OCT和FFA联合检测对中心性浆液性脉络膜视网膜病变发病机制的研究

背景以往中心性浆液性脉络膜视网膜病变（CSC）的确诊主要依靠荧光素眼底血管造影（FFA），而光学断层相干扫描（OCT）与FFA的联合应用为CSC的动态观察及评价其发病机制提供了新的途径。目的通过将CSC患者的FFA图像导人OCT中，研究2种检查方法定位病变部位的一致性，探讨CSC的发病机制。方法44例单眼诊断为CSC的患者纳入本研究，包括男36例，女8例；年龄（39．34±5．3）岁，视力0．64±0．27。所有患者均进行了FFA和OCT检查。在Topcon3DOCT1000中导人FFA图像，直接对照OCT病灶与FFA渗漏点，观察二者病变部位的一致性，并用OCT方法测量中心凹神经上皮厚度及其脱离高度。结果OCT显示视网膜色素上皮（RPE）的改变包括RPE脱离34例（77．3％），RPE小隆起和粗糙10例（22．7％）；在RPE脱离的34眼中OCT与FFA定位一致者占31例31眼（91．2％），2种结果不一致者为3例3眼（8．8％）。OCT检测CSC患眼中心凹神经上皮层的厚度为（138．5±19．40）μm，与正常眼的（137．35±5．01）μm比较，差异无统计学意义（t=0．39，P〉0．05）；神经上皮层脱离的高度为（263．34±126．7）μm。结论CSC的病理机制为RPE脱离继发黄斑区神经上皮脱离，FFA渗漏点基本与OCT所测RPE脱离的部位相对应。无RPE脱离者可能与RPE通透性改变有关，OCT能精确测量中心凹神经上皮厚度及脱离的高度。

Combination of OCT and FFA for the research of pathogenesis of central serous chorioretinopathy

Background The diagnosis of central serous chorioretinopathy (CSC) is mainly dependent onfluorescine fundus angiography (FFA). However, the combination of optical coherence topography (OCT) with FFA offers a new approach to the research of the pathogenesis of CSC. Objective This clinical study was designed to study the combined application of the FFA and OCT for the research of the pathogenesis of central serous chorioretinopathy (CSC). Methods Forty-four eyes of 44 patients with CSC were included in this study with 36 cases of males and 8 cases of female. The patients were aged 39.3 ± 5.3 years and the visual acuity was 0. 64 ±0. 27. FFA and OCT examinations were performed in all patients and the FFA images were imported into the Topcon 3D OCT 1000 device to locate the conformity of OCT lesions with the leakages of FFA. The neuroepithelial layer thickness at the fovea and the height of the neuroepithelial layer detachment were measured using 3-D OCT. Results OCT showed serous REP detachment in 34 eyes (77.3%) and rough surfaces of RPE in 10 eyes (22. 7% ). In thirtyfour eyes with RPE detachment, the OCT lesions and FFA leakage spots conformed to the same locations in 31 eyes, but the other three eyes did not. The mean foveal neuroepithelial thickness was (138.5±19.4) μm in CSC eyes and that of normal eyes was ( 131.35±5. 01 ) μm ,showing a significant difference between them( t=0. 39 ,P＞0. 05 ). The mean height of neuroepithelial detachment was (263.3 ± 126.7 ) μm in CSC eyes. Conclusion RPE detachment occurs in CSC eyes and further induces macular neuroepithelial detachment. Leakage lesion of fluorescine corresponds to RPE detachment. CSC without RPE detachment may be related to the increase in RPE permeability. OCT can accurately measure the thickness of the macular neuroepithelial layer and the height of the neuroepithelial detachment.