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.

The pathogenesis and the clinical management: the challenges of treatment of central serous chorioretinopathy faced in reality

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.