视网膜血管瘤性的增生 光学相干断层检查证实的一个视网膜内病灶

视网膜血骨瘤增生逐渐被认识到是年龄相关性黄斑变性中新生血管的一种变异。视网膜血管瘤性增生被认为是视网膜内新生血管芽。这些血管芽长入视网膜下腔导致浆液性视网膜色素上皮脱离并且可以与脉络膜新生血管吻合。我们报道1例视网膜视网膜血管瘤性的增生合并浆液性视网膜色素上皮脱离．通过光学相干断层扫描（OCT）证实有视网膜内新生血管。     

重视中心性浆液性脉络膜视网膜病变的鉴别诊断

中心性浆液性脉络膜视网膜病变（CSC）是眼科常见病,以黄斑区浆液性视网膜脱离为典型特征,但部分患者可存在弥漫性视网膜色素上皮病变、脉络膜新生血管形成、大泡性视网膜脱离、纤维素性渗出等不典型表现.由于不典型CSC的表现和症状与息肉状脉络膜血管病变（PCV）、可累及后极的炎症类疾病（如Vogt-小柳-原田综合征）等类似,一些其他全身及眼部疾病也可引起浆液性视网膜脱离及不典型CSC表现,临床上常造成误诊或漏诊,而上述不同疾病的治疗方法存在很大差别,因此,眼科医师应该充分了解CSC的表现特征,尤其是不典型表现,注意患者全身情况,包括糖皮质激素的使用,做到准确诊断,合适治疗.     

应用荧光素吲哚青绿同步眼底造影对中心性浆液性视网膜病变眼底微循改变的观察

目的 通过分析中心性浆液性视网膜病变(central serous chorioretinopathy,CSC)患者的视网膜-脉络膜同步造影特点.探究其发病机理.方法 应用海德堡造影系统HRA2对26例(28眼)患者进行视网膜.脉络膜同步造影,并对结果进行分析.结果 眼底照相:黄斑区神经上皮浆液性脱离,2眼伴色素上皮脱离.荧光素眼底血管造影(fundus fluoreseein angiography,FFA)检查显示:28眼均有视网膜色素上皮(retinal pigment epithelium,RPE)渗漏,2眼伴色素上皮脱离.吲哚青绿血管造影(indocyanine green angiography,ICGA)检查显示:早期28眼均有区域性脉络膜血管扩张充血、脉络膜高通透性,24眼区域性脉络膜血管充盈迟缓,其余4眼脉络膜充盈大致正常;中、晚期23眼RPE渗漏处有脉络膜血管的高荧光扩散,5眼表现为高荧光点:18眼ICGA揭示的病灶要比FFA多.10眼可见RPE色素脱失.1例女性CSC患者激光光凝FFA渗漏点后1个月,FFA见黄斑下液体吸收、RPE渗漏点封闭,而ICGA仍见脉络膜活动性渗漏点.结论 CSC的发生可能是由于脉络膜循环紊乱及脉络膜血管通透性增高导致RPE损害引起.激光能改善RPE渗漏,但对脉络膜病变本身没有作用.     

大泡状视网膜脱离

1973年Gass研究特发性中心性浆液性脉络膜视网膜病变(以下简称中浆)时,曾报道5例中浆并发非裂孔性视网膜脱离,命名为大泡状视网膜脱离。引起眼科医生的注意。陆续有类似的病例发表。至今收集到37例。日本称之为泡状视网膜脱离。1977年宇山等将此病命名为多发性后极部视网膜色素上皮病(MPPE)。但易与另外一种视网膜色素上皮病即急性后极部多发性鳞状视     

视网膜脱离复位后视网膜及视力改变

本文从中心性浆液性视网膜脉络膜病变（中浆病）、孔源性视网膜脱离（孔源性网脱）、泡状视网膜脱离（泡状网脱）三组病例视网膜复位后荧光血管造影所见来探讨视网膜色素上皮改变。根据临床表现来探讨网脱的部位、程度、时间和视网膜复位后的视力关系。     

中心性浆液性视网膜脉络膜病变血液流变学

中心性浆液性视网膜脉络膜病变血液流变学徐州市中医院眼科杨海燕中心性浆液性视网膜脉络膜病变（下你中浆）的病因及发病机理，众说纷坛。有学者认为本病与眼内眶内血管广泛地发生血液动力学的异常改变相关，或是因神经化学物质对血液动力学发生作用而引起发病，为了对中...     

五苓散治疗中浆疗效观察

五苓散治疗中浆疗效观察福建省武平县医院（３６４３００）邬凤岩王芬琴中心性浆液性脉络膜视网膜病变（中浆）是眼科常见的眼底疾病。近年来眼底血管荧光检查技术的广泛应用，了解到视网膜色素上皮和脉络膜Ｂｒｕｃｈ氏膜复合性损伤导致相应位置视网膜外屏障功能破坏，以...     

实验性视网膜下出血

老年性黄斑变性,近视,眼底血管样条纹,眼球钝挫伤,各种脉络膜视网膜病变如眼部拟组织胞浆菌病综合征,弓形体病,弓蛔虫病和结节病等均可导致黄斑部盘状变性。来源于脉络膜循环的新生血管,穿过Bruch膜在视网膜色素上皮下侵入视网膜下间隙。这些新生血管管壁菲薄,常引起视网膜色素上皮和视网膜发生浆液或出血性脱离,最后形成纤维瘢痕,相应的视网膜受到破坏。作者为模拟黄斑盘状变性的出血性视     

实验性猴眼脉络膜新生血管的形态

老年人眼底的脉络膜常有新生血管发生,这种新生血管穿过有病变的玻璃膜侵入视网膜,在色素上皮下蔓延。当色素上皮发生病变时,又可侵及视网膜下间隙,形成很薄的一层血管膜。大多数的新生血管膜很少引起患者的主觉症状。少数浸润性的新生血管膜有渗漏。渗漏出的浆液和血液常聚积在组织间隙中,引起视网膜水肿和色素上皮脱离,或知觉上皮脱离,并有纤维组织增生。病变的形态多呈盘状,因此人们称之为盘状反应(disciform response)。病变发生在黄斑部,中心视力受到严重损害,是目前较发达国家老年人致盲的主要原因。脉络膜新生血管膜也见于高度近视眼、视网膜血管样条纹、多灶性内层(似组织胞浆菌病)脉络膜炎、以及长期视网膜色素     

复杂性中心性浆液性脉络膜视网膜病变

通过２０４例（２３６眼）中心性浆液性脉络膜视网膜病变（中浆）荧光造影分析，重点报告４例复杂中浆，其主要临床特点：双侧性和复发性，荧光造影显示广泛的视网膜色素上皮（ＲＰＥ）失代偿和／或ＲＰＥ萎缩带，有些还伴发下方周边部泡状视网膜脱离和／或ＲＰＥ撕裂口形成和／或三角综合征样脉络膜视网膜病变等。讨论了中浆发病机制和复发基础，指出认识复杂中浆对避免误诊和不正确治疗的重要性。     

Role of psychological stress and the hypothalamicpituitary -adrenal axis in the pathophysiology of central serous chorioretinopathy

Central serous chorioretinopathy (CSC) is characterized by serous detachment of the sensory retina as a consequence of the focal leakage of fluid from the choriocapillaries to subretinal space through a defect of the retinal pigment epithelium (RPE). The exact cause of CSC has not well unknown. Psychological stress is thought to contribute to CSC, but the physiologic mechanisms are unclear. It is hypothesized that psychological stress can induce CSC through the mechanism of the hypothalamic-pituitary-adrenal (HPA) system. Psychological stress can adversely affect HPA axis and causes glucocorticoid levels to elevate. Increased glucocorticoids constrict choroid vessels, which leads to ischemia of choroids and damage vascular endothelial cells, thus causing vasopermeability to increase. RPE dysfunction will occur as a result of abnormalities in the choroidal circulation. The large molecules including protein may enter the subretinal space through the damaged vessels and RPE.     

中心性浆液性脉络膜视网膜病变的光学相干断层扫描与视力的相关性研究

目的探讨中心性浆液性脉络膜视网膜病变浆液性脱离区的光学相干断层扫描与视力的关系。方法对48例(50只眼)经FFA诊断为中心性浆液性脉络膜视网膜病变的患者行OCT检查,对浆液性脱离区进行测量并与视力进行相关分析。结果光学相干断层扫描图像可以清晰显示浆液性脱离性质、部位、高度、宽度。48 例(50只眼)结果分析显示:患者视力与浆液性脱离区的高度、范围、中心凹6．0mm容积有关,与中心凹的厚度无关。结论 OCT能显示中心性浆液性脉络膜视网膜病变患者的病变直观图像并能观察病情程度。对随访病情变化有指导意义。     

中心性浆液性脉络膜视网膜病变危险因素研究进展

中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)是一种脉络膜视网膜疾病,可引起特发性的视网膜浆液性脱离,与视网膜外屏障(血-视网膜屏障)的缺损有关。CSC主要好发于男性,表现为视力下降和(或)视物变形、对比敏感度下降。其发病原因多种多样,本文就CSC危险因素进行综述。     

中心性浆液性脉络膜视网膜病变治疗方法的研究进展

中心性浆液性脉络膜视网膜病变( central serous chorioretinopathy,CSC)是中心视力损失的一项重要原因,它主要好发于中青年男性,以后极部浆液性神经上皮层脱离伴有视网膜色素上皮( retinal pigment epithelium,RPE)水平的渗漏为特征。大多数急性CSC患者会自发吸收,但是对于持续性神经上皮层脱离的慢性CSC患者可能会发展为进展性的视力下降。本文对近年来关于CSC治疗方法的研究进展作简要综述,主要从激光光凝、光动力学疗法( PDT)、玻璃体内抗血管内皮生长因子治疗、醛固酮受体拮抗剂四方面进行阐述。     

Central serous chorioretinopathy

Central serous chorioretinopathy (CSC) is a disease of the retina characterized by serous detachment of the neurosensory retina secondary to one or more focal lesions of the retinal pigment epithelium (RPE). CSC occurs most frequently in mid‐life and more often in men than in women. Major symptoms are blurred vision, usually in one eye only and perceived typically by the patient as a dark spot in the centre of the visual field with associated micropsia and metamorphopsia. Normal vision often recurs spontaneously within a few months. The condition can be precipitated by psychosocial stress and hypercortisolism. Ophthalmoscopic signs of CSC range from mono‐ or paucifocal RPE lesions with prominent elevation of the neurosensory retina by clear fluid – typical of cases of recent onset – to shallow detachments overlying large patches of irregularly depigmented RPE. The spectrum of lesions includes RPE detachments. Granular or fibrinous material may accumulate in the subretinal cavity. Serous detachment often resolves spontaneously. From first contact, counselling about the potential relation to stress and glucocorticoid medication is warranted. After 3 months without resolution of acute CSC or in chronic CSC, treatment should be considered. Resolution of detachment can usually be achieved in acute CSC by focal photocoagulation of leaking RPE lesions or, in chronic CSC, by photodynamic therapy. The effect of therapy on long‐term visual outcome is insufficiently documented. Reattachment within 4 months of onset is considered a relevant therapeutic target because prolonged detachment is associated with photoreceptor atrophy. This suggests that the value of treatment depends upon proper selection of cases that will not resolve without therapy. Chronic CSC may be difficult to differentiate from occult choroidal neovascularization secondary to CSC. Patients with chronic CSC who receive glucocorticoid treatment for systemic disease can often be managed without having to discontinue this medication.     

Longitudinal analysis of central serous chorioretinopathy and sex

BACKGROUND: Stress has been proposed as one of the contributing factors of central serous chorioretinopathy (CSC). Because the number of women in the workforce has increased dramatically in past decades, their presumed additional stress may increase their risk for CSC. We performed a study to determine whether the ratio of men to women in whom CSC was diagnosed remained constant between 1970 and 2000 in our patient population. METHODS: We reviewed the medical records of 88 patients (69 males and 19 females) in whom CSC was diagnosed between 1970 and 2000. Only patients who were noted to have subretinal fluid on stereoscopic colour fundus photographs and focal retinal pigment epithelial hyperfluorescence on fluorescein angiography were included. Logistic regression analysis was performed to determine the probability of a patient's being male over the study period. RESULTS: No significant change was found in the proportion of male patients in whom CSC was diagnosed over the study period (p = 0.69). INTERPRETATION: The ratio of males to females with a diagnosis of CSC did not change significantly over 30 years in our study population. If stress is a contributing factor of CSC and if women are experiencing increased stress from changing societal roles, women may have different adaptations to stress than men, or other mechanisms of CSC formation may be present.     

努力探索发病机制,进一步提升治疗水平:中心性浆液性脉络膜视网膜病变研究的现实与挑战

中心性浆液性脉络膜视网膜病变(中浆)的治疗理念随着对中浆认识的逐步深入而演变.最初临床研究发现,中浆属自限性疾病,所以,主张观察或保守治疗通过荧光素眼底血管造影的进一步研究发现,中浆是视网膜色素上皮(RPE)屏障功能受损导致的浆液性RPE和(或)神经视网膜脱离,激光光凝治疗可以通过激光的热效应凝固RPE渗漏点从而达到治疗目的;吲哚青绿血管造影用于中浆的临床研究后新近发现,中浆病灶对应处脉络膜血管通透性增加,导致脉络膜组织内静水压过高引发局部RPE脱离,进而机械性破坏RPE屏障才是其病理基础的主要原因.光动力疗法可以栓塞脉络膜毛细血管网,从而阻止脉络膜毛细血管通透性增加导致的渗漏,可以取得其治疗成功.然而,关于中浆发病机制和治疗的探索远未结束.进一步探讨其发病机制,提高临床诊断治疗水平,既是临床工作的迫切需要,也是挑战眼科医生智慧的重大问题.促进更多更好的中浆临床和基础研究成果早El问世需要我们共同努力.

Abstract：

The concept of treatment of central serous chorioretinopathy (CSC) has evolved dramatically with the understanding of its pathogenesis recently. Initial clinical studies found that CSC is a self-limiting disease, therefore advocated observation or conservative treatment was recommended. Further study by fundus fluorescein angiography indicated that CSC results from barrier dysfunction of retinal pigment epithelium (RPE), which leads to serous RPE and (or) neural retinal detachment; so laser photocoagulation to close RPE leakage points by its thermal effects became a strategy to treat CSC. Recent study by indocyanine green angiography revealed that increased choroidal vascular permeability can induce high hydrostatic pressure and focal RPE detachment, resulting in mechanical breakage of RPE barrier. This is likely the major pathological basis of CSC now. Photodynamic therapy (PDT) can embolize of choroidal capillary network, thereby preventing choroidal leakage caused by increased capillary permeability, and thus cure the CSC. However the search for the pathogenesis and better treatment of CSC is far from over.Further investigation about pathogenesis and improvement of diagnosis and treatment is an urgent need for clinic work, but also major issues challenging the wisdom of an ophthalmologist. We need to work together to promote more and better clinical and basic research of CSC.     

相干光断层扫描动态分析中心性浆液性脉络膜视网膜病变激光治疗后恢复情况

目的 应用相干光断层扫描(OCT)动态观察氩激光治疗中心性浆液性脉络膜视网膜病变(CSC)后黄斑水肿吸收情况,探索其在CSC患者预后追踪中的优势.方法 对经荧光素眼底血管造影(FFA)确诊的42例(42只眼)CSC患者进行氩激光光凝治疗,分别于治疗前、治疗后3 d,1、2、4、6周行OCT及FFA检查.结果 OCT适用面广,可清楚的发现神经上皮及色素上皮脱离情况,OCT动态随访观察显示激光光凝治疗3 d时黄斑水肿无明显吸收,1周后,黄斑水肿开始明显吸收,2例患者(4.76%)水肿完全吸收;2周后5例患者(11.90%)水肿完全吸收;4周后17例患者(40.48%)水肿完全吸收;6周后34例(81.95%)水肿完全吸收.结论 激光光凝治疗能缩短CSC病程,OCT为非侵入性,观察效果好,能定量分析黄斑水肿程度,比FFA更加直观、准确.更重要的是,OCT能对预后过程进行动态、精确、灵敏的追踪.     

中心性浆液性脉络膜视网膜病变的治疗进展

中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)是一种与多种因素有关的疾病,其具体发病机制尚未明确。除了阈下微脉冲激光治疗、低剂量光动力疗法(photodynamic therapy,PDT)等治疗方法外,基于病因学治疗的药物如血管内皮生长因子(vascular endothelial growth factor,VEGF)拮抗剂、甲氨蝶呤、依普利酮(eplerenon)、幽门螺杆菌治疗药物等已经被用于CSC的实验性治疗。本文旨在回顾有关CSC治疗方面的文献,以期为CSC的临床治疗提供参考。     

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 评价光学相干断层成像术(optical coherence tomography,OCT)对中心性浆液性脉络膜视网膜病变的诊断及追踪观察的临床使用价值。 方法 对30例(32只眼)中心性浆液性脉络膜视网膜病变患者分别进行检眼镜、荧光素眼底血管造影、OCT检查。部分病例进行定期的光学相干断层成像术复查。 结果 32只眼中心性浆液性脉络膜视网膜病变的OCT图像中,27只眼表现为单纯神经上皮层脱离,2只眼为单纯色素上皮层脱离,3只眼同时存在神经上皮层脱离和色素上皮层脱离。11只眼定期追踪观察的OCT均可动态地观察到液体的吸收和测量到神经上皮层脱离高度的减少。 结论 OCT是一种新的、无损伤性的、非接触性和定量的检查方法。能鉴别中心性浆液性脉络膜视网膜病变的神经上皮层脱离和色素上皮层脱离,并能进行定量的追踪观察。 (中华眼底病杂志, 1999, 15:131-134)