联合频域 OCT中B和C扫描对中心性浆液性脉络膜视网膜病变的观察

联合频域相干光断层扫描（ CirrusTM HD-OCT）中B和C扫描来观察中心性浆液性脉络膜视网膜病变（CSC）患者的视网膜色素上皮层（RPE）形态的改变。方法31例（34只眼）患者进行OCT 扫描,联合断层成像图和冠状面成像图RPE形态改变,冠状面成像图与荧光素眼底血管造影（ FFA）图像比较定位渗漏点。结果在断层成像图上（B扫描）可发现：RPE圆弧样脱离9只眼（26．47％）,RPE突起样8只眼（23．52％）,波浪纹样改变4只眼（11．76％）,圆弧＋突起样改变13只眼（38．23％）。在冠状面成像图（C扫描）中,均能与B扫描图对应,同时能精确定位眼底图,与FFA图像相对应。结论在CirrusTM HD-OCT多种扫描模式下能容易观察到CSC患者的RPE出现特征性的改变。     

激光联合药物治疗中心性浆液性脉络膜视网膜病变

目的评价激光联合药物治疗中心性浆液性脉络膜视网膜病变（CSC）的疗效。方法cSC52例（52只眼）分成2组,Ⅰ组激光封闭渗漏点并覆盖渗漏点周围约1／3PD范围,不用任何药物;Ⅱ组激光封闭渗漏点并覆盖渗漏点周围约1／3 PD范围,术后加用复方血栓通胶囊1．5g口服,3次／d,连用1周,对两组疗效进行观察比较。结果Ⅰ、Ⅱ组中心视力恢复到1．0的时间分别为（21．36±7．48）d、（11．23±5．37）d,经检验t=5．62,P〈0．001,两组间差异有统计学意义。结论激光联合药物治疗CSC,加快了机体对渗出液的吸收,视功能恢复快,病程比单纯激光治疗明显缩短,可提高对CSC的疗效。     

Traumatic central serous chorioretinopathy

Central serous chorioretinopathy (CSR) is well described in the literature, with recognized associations such as systemic steroid therapy and stress; the association of blunt trauma with CSR is highly unusual. A 44-year-old male developed CSR rapidly after blunt trauma to his left eye with a significant reduction in visual acuity to hand movements. Serial optical coherence tomography and fundus fluorescein angiography images are presented. The patient was managed conservatively and spontaneous resolution occurred by 2 months with an excellent visual outcome. There was no evidence of an alternative underlying pathology for the presentation and particularly no signs of posterior uveitis. Investigations for an underlying vascular, inflammatory or infectious cause were all negative. The patient had previously had CSR in his other eye, and this may indicate a potential predisposition to developing the condition, triggered by blunt trauma.     

A pilot study of intravitreal bevacizumab for the treatment of central serous chorioretinopathy (Case reports)

BACKGROUND: We report the use of intravitreal bevacizumab as a new option in the treatment of central serous chorioretinopathy (CSC). METHODS: Five eyes with retinal pigment epithelium (RPE) leaks secondary to CSC received intravitreal bevacizumab (2.5 mg/0.1 cc), and underwent best corrected visual acuity, fluorescein angiography and optical coherent tomography before, 1, 3 and 6 months after treatment. RESULTS: All patients showed improvement in visual acuity, fluorescein angiographic leakage, and reduced or resolved neurosensory detachment following treatment. CONCLUSIONS: Intravitreal injection of bevacizumab was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with CSC. Although these results are promising, further investigations would be helpful to understand this therapy for patients with CSC.     

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.     

经瞳孔温热疗法治疗中心性浆液性脉络膜视网膜病变

目的 观察经瞳孔温热疗法（transpupillary thermal therapy，TTT）治疗中心性浆液性脉络膜视网膜病变（centralserous chorioretinclmthy）（简称“中浆”）的疗效。方法 治疗组采用半导体810nm红外激光对25例“中浆”患者的25只眼进行治疗。根据病灶大小选择光斑和能量。治疗后随访，如复发则进行重复治疗。对照组以荧光素钠试敏阳性者作为对照组，12例12眼，口服吸收剂、芦丁，维生素C。随访时间和检查项目同治疗组。结果 以患者自诉Amsler表中心暗点及变形情况，最佳矫正视力，OCT测黄斑中心凹厚度，平均光敏感度，以及FTA示渗漏点渗漏情况为观察指标。结果治疗前两组各指标差异无显著性意义（P＞0．05），治疗后1m治疗组各项指标均比对照组显著好转（P＜0．05），治疗后6m两组视力提高和Amsler表暗点及变形情况差异无显著性意义（P＞0．05），治疗组平均光敏感度高于对照组（P＜0．05），黄斑中心凹厚度小于对照组（P＜0．05）。随访过程中未发现有严重并发症者。结论 TTT治疗“中浆”安全有效，能缩短病程，且能保护黄斑的视功能。     

Electrophysiology of the retinal pigment epithelium in central serous chorioretinopathy

The pathophysiology of central serous chorioretinopathy is incompletely understood but appears to involve the retinal pigment epithelium. We recorded consecutively the fast oscillation, hyperosmolarity response, acetazolamide response, and light peak from four patients with active central serous chorioretinopathy and three normal subjects to determine whether the affected eyes showed any electrophysical abnormalities. We found essentially no differences in any of the four responses between the active and the inactive eyes of the patients or between patients and normal subjects. Whatever retinal pigment epithelial dysfunction exists in central serous chorioretinopathy is unassociated with clinically evident changes in these retinal pigment epithelial electrophysiologic responses.Abbreviations CSC central serous chorioretinopathy     

中心性浆液性脉络膜视网膜病变的激光和非激光治疗

目的 通过对比研究,评价氪黄激光治疗中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的治疗和预防复发的效果.方法 回顾性分析经眼底荧光血管造影(fundus fluo-rescein angiography,FFA)确诊为CSC的患者67例(68只眼)的临床治疗效果,比较单纯药物治疗与氪黄激光(波长568nm,光斑直径100μm,曝光时间0.1s,功率60～120mw)联合口服药治疗,在治愈率、治愈时间和复发率等方面的差异.随访时间为治疗后1个月、3个月、半年、1年、2年和3年.结果 激光组(39例39只眼)的治愈率为92.3%(36/39),平均治愈时间(32.8±8.9)d,复发3例(3只眼),占7.7%;单纯药物组(28例29只眼)的治愈率为86.2%(25/29),平均治愈时间(69.4±17.2)d,复发8例(8只眼),占27.6%.两组比较,治愈率无明显差异(x2=0.670,P>0.05),平均治愈时间天数有明显差异(t=2.667,P<0.01),复发率有明显差异(x2=4.854,P<0.05).结论 氪黄激光治疗CSC安全、有效,对缩短病程和降低复发率效果明显.     

Bilateral central serous chorioretinopathy with retinal pigment epithelium tears following epidural steroid injection

The cause of central serous chorioretinopathy (CSC) is mostly idiopathic. Other cause such as stressful event or use of corticosteroid has been associated with severe form of CSC. Atypical presentation of CSC has widespread degeneration of retinal pigment epithelium (RPE) or bullous retinal detachment. In this report, we describe a case of bilateral CSC with RPE tear after epidural steroid injection.     

半量光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变的疗效分析

目的 探讨半剂量维替泊芬光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变的安全性和疗效.方法 结合患者病史和眼底检查、眼底荧光血管造影(FFA)及吲哚菁绿造影(ICGA)检查,诊断为慢性CSC的连续病例24例25只眼,以ICG为指导确定光斑大小和位置,采用1/2剂量维替泊芬PDT治疗.术后随访6～12个月.术前后进行最佳矫正视力(ETDRS视力表)、FFA、ICGA和OCT检查.结果 术后6个月时,最佳矫正视力平均提高(20.6±8.7)个字母(0～32个字母).视力稳定者(0～4个字母)2只眼,占8％;视力提高5～9个字母1只眼,占4％,视力提高10～19个字母8只眼,占32％,视力提高20个字母以上14只眼,占56％,无一只眼视力下降.所有患者诉眼前暗影减轻,视物变形改善.荧光血管造影显示,荧光素渗漏消失22只眼,占88％;渗漏减轻3只眼,占12％;无渗漏加重者.ICG示脉络膜血管通透性下降.OCT显示中央视网膜厚度由术前的(323.55±50.55)μm下降至(168.37±25.35) μm.术后未发现与PDT相关的并发症.结论 1/2剂量维替泊芬联合PDT治疗慢性CSC安全,具有良好疗效,但其长期安全性和有效性还有待于进一步对照研究来证实.     

中心性浆液性脉络膜视网膜病变的不同治疗疗效观察

目的 比较中心性浆液性脉络膜视网膜病变(中浆)的激光治疗与药物治疗的疗效.方法 选择门诊FFA造影确诊为中浆的64例69只眼,随机分为三组:激光治疗组21只眼,活血化瘀组23只眼,支持疗法组23只眼.激光治疗采用Omni多波长氪激光,活血化瘀采用复方血栓通胶囊,支持疗法采用复合VitB、肌苷、ATP.比较分析其随访3周、6周治疗效果以及平均治愈时间、最终随访视力,x2及t检验分析其统计学意义.结果 (1)激光治疗组随访3周与6周治愈率为66.7%和100%,平均治愈时间(±s)(2.81±0.65)w,最终随访视力1.08±0.11.(2)活血化瘀组随访3周与6周治愈率为26.0%和47.8%,平均治愈时间(7.23±4.51)w,最终随访视力0.98±0.15.(3)支持疗法组随访3周与6周治愈率为16.0%和32.0%,平均治愈时间(9.78±6.86)w,最终随访视力1.05±0.23.(4)激光治疗组与药物治疗组比较,3周与6周治愈率为P＜0.01,平均治愈时间P＜0.01,最终随访视力P＞0.05.(5)治愈后复发率,激光组4.4%,活血化瘀组17.3%,支持疗法组20%.结论 比较药物治疗,激光治疗中浆可提高治愈率,缩短治愈时间,降低复发率,但对最终视力恢复没有影响.

Abstract：

Objective To compare the efficacy of central serous chorioretinopathy by laser treatment and drug therapy. Methods Selected 69 outpatient with central serous chorioretinopathy (CSC) confirmed by imaging FFA were randomly divided into three groups: laser treatment group, 21 eyes, promoting blood circulation treatment group 23, and support therapy group 23. Omni multi-wavelength laser with krypton laser, promoting blood circulation by Fufang XueShuanTong capsule, supportive therapy with co-VitB, inosine, ATP.Comparative analysis of the follow-up 3 weeks, 6 weeks of treatment effect and the average healing time, the final follow-up vision, x2 and t test to analyze statistical significance. Results (1) laser treatment group was followed up for 3 weeks and 6 weeks the cure rate was 66.7% and 100%, the average healing time (x± s) 2.81± 0.65w, the final follow-up visual acuity 1.08 ± 0.11. (2) follow-up promoting blood circulation group 3weeks and 6 weeks the cure rate was 26.0% and 47.8%, the average healing time was 7.23 ± 4.51w, the final follow-up visual acuity 0.98 ± 0.15. (3) supportive care group were followed up for 3 weeks and 6 weeks the cure rate was 16.0% and 34.8%, The average healing time 9.78 ± 6.86 w, the final follow-up visual acuity 1.05± 0.23. (4) Laser treatment group compared with the drugs treatment group, 3 weeks and 6 weeks the cure rate was P ＜0.01, the average healing time was P ＜0.01, the final follow-up visual acuity P＞ 0.05. (5) the recurrence rate after cure, the laser group 4.4%, 17.3% blood circulation group to support the therapy group 20%. Conclusions Comparison of drug therapy, laser therapy can increase cure rate of central serous chorioretinupathy,shorten healing time, reduce the relapse rate, but do not affect the final visual acuity.     

半量维替泊芬光动力疗法治疗黄斑区中心性浆液性脉络膜视网膜病变的观察

目的 观察半量维替泊芬光动力疗法(PDT)治疗黄斑区中心性浆液性脉络膜视网膜病变(中浆)的疗效.方法 经临床眼底镜检查、眼底荧光血管造影(FFA)及光学相干断层成像(OCT)检查确诊为黄斑区的中浆患者15例15只眼,采用半量PDT进行治疗,维替泊芬注射15 min后689 nm激光进行照射83 s.治疗后随访1～12月,平均4.5月,术后行视力、眼底、FFA及OCT检查.结果 最佳矫正视力0.4～1.2,平均0.78,视力明显改善者14只眼,视力稳定者1只眼,FFA检查显示渗漏完全消失者13只眼,部分消失者2只眼.治疗后1、3月OCT检查显示黄斑厚度恢复正常14只眼,部分吸收1只眼;眼底检查显示黄斑水肿基本消失,未见病情恶化者,半年后1只眼复发.结论 半量PDT是治疗黄斑中心区中浆的有效方法,病程越短显效越快,黄斑OCT可以很好显示治疗效果,但是尚需要进一步的对照研究来观察其长期安全性和有效性.     

氢激光治瘵中心性漿液性脉絡膜視網膜病變的臨床研究

目的平估氩激光對中心性漿液性脉絡膜視網膜病燮(中漿)的治瘵效應.方法將42例中蔣患者随機分爲激光治瘵組19例和口服藥物對照組23例,觀察兩組治瘵前後視力、眼底、眼底熒光造影、恢復時間、復發率等.結果治瘵組舆對照組的視力無明顯差异,但可顯著縮短病程,改善自覺癥狀,降低復發率.結論氩激光治瘵中漿是安全有效的,應作爲首選治瘵方案.     

高压氧联合鼠神经生长因子治疗中心性浆液性视网膜病变的综合疗效

目的探讨高压氧联合鼠神经生长因子(NGF)治疗中心性浆液性脉络膜视网膜病变(CSC)的综合疗效。方法将2015年1月至2016年1月我院眼科收治的60例(72只眼)CSC的患者随机分为治疗组和对照组,治疗组采用高压氧联合NGF综合疗法,对照组采用NGF疗法。比较两组临床治疗效果、治疗后不同时间临床愈合情况、视力比较情况。结果①治疗组总眼数36只眼,治疗有效眼数33只眼,总有效率91.67%;对照组总眼数36只眼,治疗有效眼数26只眼,总有效率72.2%,两组临床有效率比较差异有统计学意义(P<0.05);②两组治疗后4周、12周临床愈合情况比较,差异均有统计学意义(P<0.05);③两组治疗前后视力比较差异有统计学意义(P<0.05),且治疗组治疗后视力明显优于对照组治疗后视力(P<0.05)。结论高压氧联合NGF治疗CSC的疗效显著且疗程较短,经济,无明显副作用,具有一定临床价值。     

中心性浆液性脉络膜视网膜病变激光治疗后的对比敏感度特点

目的 测量和观察急性中心性浆液性脉络膜视网膜病变（CSC）经视网膜激光光凝（LP）治疗后的对比敏感度（CS）恢复情况。方法 前瞻性自身对照研究。临床确诊为单眼急性CSC的20例患者纳入本研究。其中,男17例,女3例,年龄32～49岁,平均（40.0±4.3）岁;均经荧光素钠眼底血管造影确诊为CSC且渗漏点位于黄斑中心凹无血管区外,LP治疗后第2个月和第6个月各随访1次,随访时测量CS、中心视网膜厚度（CRT）。首先比较患眼与对侧眼的测量值是否在正常曲线内,然后将患眼与对侧眼CS、CRT分别进行比较。患眼与对侧眼的数据比较采用配对t检验。结果 LP治疗后第2个月,2例双眼对比敏感度均在正常范围内;18例患眼对比敏感度曲线低于正常范围。与对侧眼比较,患眼各空间频率均降低,差异有统计学意义（t=2.428、6.581、5.084、3.461,P＜0.05）;患眼CRT明显降低（t=5.784,P＜0.01）。第6个月随访,7例双眼对比敏感度均都在正常范围内;13例患眼对比敏感度低于正常范围;与对侧眼比较,患眼在6 c/d、12 c/d、18 c/d空间频率CS降低,差异有统计学意义（t=2.236、3.359、3.404,P<0.05）;患眼CRT低于对侧眼,差异有统计学意义（t=6.489,P<0.01）。结论 LP治疗后视力恢复正常的急性CSC的患眼,第6个月中高频段对比敏感度仍然明显低于对侧眼,或者说其低对比度的形觉分辨力仍然低于正常。     

中心性浆液性脉络膜视网膜病变的多焦视网膜电图改变

目的 测试并比较中心性浆液性脉络膜视网膜病变(CSCR)患者和正常人的多焦视网膜电图，探讨CSCR患者的视网膜功能。方法 应用EDI公司生产的VERIS系统对8例CSCR12只眼和14例正常人的16只眼进行检测，检测结果进行Mann—Whitney检验。结果 CSCR患者1环、2环的P1波反应密度下降，与正常对照组相比差异有显著性意义。结论 多焦视网膜电图可对CSCR患者的视功能进行定量检测且具有较好的重复性。     

Assessment of metamorphopsia in patients with central serous chorioretinopathy

Background:

To evaluate the presence and extent of metamorphopsia using M-CHARTS™ (Inami Co., Tokyo, Japan) in patients with central serous chorioretinopathy (CSC).

Design:

Retrospective consecutive medical record review in a university hospital.

Materials and Methods:

We examined 33 eyes of 33 consecutive CSC patients using M-CHARTS, which yields scores reflecting the severity of metamorphopsia. The condition was considered present when an M-CHARTS score was 0.3 or over. In all patients, optical coherence tomography (OCT) was performed, best-corrected visual acuity (BCVA) was assessed, and M-CHARTS scores were calculated at the first and the 1- and 3-month follow-up visits. The correlation between M-CHARTS scores and BCVA values was determined. We also sought to define relationships between the level of metamorphopsia and specific OCT findings.

Results:

Of 33 CSC patients, 15 showed symptoms of metamorphopsia, and all 15 had M-CHARTS scores of over 0.3. However, no correlation was evident between BCVA values and the extent of metamorphopsia as determined using M-CHARTS. In metamorphopsia patients, the incidence of focal retinal pigment epithelial detachment was notably greater than in the non-metamorphopsia group (P = 0.03).

Conclusion:

M-CHARTS is valuable for monitoring subjective symptom improvement during the clinical course of CSC. M-CHARTS serves as a useful adjunct to OCT.     

Indocyanine green angiography in central serous chorioretinopathy

Purpose. To analyse images obtained by indocyanine green angiography in central serous chorioretinopathy (CSC). Methods. Ninety patients affected with CSC were examined using indocyanine green angiography. Results. CSC was detected in 127 of the 180 eyes examined. Leakage points were detected in 99 eyes with fluorescein angiography; in 85 of these eyes, they corresponded o hyperfluorescence with indocyanine green angiography, while a hyperfluorescence of the neuroepithelial detachment was seen in 21 eyes. Areas of choriodal hyperpermeability were seen in all 127 eyes with CSC and in 9 fellow eyes. With ICG angiography, the appearance of pigment epithelial detachments was similar to that previously described (early hyperfluorescence and later hypofluorescence), and was seen in 47 eyes. In 103 eyes, hypofluorescence lesions of various sizes, were detected which became more marked in the later stages. These lesions corresponded to retinal pigment epithelium lesions in fluorescein angiography, mainly hyperfluorescence caused by window defect. We were also able to observe RPE atrophic tracts in 31 eyes. These tracts appeared hyperfluorescent in 11 eyes where a minimal amount of RPE atrophy was present and hypofluorescent in 20 eyes in which the tract had marked RPE atrophy. Conclusion. The results obtained confirm the finding of choriodal hyperpermeability and subretinal diffusion of ICG, which indicate involvement of the choroid in CSC. The observation of progressively hypofluorescent lesions corresponding to retinal pigment epithelium alterations suggests that there may be as yet unknown interactions of pigment epithelium and ICG. This revised version was published online in September 2006 with corrections to the Cover Date.     

半剂量光动力疗法治疗中心性浆液性脉络膜视网膜病变观察

目的 观察半剂量光动力疗法治疗中心性浆液性脉络膜视网膜病变的疗效及安全性.方法 2008年4月至2010年9月在门诊确诊的中心性浆液性脉络膜视网膜病变患者24例24只眼,其中男20例20只眼,女4例4只眼,年龄27～48岁,平均36.8岁,最佳矫正视力0.2～0.5,平均0.42,行半剂量光动力疗法治疗,随访按照术后l周、1月、3月、6月、9月进行,随访时间3～8月,平均4.8月,随访期间分别行裂隙灯眼底镜检查、最佳矫正视力、OCT及FFA检查,观察治疗的有效性和安全性.结果 术后l周,OCT显示4只眼视网膜下积液吸收,19只眼视网膜下积液部分吸收,1只眼视网膜下积液无明显变化;术后1月,OCT显示18只眼视网膜下积液吸收,5只眼视网膜下积液部分吸收,1只眼视网膜下积液无明显变化;FFA显示19只眼荧光渗漏消失,4只眼渗漏减轻,1只眼渗漏无明显变化.术后3月,OCT最示23只眼视网膜下积液吸收,1只眼视网膜下积液部分吸收;FFA显示23只眼荧光渗漏消失,1只眼渗漏减轻.对渗漏未完全消失眼再次行半剂量光动力疗法,1月后OCT显示视网膜下积液吸收,FFA显示荧光渗漏消失呈荧光着染.末次随访时最佳矫正视力0.5～1.0,提高2行以上者19只眼.结论 半剂量光动力疗法治疗中心性浆液性脉络膜视网膜病变疗效显著,安全.     

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（csc）系一种主要在男性中青年人患病具有自限性的黄斑部疾病,多数患者可自行恢复,因此对其治疗结果解释时应谨慎。迄今有关CSC治疗的随机对照临床研究很少,主要是基于无对照组的观察性研究。本文对传统激光局部光凝、减量光动力疗法、微脉冲二极管激光阈下光凝、抗血管内皮生长因子药物玻璃体内注射、糖皮质激素拮抗剂、肾上腺素能受体抑制剂、碳酸酐酶抑制剂、小剂量阿斯匹林等CSC治疗方法进行简要介绍与评价。