影检查确诊。选择同期年龄、性别、屈光度及眼轴匹配的正常人62例62眼作为正常对照组。用加强成像深度扫描OCT检测并比较CSCR组及对照组SFCT。单因素和多因素分析 SFCT 与各临床资料之间的关系。 Meta分析用Stata软件计算两组之间的加权均数差。
　　结果：CSCR患者的平均SFCT为397.34±83.91μm,正常对照组为274.48±62.57μm。 CSCR组SFCT较对照组明显增厚,差异有统计学意义(P<0.01)。单因素与多因素线性回归分析, SFCT与CSCR诊断显著相关。 Meta分析结果：CSCR组的黄斑中央凹下脉络膜较正常组厚,加权平均差异为156.13μm(95% CI：137.43,174.83)。
　　结论：CSCR患者黄斑中央凹下脉络膜较正常眼厚,增厚的SFCT与CSCR诊断存在相关性。     

Structural and Functional Outcomes in Chronic Central Serous Chorioretinopathy Treated with Photodynamic Therapy

PurposeTo study the retinal pigment epithelium (RPE) and retinal alterations in chronic central serous chorioretinopathy treated with photodynamic therapy, and its correlation with functional parameters such as best-corrected visual acuity (BCVA) and contrast sensitivity (CS).MethodsRetrospective, noncomparative, consecutive evaluation by optical coherence tomography and its correlation with BCVA and CS in 31 eyes of 26 patients.ResultsIn all affected patients, 88.5% were male with a mean age of 42.9 years. The right eye was involved in 64.5% of cases, bilateral in 19% and 73.9% were hyperopic (spherical refraction between 0 and +5.0 diopters). Of these cases, 51.5% had peri-RPE abnormalities, 17.3% hyperreflective substances at RPE, 19.4% RPE atrophy, 55.3% foveolar atrophy, 3.1% pigment epithelial detachment, 5.2% subretinal fluid persistence, 8.3% fibrin deposits, 68.4% photoreceptor inner and outer segment line interruption and 31.1% external limiting membrane interruption.ConclusionsTime evolution and number of outbreaks were related to the decrease in foveal and chorodial thickness and in those with worse BCVA and CS. RPE abnormalities and atrophy were related to the age of onset of symptoms. Photoreceptor elongation has been correlated with poor BCVA and inner and outer segment line destructuring and interruption with poor CS.     

QT interval dispersion in the patients with central serous chorioretinopathy

AIM: To evaluate QT dispersion (QTD) in patients with central serous chorioretinopathy (CSC). METHODS: This clinical, comperative, case-control study included 30 patients with CSC at acute phase (Group 1) and 30 age- and sex-matched healthy subjects (Group 2, the control group). From all subjects, a 12-lead surface electrocardiography was obtained. The heart rate (HR), QT maximum (QTmax), QT minimum (QTmin), QT corrected (QTc), QTD and Tmean were manually measured and analyzed. Student’s t-test and Pearson’s method of correlation were used for statistical analysis. RESULTS: The patient and control groups were matched for age, smoking status (rate and duration) and gender. There were no significant differences with regard to these among the groups (P>0.05). The participants included 19 men (63.3%) and 11 women (36.7%) in Group 1, 20 men (66.7%) and 10 women (33.3%) in Group 2. QTmax, QTD and QTc were significantly higher than those of healthy controls (P<0.001 for QTmax, P=0.01 for QTD and P=0.001 for QTc). QTmin, Tmean and HR did not differ significantly between the study groups (P=0.28 for QTmin, P=0.56 for Tmean and P>0.05 for HR). No significant correlation was found between duration of the disorder and QTD values (r=0.13, P>0.05). CONCLUSION: These findings suggest that CSC may be associated with an increase in QTD and that the patients might be at risk for ventricular arrhythmia.     

A novel mutation of sgk-1 gene in central serous chorioretinopathy

AIM

To investigate the association of serum glucocorticoid kinase gene-1 (SGK-1) DNA variants with chronic central serous chorioretinopathy (CSC).

METHODS

We enrolled 32 eyes of 32 patients who were diagnosed with chronic CSC and composed 32 normal eyes as a control group. Peripheral blood was used for DNA extraction and polymerase chain reaction (PCR) amplification. SGK1 gene was sequenced by using BigDye^® Terminator v3.1 cycle sequencing KIT (Applied Biosystems, Foster City, CA, USA). The SGK1 gene and its variants were investigated in CSC patient group and control group.

RESULTS

We identified a new polymorphism M32V in two person in the patient group (Minor allele frequency (MAF)=0.009) on the region of 1-60 amino acids. The rs1057293 was located in the encoder region of the SGK 1 gene but not associated with CSC (P=0.68). An intrinsic rs1743966 is also not associated (P=0.28).

CONCLUSIONS

The new polymorphism M32V is located on the region of 1-60 amino acids which is necessary for localization to the mitochondria in CSC patient. This mutation is probably important for the energy metabolism and plays an important role in the cellular response to hyperosmotic stress and other stress stimuli. Both rs1057293 and rs1743966 are not associated with CSC.     

Fundus autofluorescence in central serous chorioretinopathy:association with spectral-domain optical coherence tomography and fluorescein angiography

AIM: To evaluate the correlation among changes in fundus autofluorescence (AF) measured using infrared fundus AF (IR-AF) and short-wave length fundus AF (SW-AF) with changes in spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) in central serous chorioretinopathy (CSC).METHODS:Two hundred and twenty consecutive patients with CSC were included. In addition to AF, patients were assessed by means of SD-OCT and FA. Abnormalities in images of IR-AF, SW-AF, FA were analyzed and correlated with the corresponding outer retinal alterations in SD-OCT findings.RESULTS:Eyes with abnormalities on either IR-AF or SW-AF were found in 256 eyes (58.18%), among them 256 eyes (100%) showed abnormal IR-AF, but SW-AF abnormalities were present only in 213 eyes (83.20%). The hypo-IR-AF corresponded to accumulation of sub-retinal liquid, collapse of retinal pigment epithelium (RPE) or detachment of RPE with or without RPE leakage point in the corresponding area. The hyper-IR-AF corresponded to the area with loss of the ellipsoid portion of the inner segments and sub-sensory retinal deposits or focal melanogenesis under sensory retina. The hypo-SW-AF corresponded to accumulation of sub-retinal liquid or atrophy of RPE. The hyper-SW-AF associated with sub-sensory retinal deposits, detachment of RPE and focal melanogenesis.CONCLUSION:IR-AF was more sensitive than SW-AF and FA for identifying pathological abnormalities in CSC. The characteristics of IR-AF in CSC were attributable to the modification of melanin in the RPE. IR-AF should be used as a common diagnostic tool for identifying pathological lesion in CSC.KEYWORDS:central serous chorioretinopathy; fluorescein angiography; fundus autofluorescence; optical coherence tomography     

Usefulness of optical coherence tomography to detect central serous chorioretinopathy in monkeys

Many systemic drugs can induce ocular toxicity and several ocular side‐effects have been identified in clinical studies. However, it is difficult to detect ocular toxicity in preclinical studies because of the lack of appropriate evaluation methods. Optical coherence tomography (OCT) is useful because it can provide real‐time images throughout a study period, whereas histopathology only provides images of sacrificed animals. Using OCT alongside histopathology, attempts were made to find effective approaches for screening of drug‐induced ocular toxicity in monkeys. Such approaches could be used in preclinical studies prior to human trials. Six male cynomolgus monkeys (Macaca fascicularis Raffles) were orally administered one of six candidate MAPK/ERK kinase (MEK) inhibitors. Central serous chorioretinopathy, a known side‐effect of such inhibitors, was identified in four monkeys by OCT. Artifacts generated during tissue processing meant that histopathology could not detect edematous changes. Thus, OCT is a useful tool to detect ocular toxicity which cannot be detected by histopathology in preclinical studies. Copyright © 2014 John Wiley & Sons, Ltd.