视网膜厚度分析仪对中心性浆液性脉络膜视网膜病变的诊断作用

近年来对中心性浆液性脉络膜视网膜病变(中浆)的检查和诊断手段不断增多，其中视网膜厚度分析仪(retinal thickness analyzer，RTA)以其能迅速对后极部视网膜进行扫描，从而获取客观和定量的视网膜厚度的明显优势被广泛应用于眼科临床。笔者于2001年始，应用RTA检测38例中浆患者的黄斑部视网膜厚度，旨在探讨RTA对中浆的诊断价值。     

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。     

复方血栓通联合激光治疗CSCR的疗效观察

目的：探讨复方血栓通联合激光治疗中心性浆液性脉络膜视网膜病变( central serous chorioretinopathy,CSCR)的临床疗效。
　　方法：将我院治疗的181例中心性浆液性脉络膜视网膜病变患者随机分为治疗组91例和对照组90例,对照组行激光治疗,治疗组在激光治疗后口服复方血栓通;比较两组患者临床疗效、平均光敏感度和血清睾酮、雌激素水平。结果：治疗后3wk,治疗组总有效率为90.1%,对照组为72.2%,治疗组显著高于对照组(χ2=10.473,P=0.001);治疗后6wk,治疗组总有效率亦显著高于对照组(χ2=4.499,P=0.034)。治疗组治愈时间、视力恢复时间均显著少于对照组,平均光敏感度显著高于对照组,两组间相比差异具有统计学意义(P<0.05)。治疗后两组患者相关激素水平均显著降低,其中治疗组血清激素水平降低程度显著优于对照组,组间相比差异具有统计学意义(P<0.05)。
　　结论：复方血栓通联合激光治疗中心性浆液性脉络膜视网膜病变,能够显著提高疗效,缩短病程,有利于视功能恢复,值得临床推广。     

CSC患者血浆儿茶酚胺与视网膜厚度变化的临床观察

目的　探讨儿茶酚胺在中心性浆液性脉络膜视网膜病变 (CSC)中的作用机制 ,以及与黄斑中心凹厚度与视力转归的关系。方法　对随访的 3 0例CSC患者不同时期血浆肾上腺素 (E)与去甲肾上腺素 (NE)定量检测 ,并应用RTA测量其黄斑视网膜厚度改变 ,所得数据同正常人进行比较并用SAS进行统计学分析。结果　CSC患者活动期血浆E与NE质量浓度为 ( 5 69± 12 3 )ng/L和 ( 72 1± 10 4)ng/L ,较正常人明显升高 (P <0 0 1) ,恢复期E与NE质量浓度趋于正常。RTA检测CSC患者活动期与恢复期视网膜厚度均较正常人增厚 ;且CSC患者血浆E质量浓度与视网膜厚度有显著相关性 (t=2 173 ,P <0 0 5 ) ;黄斑中心凹厚度改变与患者远视力有负相关关系 (r =-0 80 46,P <0 0 1)。结论　CSC患者黄斑视网膜厚度测量可以定量检测患者病情变化和评估视力恢复预后。血浆中E质量浓度影响CSC黄斑水肿的产生与吸收 ,可能是CSC早期损害的病因机制。     

血浆儿茶酚胺与中心性浆液性脉络膜视网膜病变的临床研究

中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy，CSC)是一种好发于男性中青年的眼底黄斑部病变。目前对CSC发病机制的认识尚未统一。笔者于2002年5月至2003年2月，对本院门诊确诊的CSC患者进行血浆儿茶酚胺浓度检测，了解其血浆中儿茶酚胺浓度变化，及其与CSC患者视力改变的关系，以探讨CSC的可能发病机制。     

半剂量维替泊芬光动力疗法治疗慢性CSCR的回顾性研究

目的：探讨半剂量维替泊芬光动力疗法(photodynamic therapy,PDT)对慢性中心性浆液性脉络膜视网膜病变(central serous chororetinopathy,CSCR)的治疗效果。

方法：病例回顾研究。选择14例19眼已确诊的CSCR患者,所有患者均行Snellen视力表最佳矫正视力(best corrected visual acuity,BCVA)、直接检眼镜眼底检查、荧光素眼底血管造影(fundus fluorescein angiography,FFA)和光相干断层扫描(optical coherence tomography,OCT)检查。病程6～12mo,进行半剂量维替泊芬PDT治疗。治疗后随访6～12mo,观察患者病变区结构和功能改变。对患者治疗前后BCVA和黄斑中心凹区视网膜厚度(central foveal thickness,CFT)进行比较,采用配对t检验。

结果：患者14例19眼经PDT治疗后末次随访时BCVA为0.57±0.08,与治疗前BCVA比较,差异有显著统计学意义(t=2.110,P<0.01)。末次随访时的BCVA与治疗前相比,19眼中有17眼(89.5%)视力改善,2眼(10.5%)视力不变。患者治疗后末次随访时CFT为228.44±56.88μm,与治疗前(368.67±32.18μm)比较,差异有显著统计学意义(t=2.110,P<0.01)。末次随访时OCT检查显示视网膜下液完全吸收17眼(89.5%),部分吸收者2眼(10.5%),随访期间病变无复发。

结论：半剂量维替泊芬光动力疗法对慢性CSCR患者的治疗安全有效。     

慢性中心性浆液性视网膜脉络膜病变PDT与IMP疗效对比观察

目的 比较吲哚青绿介导的光栓疗法(Indocyanine green-medicated photothrombosis,IMP)与光动力疗法(PDT)治疗慢性中心性浆液性视网膜脉络膜病变(Centralserousehorioretinopathy,CSC)疗效.方法 对比分析两组共19例22只眼慢性CSC患者分别进行IMP与PDT治疗后1个月,3个月的矫正视力(BCVA),眼底彩色照相,眼底荧光血管造影(FFA)与光学断层相干扫描(OCT).其中IMP治疗10例11眼,PDT治疗9例11只眼.结果 IMP与PDT两组患者治疗后1、3月矫正视力比较,PDT治疗组治疗后1、3月视力提高8例9只眼(90%),视力不变1例1只眼(10%),无视力下降病例;IMP治疗组治疗后视力1月提高8例8只眼(72.7%),治疗后3月1例1只眼视力下降.治疗后1月两组矫正视力比较差异没有统计学意义(χ~2=0.11,P>0.05 ).治疗后3月比较差异也没有统计学意义.(χ~2=0.02,P>0.05 ). PDT与IMP治疗后黄斑视网膜厚度比较,PDT组治疗前黄斑视网膜厚度(408±57.1)μm与治疗后3月黄斑视网膜厚度(143.9±43.6)μm比较差异有统计学意义(t=7.06,P<0.05).IMP组治疗前黄斑视网膜厚度(397.2 4±52.3)μm,与治疗后3月黄斑视网膜厚度(161.24 ±47.2)μm比较差异有统计学意义(t=5.0,P<0.05) .治疗后三月PDT与IMP组黄斑视网膜厚度比较差异没有统计学意义 (t=0.83,P>0.05) . PDT与IMP治疗后3月黄斑区RPE渗漏观察,治疗后3月两组FFA显示黄斑区RPE渗漏灶均消退.照射部位存在不同程度的RPE窗样缺损或轻微荧光染色.6月后FFA随诊发现IMP治疗组2例2只眼黄斑区原照射部位的RPE重新渗漏.结论 PDT改变治疗参数如减半光敏剂用量,以减少对脉络膜血液循环的影响的疗法可有效安全的治疗慢性 CSC,本课题研究表明IMP治疗慢性CSC的短期疗效比较好,安全性高.而治疗费用远低于 PDT,是-种较实用治疗慢性CSC的方法.但目前缺乏多中心,随机对照的长期的临床研究证实其可靠性.     

中心性浆液性脉络膜视网膜病变的屈光变化幅度与视力预后

目的：探讨中心性浆液性脉络膜视网膜病变（CSC）患眼的屈光变化幅度及其与视力预后的关系。方法：对23例原为正视眼的单眼活动期CSC患眼作随访前后屈光状态及矫正视力的检测。随访时间3至12个月（平均7．2个月）。结果：随访前15只患眼（65．2％）呈轻度远视状态，而对侧健眼呈远视状态的为5只眼（21．7％），远视率在患眼与健眼的分布上差异有显著性意义（P＜0．01）。随访后仅5只患眼（21．7％）仍呈远视状态，随访前后患眼远视率比较差异有显著性意义（P＜0．01）。随访前经验光矫正视力增进3行或以上的患眼90．9％在随访后矫正视力可达到1．0或以上。结论：大部分CSC患眼由于黄斑区神经上皮脱落、水肿而呈暂时性的轻度远视；通过活动期患眼屈光状态及矫正视力的检测，对患眼视力预后的评价有一定的价值。     

视瞻有色辨证与眼底及眼底荧光血管造影检查关系的探讨

目的探讨视瞻有色（即西医中心性浆液性脉络膜视网膜病变，简称中浆）辨证各分型与检眼镜眼底检查及FFA检查的关系。方法将218例中浆患者眼底表现及FFA特征分别与中医各辨证分型对照分析。结果中浆各不同证型的眼底表现及FFA特征有明显的差异及规律。结论中浆的不同证型有不同的眼底表现及FFA特征，眼底检查与FFA检查可为中浆的中医辨证施治提供更为直观、准确的诊断依据。     

IL-6基因启动子区-572C/G多态性与大理白族2型糖尿病视网膜病变的关系

目的：探讨IL-6基因启动子区-572C/G多态性与大理白族2型糖尿病(type diabetic mellitus,T2DM)视网膜病变(diabetic retinopathy,DR)人群的相关性及视网膜病变程度的关系。

方法：采用聚合酶链反应联合限制性片段长度多态性分析(polymerase chain reaction-restriction fragment polymorphisms assay,PCR-RFLP)技术及基因测序技术,在大理白族人群中对150例T2DM患者及100例健康对照者(CON组)的IL-6-572C/G位点基因多态性进行检测。150例T2DM患者中,NDR(未合并DR)组57例,NPDR(合并非增生性糖尿病视网膜病变)组77例,PDR(合并增生性糖尿病视网膜病变)组16例。比较各组间基因型及等位基因分布频率,同时收集临床生化指标,最终数据使用SPSS22.0统计软件进行统计学分析。

结果：IL-6基因-572C/G位点组间基因型及等位基因频率相比较,差异均具有统计学意义(P<0.05); 携带C等位基因的个体避免患T2DM的风险为G等位基因的1.182倍(95% CI：1.059～1.319,P=0.004); 携带G等位基因的T2DM患者并发DR的风险为C等位基因的1.667倍(95% CI：1.195～2.326,P=0.003),但基因型及等位基因频率在PDR组与NPDR组比较,差异均无统计学意义(P>0.05); T2DM、NPDR+PDR组与CON组在空腹血糖、甘油三酯、体质量指数比较均有统计学差异(P<0.05); NPDR组与PDR组相比只有空腹血糖比较差异有统计学意义(P<0.05); 合并高血压的个体患T2DM的风险为未患高血压的 3.730倍(95% CI：2.060～6.754,P=0.000),同时患DR的风险为3.997倍(95% CI：2.099～7.612,P=0.000); 不同基因型间临床生化指标比较均无统计学差异(P>0.05)。

结论：IL-6基因-572C/G基因多态性与大理白族T2DM及DR的易感性相关,但临床生化指标对此易感关联没有协同作用,G等位基因是DR和T2DM发病的危险因素,但在NPDR进展至PDR过程中无意义,C等位基因对于T2DM和DR的发病具有保护作用; 高血压、空腹血糖、甘油三酯、体质量指数促进T2DM和DR的发病,空腹血糖在DR病情进展中具有重要作用。     

Serum cortisol and testosterone levels in idiopathic central serous chorioretinopathy

Context:

The preferential occurrence of idiopathic central serous chorioretinopathy (ICSC) in males with a typical Type A personality and behavior and a relative absence in females is a possible indicator towards the role of serum cortisol and /or the male sex hormone testosterone.

Aims:

To study levels of cortisol and testosterone in ICSC.

Settings and Design:

Case-control study in a tertiary care teaching hospital.

Materials and Methods:

The study was conducted on 23 cases of ICSC. Twelve patients with unilateral sudden painless loss of vision of less than one month duration served as controls. Serum cortisol and testosterone levels at 8.00 a.m. were estimated by radioimmunoassay in both groups.

Statistical analysis used:

Statistical analysis was done using SPSS 13.0 software. Independent Sample t-test was applied to analyze statistical significance between the two groups.

Results:

Mean age of patients with ICSC was 37.1 ± 9.7 years and 96% of the patients were males. Mean serum cortisol levels were significantly higher (P=0.002) in patients with ICSC i.e., 495.02 ± 169.47 nano moles/liter (nmol/L) as compared to controls i.e., 362.25 ± 51.54 nmol/L. Mean serum testosterone levels were 3.85 ± 1.81 nano grams/ml (ngm/ml) and 4.23 ± 1.89 ngm/ml in cases and controls respectively and the difference was not statistically significant (P=0.58).

Conclusions:

ICSC is associated with elevated 8.00 a.m. serum cortisol levels. However, mean serum testosterone levels in both patients of ICSC and controls were within normal range.     

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。     

低剂量PDT治疗中心性浆液性脉络膜视网膜病变

目的：观察低剂量光动力学疗法(photodynamic therapy, PDT)治疗中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy, CSC)的短期疗效。

方法：选取急性CSC患者36例36眼,进行单次1/2量维替泊芬(3mg/m²)进行PDT治疗,分别于术前和术后1,4,12,24wk进行最佳矫正视力和OCT的检查,术前、术后4,24wk进行FFA和ICG检查。

结果：术后1wk,36眼中有27眼(75%)OCT显示视网膜下积液完全吸收,其余9眼(25%)视网膜下液部分吸收; 术后4wk,36眼视网膜下积液全部吸收,FFA+ICG示36眼荧光渗漏完全消失,脉络膜血管高渗透性消失; 术后12～24wk,36眼无复发。治疗后4wk,最佳矫正视力从术前平均0.52提高至0.80。随访期间36眼未见任何不良反应。

结论：低剂量PDT治疗CSC短期内安全有效,能缩短病程,显著提高视力。     

Fundus autofluorescence in acute and chronic central serous chorioretinopathy

Background: A prospective evaluation of the pattern of fundus autofluorescence in cases of acute versus chronic central serous chorioretinopathy (CSR). Methods: A prospective, cross‐sectional, single‐centre investigation was performed using three diagnostic techniques, namely, fundus autofluorescence, optical coherence tomography and fundus fluorescein angiography to evaluate a sample of patients (n = 42 eyes) with both acute (n = 25 eyes) and chronic (n = 17 eyes) CSR. Results: Hypoautofluoresecence was found in 80 per cent (20 eyes) and 88.2 per cent (15 eyes) of eyes in the acute and chronic central serous chorioretinopathy groups, respectively, corresponding to the leakage points depicted by fluorescein angiography. Hypoautofluoresence corresponding to the areas of subretinal fluid accumulation was seen in 92 per cent (23 eyes) and 82.3 per cent (14 eyes) of the acute and chronic central serous chorioretinopathy groups, respectively. In two eyes (11.6 per cent) with chronic CSR, hyperautofluorescent changes were noted at the previous leakage points. In the acute CSR group, speckled hyperautofluorescence was detected in nine eyes (36 per cent) after the resolution of subretinal fluid. In the chronic CSR group, simultaneous speckled hyperautofluorescence was detected in the previous areas of subretinal fluid accumulation in 12 eyes (70.5 per cent). Conclusion: Fundus autofluorescence imaging delineates endogenous fluorescence derived mainly from lipofuscin within the retinal pigment epithelium (RPE) layer and therefore permits evaluation of functional alterations in the RPE in numerous retinal diseases. Data from fundus autofluorescence revealed distinctive findings in acute and chronic CSR. Fundus autofluorescence imaging may be used as a supplementary diagnostic tool for identifying patients with CSR and differentiation may be made between acute and chronic cases.     

Long-term macular function in eyes with central serous chorioretinopathy

BACKGROUND: This study aimed to investigate the long-term effects of central serous chorioretinopathy (CSCR) on macular function. METHODS: Sixty-two eyes of 31 patients were included in this study. All patients were diagnosed with unilateral CSCR at the Retina Unit of the Ophthalmology Department, Trakya University Medical Faculty, and had a post-attack bilateral visual acuity of 6/6 and a follow-up period of a minimum of 6 months. Visual function was assessed using the Amsler grid, 40-hue colour discrimination test, visual field examination by means of Octopus automatic perimeter and Cambridge contrast sensitivity tests. RESULTS: Of the 31 patients, 71% were men and 29% were women, with a mean age of 39.3 +/- 7.6 years. The patients had a mean follow-up period of 50.6 +/- 40.5 months after the acute attack. Metamorphopsia was observed in 67.7% of the cases with CSCR. A colour discrimination defect was found in 48.4% of the CSCR eyes and in 54.8% of the fellow eyes. As compared with the fellow eyes, the mean deviation in the central 10 degrees of visual field was significantly higher (t = 2.9, P = 0.007) and the mean contrast sensitivity score was significantly lower (t = -3.2, P = 0.004) in the CSCR eyes. DISCUSSION: Patients with unilateral CSCR were observed to have long-term bilateral colour discrimination defects, and eyes with clinical CSCR were determined to have central relative scotoma and loss of contrast sensitivity.     

Oral eplerenone for the management of chronic central serous chorioretinopathy

AIM: To examine eplerenone (Inspra, Pfizer), a mineralocorticoid receptor antagonist, as a treatment option for chronic central serous chorioretinopathy (CSCR). METHODS: A retrospective consecutive case series was conducted for patients receiving oral eplerenone for chronic CSCR. At baseline and each follow-up visit, spectral domain optical coherence tomography (SD-OCT) imaging was performed, including manual measurements of the height and diameter size of subretinal fluid. The primary outcome measure was the reduction in subretinal fluid following initiation of therapy. RESULTS: A total of 17 eyes of 13 patients treated with 25 and 50 mg of oral eplerenone per day were identified. Subretinal fluid (SRF) decreased over time following eplerenone therapy (P= 0.007 and P = 0.002, diameter and height respectively). Maximum SRF height decreased from a mean of 131.5 μm at baseline to 15.3 μm at day 181+. SRF diameter decreased from an average of 2174.4 μm at baseline to 46.9 μm at day 181+. LogMAR visual acuity improved from 0.42 (Snellen equivalent: 20/53) at baseline to 0.29 (Snellen equivalent: 20/39) at day 181+ (P = 0.024). Central subfield thickness (CST) decreased from 339.5 μm at baseline to 270.3 μm at day 181+ (P = 0.029). CONCLUSION: Eplerenone therapy resulted in significant anatomic and visual improvements in eyes with chronic CSCR.     

中心性浆液性脉络膜视网膜病变的治疗

中心性浆液性脉络膜视网膜病变好发于中青年男性,大多数病例视网膜下积液可自行吸收,视力预后良好,但也有部分患者迁延不愈,生活质量明显下降.目前临床尚无针对性治疗方法,近几年来随着人们对此病的重视和影像学的快速发展,其早期诊断率不断提高,药物、激光及各种新兴治疗方法的应用也使治愈率不断提高.本文就目前对该病的各种治疗方法进行综述,探讨中心性浆液性视网膜脉络膜病变的可行性治疗方案及其利与弊.     

Congenital optic pits and central serous chorioretinopathy

Purpose: The reporting of the occurrence of central serous chorioretinopathy in a patient with congenital optic pits. Methods: A 31-year-old man complained of blurred vision in the right eye for 1 week. He had a visual acuity of 20/25 in the right eye. He underwent ophthalmoscopy and fluorescein angiography. Results: Ophthalmoscopy revealed serous detachment of macula with its margin not adjacent to the margin of optic disc. Fluorescein angiography showed a typical ink blot appearance of dye leakage. Conclusions: Central serous chorioretinoapthy can occur in the patient with congenital optic pits. Detailed ophthalmoscopic and fluorescein angiographic studies are necessary to establish the diagnosis of optic pits associated with macular detachment. Various mechanisms have been reported to explain the serous macular detachment in patients with optic pits including vitreous and cerebrospinal fluid leakage through the optic pit and from there into the subretinal space. The present case further denotes that central serous chorioretinopathy in the presence of optic pits can be due to leakage from the retinal pigment epithelium.     

Masqueraders of central serous chorioretinopathy

Central serous chorioretinopathy (CSCR) is one of the most common chorioretinal pathologies affecting middle-aged men worldwide. Although it has a self-limited course, a significant number of patients suffer from chronic and recurrent episodes. This often leaves the patient with various degrees of visual impairment. The situation is further aggravated by the fact that it is one of the most common conditions to be misdiagnosed. Because of overlapping features with other diseases or the atypical presentation of the disease itself, CSCR is a great mimicker and is one of the commonest causes of referral. We describe some of the conditions which can masquerade as CSCR.