Evaluation of the changes in choroidal thickness in patients with central serous chorioretinopathy as measured by optical coherence tomography

AIM: To study the changes in choroidal thickness in central serous chorioretinopathy (CSCR) over a 3mo follow-up using spectral domain optical coherence tomography (SD-OCT). METHODS: This prospective study included 60 eyes, both eyes of 20 patients (mean age: 33.65±5.24y) with classic acute unilateral central serous chorioretinopathy and normal fellow eye and 20 eyes as healthy controls. Fluorescein angiography and OCT were done. The subfoveal choroidal thickness (SFCT), central macular thickness (CMT), 1000 μm temporal and nasal to the centre of the fovea and the subretinal fluid were measured. RESULTS: There was a statistically significant difference in SFCT among the three groups at the three different locations. SFCT in eyes with CSCR (372.40±34.39 μm) was significantly greater than that in each of the unaffected fellow eyes (302.10±8.9 μm) and control eyes (279.80±14.49 μm) at the base line and after 3mo follow-up. The mean CMT in CSCR was 317±141.86 μm, with a statistically significant positive correlation between SFCT and CMT. CONCLUSION: The increase in the choroidal thickness at different locations as well as hyper-dilated and hyper-permeable vessels known as “pachychoroid” seems to play an important role in a broad spectrum of diseases that includes central serous chorioretinopathy.     

使用OCT评估中心性浆液性脉络膜视网膜病变患者脉络膜厚度的变化

目的:使用光谱域光学相干断层成像(SD-OCT)技术研究中心性浆液性脉络膜视网膜病变(CSCR)3mo后脉络膜厚度的变化。方法:前瞻性研究。共纳入60眼,20眼(平均年龄:33.65±5.24岁)典型急性单侧中心性浆液性脉络膜视网膜病变以及对侧正常眼,20眼为健康对照组。进行荧光素血管造影和OCT检查。测量中心凹下脉络膜厚度(SFCT),黄斑中心凹视网膜厚度(CMT),到中央凹和视网膜下液1000μm处颞部和鼻部。结果:在三个不同的位置,三组间的SFCT差异有统计学意义。中心性浆液性脉络膜视网膜病变眼中心凹下脉络膜厚度(372.40±34.39μm)在基线和随访3mo后均显著大于对侧正常眼(302.10±8.9μm)和对照组眼(279.80±14.49μm)。CSCR眼平均CMT为317±141.86μm,并且SFCT与CMT呈显著正相关。结论:不同部位脉络膜厚度的增加,以及被称为“厚脉络膜”的过度扩张和高渗透血管,似乎在包括中心性浆液性脉络膜视网膜病变在内的广泛疾病中起着重要作用。     

Comparison of peripapillary and macular choroidal thickness and ganglion cell complex thickness in glaucomatous and healthy eyes

AIM: To assess choroidal thickness (CT) and its association with ganglion cell-inner plexiform layer thickness (GCIPLT) and retinal nerve fiber layer thickness (RNFLT) in open angle glaucoma (OAG) comparing with preperimetric glaucoma (PPG) and normal eyes. METHODS: Totally 55 eyes of OAG, 40 eyes of PPG, and 40 eyes of age-matched normal eyes were studied. Peripapillary CT (PCT), macular CT (MCT), RNFLT, and GCIPLT were evaluated. Relationship between the CT with RNFLT and GCIPLT were studied. The correlation between CT and confounding variables as gender, age, intraocular pressure, and visual field mean deviation were analyzed. RESULTS: Mean PCT were 113.6±39.1 μm in OAG, 116.3±42.7 μm in PPG, and 148.9±41.7 μm in normal eyes. PCT and MCT was thinner in OAG compared to healthy eyes. There was a significant correlation for PCT and mean RNFLT in 1, 2, 6, and 7 clock hours of OAG eyes. The difference in PCT remained after adjusting for axial length, age, and disc area (P=0.003). No significant correlation was shown between MCT and mean GCIPLT in all eyes. CONCLUSION: PCT is thinner in OAG and PPG compared with healthy eyes. The correlation of RNFLT and PCT found in OAG and PPG is not revealed in normal eyes.     

中心性浆液性脉络膜视网膜病变患者脉络膜毛细血管扩张和中心凹下脉络膜厚度关系的研究

目的 探讨中心性浆液性脉络膜视网膜病变患者脉络膜毛细血管扩张和黄斑中心凹下脉络膜厚度的关系.方法 选取2015年2月至2016年4月我院收治的中心性浆液性脉络膜视网膜病变患者84例(84眼),依据荧光素眼底血管造影检查结果分为3组:轻度组(注射后9 ～ 10 min渗漏)26例,中度组(注射后5～8 min渗漏)37例,重度组(注射后5 min内渗漏)21例,利用OCTA技术确定脉络膜毛细血管扩张程度,利用EDI-OCT测量3组患者以及脉络膜毛细血管不同扩张程度下患者的黄斑中心凹下脉络膜厚度,并进行相关性分析.结果 轻度、中度、重度患者的脉络膜毛细血管重度扩张比例依次升高(7.69％、13.52％、23.81％),黄斑中心凹下脉络膜厚度依次增加,差异具有统计学意义(P＜0.05).脉络膜毛细血管轻度、中度、重度扩张患者的黄斑中心凹下脉络膜厚度分别为(306.59±74.18)μm、(367.21±85.04) μm、(416.27±104.56) μm,差异具有统计学意义(P＜0.05).中心性浆液性脉络膜视网膜病变患者患侧脉络膜毛细血管扩张程度与黄斑中心凹下脉络膜厚度明显正相关(r =0.812,P=0.037).结论 随着病情的加重,中心性浆液性脉络膜视网膜病变患者脉络膜毛细血管扩张程度和黄斑中心凹下脉络膜厚度明显增加,且二者存在明显的正相关关系.     

Improved thickness measurement method for choroidal hyperpermeability in central serous chorioretinopathy

AIM: To evaluate the efficacy and safety of subthreshold micropulse yellow laser (SMYL) in the treatment of chronic central serous chorioretinopathy (CCSC). METHODS: The medical records of 58 eyes of 58 patients with CCSC were reviewed. A 577-nm SMYL system was used for the treatment. Fundus fluorescein angiography was used as the primary method of identifying CCSC, and resolution of subretinal fluid evaluated by optical coherence tomography (OCT) and fundus autofluorescence. Central macular thickness (CMT), central macular volume (CMV), total macular volume (TMV), subfoveal choroidal thickness (SFCT), subretinal fluid height (SRFH), and subfoveal fluid basement diameter values were measured by SD-OCT for all eyes. RESULTS: The mean age of the patients was 42.4±9.9 (range: 20-72)y. The mean follow-up was 11.4±8.5 (range: 6-37)mo. Median BCVA at at the final follow up after treatment was statistically significant from the baseline. Complete SRF resolution was 12.1% of the eyes in the 1st month, 67.2% of the eyes in the 3rd month and 67.2% of the eyes in the last follow up. The initial median CMT, CMV, TMV, and SFCT values before treatment was significantly higher than 3rd month visit values (P<0.001). In the multivariate analysis performed, age and disease duration were found to be a risk factor for persistent SRF (P=0.017, P=0.016, respectively). CONCLUSION: SMYL treatment provides a significant anatomical and functional improvement and is effective in eliminating SRF in eyes with CCSC.     

EDI-OCT对中心性浆液性脉络膜视网膜病变脉络膜厚度的研究

目的：：评价利用OCT加强深度扫描模式测量中心性浆液性脉络膜视网膜病变( central serous chorioretinopathy, CSC)脉络膜厚度的意义。方法：采用回顾性病例对照研究。纳入经临床确诊的CSC患者65例65眼和年龄、性别、屈光度相匹配的正常对照组50例50眼。使用光学相干断层扫描的加强深度扫描模式( coherence tomography with enhanced depth imaging, OCT-EDI)分别测量65例患者的患眼和对侧眼,以及50例50眼正常对照者的黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)。其中65例患者中有40例自愈,14例行光动力学( photodynamic therapy, PDT)治疗,11例行氩激光(laser photocoagulation,LP)治疗,分别测量3mo后的SFCT,与前次的比较进行统计学分析。结果：CSC患者65例的患眼和对侧眼,以及50例50眼正常对照组的SFCT测量结果分别为436.23±89.50,389.45±101.03,329.36±95.87μm。患眼和对侧眼SFCT分别与正常对照组比较,显著增加(P=0.008,P=0.013)。患眼的SFCT与对侧眼比较也有统计学差异( P=0.021)。 PDT治疗后SFCT显著性降低( P=0.032), LP治疗后和自愈者SFCT水平较前降低,但未显示出统计学差异( P=0.057 , 0.076)。结论：OCT-EDI是观察CSC脉络膜形态的有效方法,CSC患者SFCT较对侧眼和正常对照组明显增高。     

Choroidal vessel diameter in central serous chorioretinopathy

Purpose: To measure the hyporeflective lumen in the choroid of patients with central serous choroidopathy (CSC) and to compare the diameter with that of a control group. Methods: The prospective comparative observational clinical study included patients with unilateral CSC and a control group of normal subjects, matched in age, gender and refractive error with the study group. Subfoveal choroidal thickness (SFCT) and the largest diameter of choroidal hyporeflective lumen as surrogates for the choroidal vessels were measured by enhanced depth imaging optical coherence tomography (OCT). Results: The study group included 15 Chinese patients and the control group 15 control subjects. Mean SFCT was significantly (p = 0.04) larger in the affected eyes (455 ± 73 μm) than in the contralateral unaffected eyes (387 ± 94 μm), in which it was significantly (p = 0.005) larger than in the control group (289 ± 71 μm). In a parallel manner, the mean diameter of the largest hyporeflective lumen was larger, but not significantly larger (p = 0.18) in the affected eyes (305 ± 101 μm) than in the in the contralateral unaffected eyes (251 ± 98 μm), in which it was significantly (p = 0.001) larger than in the control group (140 ± 40 μm). Largest vessel diameter was significantly (p < 0.001; correlation coefficient: 0.73) correlated with the thickness of the total choroid. Conclusions: In patients with CSC, the affected eyes show larger hyporeflective lumen than the contralateral clinically unaffected eyes and significantly larger than normal control eyes. Assuming these hyporeflective lumens to be choroidal vessels, macular swelling in CSC is markedly associated with vascular engorgement. As also the clinically unaffected eyes showed macular choroidal significant swelling, CSC may have a systemic component with usually asymmetric ocular involvement.     

Efficacy of the subthreshold micropulse yellow wavelength laser photostimulation in the treatment of chronic central serous chorioretinopathy

AIM: To observe choroidal thickness changes in the choroidal hyperpermeability area (CHA) in patients with central serous chorioretinopathy (CSC) after photodynamic therapy (PDT) using indocyanine green angiography (ICGA) combined with optical coherence tomography (OCT). METHODS: This was a cohort study of 17 eyes (17 patients) with CSC. In all patients, the range of CHA was determined by ICGA. The patients were divided into two groups based on CHA covered the fovea (group) or not (group B). All patients received half-dose verteporfin PDT over CHA in ICGA. Choroidal thickness was measured by OCT before and 1 and 3mo after treatment. The choroidal thickness values of the fovea and CHAs were obtained for each measurement. Secondary outcomes were changes in the best-corrected visual acuity (BCVA) and amount of subretinal fluid (SRF). RESULTS: The differences in center choroidal thickness at baseline and at 1 and 3mo post-PDT were statistically significant in group A and all patients (both P<0.001). There was no significant difference in group B (P=0.059). The differences of thickness of CHA and BCVA at baseline and 1 and 3mo post-PDT were statistically significant in group A, group B, and all patients (P<0.001, P=0.005 or <0.001, and P<0.001, respectively). All patients showed complete SRF absorption at 3mo post-PDT. CONCLUSION: Center choroidal thickness does not accurately reflect changes in CHA of patients whose CHA does not covered the fovea center. Using CHA as the observation target can make up for this limitation, expand the scope of application, and reduce bias.     

中心性浆液性视网膜脉络膜病变的光学相干断层扫描图像改变

目的　研究中心性浆液性视网膜脉络膜病变 (CSC)的光学相干断层扫描 (OCT)图像的变化。方法　对 4 2例患者的 4 4眼进行OCT检查 ,对其进行动态观察和测量 ,分析其结果。结果　根据OCT图像 ,病变表现为视网膜神经上皮层脱离、神经上皮层和色素上皮层同时脱离、色素上皮脱离 3种不同形式。结论　OCT对CSC的诊断和判断治疗的预后有临床应用价值     

雷珠单抗治疗慢性中心性浆液性脉络膜视网膜病变合并CNV的疗效及其影响因素

目的:应用多模式影像观察玻璃体腔抗血管内皮生长因子(VEGF)注射在慢性中心性浆液性脉络膜视网膜病变(CCSC)合并脉络膜新生血管(CNV)的治疗效果,探讨评估其影响因素。方法:回顾性分析30例30眼确诊为CCSC合并CNV患者的资料。所有患者均行最佳矫正视力(BCVA)、频域相干光断层扫描(SD-OCT)的增强深度成像(EDI)模式,荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)及光学相干断层扫描血管成像(OCTA)血流扫描检查。对存在黄斑区视网膜下积液(SRF)以及CNV的患眼行玻璃体腔雷珠单抗(IVR)注射治疗,采取1+PRN方案,随访时间为注药治疗后1wk, 1mo,末次注药治疗后3mo。观察指标为最佳矫正视力(BCVA,LogMAR)、黄斑中心凹厚度(CMT)、黄斑中心凹下脉络膜厚度(SFCT)以及CNV血流面积。结果:所有患眼在基线、眼内注药治疗后1wk, 1mo,末次治疗后3mo时各时间点CMT有差异(F=62.06,P<0.01);治疗后各时间点CMT与治疗前比较均有差异(t=3.08、6.57、4.90,P=0.01、0.02、<0.01),其...     

Choroidal thickness in both eyes of patients with unilaterally active central serous chorioretinopathy

Objective

To assess the change in the choroidal thickness of the unaffected eyes in patients with unilateral central serous chorioretinopathy (CSC).

Methods

Thirty eyes with unilateral idiopathic CSC and 30 age-matched normal eyes were included in this study. Choroidal thickness was evaluated from images obtained by enhanced depth image optical coherence tomography. The choroidal thicknesses of the affected eyes, unaffected eyes, and normal eyes were analyzed. Choroidal vascular dilation and hyperpermeability on indocyanine green angiography (ICGA) were analyzed and correlated with the changes in choroidal thickness.

Results

The mean choroidal thicknesses of the affected eyes, unaffected fellow eyes, and normal individuals were 445.58±100.25, 378.35±117.44, and 266.80±55.45 μm, respectively. Compared with normal eyes, subfoveal choroidal thickness was increased significantly in the eyes with active CSC and in the unaffected fellow eyes (P<0.001 in both groups). The choroidal thickness was significantly greater in the eyes with active CSC than in the unaffected fellow eyes (P=0.003). ICGA revealed choroidal vascular hyperpermeability in 28 (93.3%) eyes with CSC and in 23 (73.3%) unaffected fellow eyes. Choroidal vascular dilation was detected in 21 (70.0%) eyes with CSC and in 18 (60.0%) unaffected fellow eyes.

Conclusion

Increased choroidal thickness in patients with unilateral CSC was noted not only in the affected eyes, but also in the unaffected fellow eyes. The results of this study suggest that CSC might be an essentially bilateral disorder.     

中心性浆液性脉络膜视网膜病变的光学相干断层照相

探讨光学相干断层照相这种新的影像方法在对中心性浆液性脉络膜视网膜病变检查中的应用价值。方法对６２例患者的６４只眼进行了ＯＣＴ检查,部分患者进行追踪观察,并对所得结果进行分析。结果根据ＯＣＴ图像可将病变分为４种不同的表现形式,并对其进行动态观察和精确测量。     

中心性浆液性脉络膜视网膜病变的光学相干断层成像分析

目的探讨中心性浆液性脉络膜视网膜病变(centralserouschorioretinopathy,CSC)光学相干断层成像(opticalcoherencetomography,OCT)的特征和临床应用.方法对临床诊断为急性期CSC患者(即出现主观症状4～8周之内)47例50只眼,经散瞳后进行OCT检查,并对病变图像进行分析和测量.结果急性期CSC患者OCT图像特征为累及黄斑中心凹的视网膜神经上皮层的拱形隆起与色素上皮层之间的浆液性弱反射暗区.病变范围618～6400μm,平均(3185.01±1495.21)μm;高度59～790μm,平均(262.28±175.20)μm.经统计学处理,表明CSC神经上皮层脱离范围、高度均与视力相关(P＜0.05).结论OCT是一种新型非侵入性的客观定量检查技术.通过OCT对所有急性期CSC眼表现的浆液性视网膜脱离病变的定量分析,表明它对CSC的诊断、鉴别诊断、定量测量和病情监测等方面具有重要的临床应用价值.     

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。     

慢性中心性浆液性脉络膜视网膜病变与息肉样脉络膜血管病变多模式影像学特征的比较

目的比较慢性中心性浆液性脉络膜视网膜病变(chronic central serous chorioretinopathy,CCSC)与息肉样脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)的多模式影像学差异。方法回顾性分析CCSC组11例11眼患者及PCV组21例21眼患者的临床资料。所有患者均行最佳矫正视力、黄斑中心凹下脉络膜厚度测量及荧光素眼底血管造影、吲哚菁绿血管造影、光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)和频域光学相干断层扫描多模式影像学检查,并对检查结果进行统计学分析。结果 CCSC组患者最佳矫正视力为0.33±0.11,显著高于PCV组(0.21±0.13),差异有统计学意义(P<0.05)。CCSC组患者黄斑中心凹下脉络膜厚度为(368.20±51.65)μm,PCV组为(342.28±37.18)μm,两组相比差异无统计学意义(P>0.05)。荧光素眼底血管造影检查结果显示,CCSC组和PCV组均为斑点状高荧光表现,CCSC组患眼可伴...     

Photodynamic therapy for chronic central serous chorioretinopathy

Purpose: This study aimed to evaluate the efficacy of photodynamic therapy (PDT) in treating chronic central serous chorioretinopathy (CSC). Methods: We describe a non‐randomized, multicentre, interventional case series. A total of 82 eyes of 72 patients with chronic CSC were treated by conventional PDT. LogMAR best corrected visual acuity (BCVA) (ETDRS charts) and central foveal thickness (CFT) measured by optical coherence tomography before and after PDT, number of PDT treatments and complications were used as outcome indicators. Results: Mean follow‐up was 12 ± 10 months and mean age was 46 ± 10 years. Mean logMAR BCVA changed from 0.53 (standard deviation [SD] 0.43) before PDT to 0.38 (SD 0.41) at 3 months and 0.48 (SD 0.50) at 6 months (p < 0.0001 and p = 0.007, respectively, Student’s t‐test for paired data). Mean BCVA at the end of follow‐up was 0.37 (SD 0.45; p < 0.0001 from baseline). Macular detachment was resolved and subretinal fluid (SRF) disappeared in all cases. Central foveal thickness decreased from 325 μm (SD 95), to 229 μm (SD 70) at 1 month after PDT, 206 μm (SD 68) at 3 months, and 202 μm (SD 76) at 6 months (all p < 0.0001, Student’s t‐test for paired data). No cases developed severe visual loss or complications derived from PDT. Reactive retinal pigment epithelium hypertrophy appeared in nine cases after PDT. Conclusions: Photodynamic therapy with verteporfin may be useful in chronic CSC for improving BCVA and reducing SRF and CFT. Randomized studies with longer follow‐up are needed to assess the real role of this treatment in chronic CSC.     

577nm微脉冲激光治疗慢性中心性浆液性脉络膜视网膜病变

目的：探讨577nm阈值下微脉冲激光(SML)治疗慢性中心性浆液性脉络膜视网膜病变(CSC)的有效性及安全性。

方法：采用前瞻性单臂病例研究,对慢性CSC患者24例32眼行577nm SML治疗。治疗后共计随访6mo,每月行最佳矫正视力(BCVA,LogMAR)及光学相干断层扫描(OCT)检查。于治疗后1、3、6mo行眼底荧光血管造影(FFA)。

结果：基线期,32眼的BCVA为0.46±0.34,中心视网膜厚度(CRT)为259.15±57.54μm。SML治疗后1mo,21眼(66%)已无视网膜下液,11眼(34%)的视网膜下液仍存在,BCVA为0.43±0.27,CRT为232.13±42.58μm,CRT较基线期显著降低(P<0.05)。SML治疗后3mo,5眼(16%)仍有视网膜下液,存在视网膜色素上皮(RPE)荧光素渗漏; 患眼BCVA为0.39±0.26,CRT为231.26±49.25μm,CRT较基线期仍显著降低(P<0.05)。对FFA显示RPE仍有荧光素渗漏的5眼再次行SML。治疗后6mo,仅见3眼(9%)的视网膜下液仍存在; 患眼BCVA为0.19±0.47,CRT为217.25±35.54μm,BCVA及CRT均较基线期有显著改善(P<0.05)。

结论：SML对于慢性CSC的治疗有效且安全,有望成为慢性CSC的治疗选择。     

中心性浆液性脉络膜视网膜病变的光学相干断层扫描

目的:观察中心性浆液性脉络膜视网膜病变(central serouschorioretinopathy,CSC)患者发病期与恢复期光学相干断层扫描(opticalcoherencetomography,OCT)的形态学特征,并探讨其与视力改变之间的关系。方法:临床诊断为单眼首次发病的CSC患者34例,发病期与恢复期分别行OCT检查,观察其形态学特征,对病变图像进行测量和分析。比较其形态学改变与视力预后之间的关系。结果:发病期CSC患者OCT表现为累及黄斑中心凹的视网膜神经上皮层的脱离、水肿。恢复期OCT表现为神经上皮层下液体完全吸收,部分患者黄斑区可观察到外界膜及内外节连接,部分患者黄斑中心凹厚度变薄,外界膜及内外节连接消失。CSC患者预后视力与发病期神经上皮层脱离范围、黄斑中心凹厚度呈负相关(r=-0.402、-0.485、-0.360,P<0.05)。恢复期CSC患者双眼的黄斑中心凹厚度与视力均有明显差异(P<0.05);患眼的预后视力与黄斑中心凹的厚度存在明显的正相关(Spearmanr=0.48,P<0.05)。外界膜及内外节连接存在的患眼视力好于内外节连接消失的患眼视力(P<0.05)。结论:CSC患者神经上皮层脱离范围、黄斑中心凹厚度、外界膜及内外节连接均可能影响视力的预后;高分辨率的OCT能在CSC患眼上获得类似于眼组织病理学改变的影像。