自发荧光和OCT特征与中心性浆液性脉络膜视网膜病变的病程和视力预后的关系

目的 观察中心性浆液性脉络膜视网膜病变(CSC)患眼眼底自发荧光(FAF)和频域光学相干断层扫描(OCT)图像特征,研究自发荧光和OCT表现与CSC的病程及视力预后的关系.方法 横断面研究.对67例(70眼)CSC患者黄斑部进行自发荧光拍摄和OCT扫描,观察不同病程的患者的病变特征,比较各类表型与病程及最佳矫正视力(BCVA)间的关系.数据比较采用秩和检验.结果 CSC患者的自发荧光图像表现各异:①正常型:7眼(10％),自发荧光图像表现正常,对应OCT显示神经上皮层均拱形向上隆起,与RPE带分离,下方有液性暗区,光感受器外节完整平坦,均匀一致.②单纯增强型:32眼(46％).其中28眼(88％)有神经上皮脱离(SRD),自发荧光主要表现为SRD范围内自发荧光增强,OCT显示神经上皮脱离区外节带表面有不均突起;20眼(62％)伴高荧光颗粒,与眼底所见的黄白色小点基本相对应,对应OCT外节带或RPE表面也有高反射颗粒状样突起.③单纯减弱型:9眼(13％),均伴SRD,对应OCT显示外节带完整平坦,均匀一致.④混合改变型:即自发荧光信号高低相间,22眼(31％).其中17眼(77％)表现自发荧光规则,通常表现为低自发荧光围绕高自发荧光,OCT显示神经上皮层拱形隆起,下方液性暗区,低荧光区对应外节带光滑平坦,高荧光区对应外节带高反射颗粒状突起.正常或单纯减弱、单纯增强、混合改变规则、混合改变不规则等对应的病程,差异均有统计学意义(Z=-5.380、-3.791、-3.416、-4.049、-3.309、-3.421,P＜0.01).对应的BCVA,除了单纯增强组与混合改变规则组相比,差异无统计学意义外(Z=-2.012,P＜0.05),其余对比组间的差异均有统计学意义(Z=-3.792、-2.676、-2.790、-3.128、-3.311,P＜0.01).结论 CSC患者早期可表现为SRD正常自发荧光或低自发荧光.随着病程的延长,自发荧光增强且延续的时间较长,慢性迁延的患者可出现不同程度的低自发荧光带,对应萎缩病灶或流水带;CSC患者的自发荧光图像改变主要与光感受器外节脱落的盘膜变性及RPE细胞的病理改变有关;病程越长,BCVA越差.

Correlation of fundus autofluorescence with spectral-domain optical coherence tomography & the course & visual outcome in central serous chorioretinopathy

Objective To describe fundus autofluorescence (FAF) and optical coherence tomography (OCT) patterns in central serous chorioretinopathy (CSC) and correlate them with the stage of disease as well as the prognosis for visual acuity.Methods In this cross-sectional study,70 eyes of 67 patients with CSC underwent FAF imaging and spectral-domain OCT scans,and routine ophthalmologic examinations as well.The pattern of fundus alterations in various stages of disease detected by FAF and OCT,and their correlation with best corrected visual acuity (BCVA) were evaluated and analyzed.Data were analyzed using a rank-sum test.Results FAF and OCT images showed correlated but not identical findings that were classified into four phenotypic patterns: ①Normal type: 7 eyes (10％) displayed no abnormal FAF signal with consistent OCTs showing the upward arch bulge of the neurosensory layer,separated from the retinal pigment epithelium (RPE),with a dark liquid zone underneath.The outer segments of the photoreceptor layer were intact and flat,and uniformly distributed.②HyperFAF type:observed in 32 eyes (45.7％).Among them,28 eyes (88％) had neurosensory layer detachment (SRD).The FAF imaging mainly displayed an increased presence of fluorophores within the SRD area,while OCT demonstrated uneven processes at the surface of the outer segment band.Twenty eyes (62％) contained granules of hyperFAF that basically correlated with the yellowish-white dots seen in the retina,and highly reflective granule-like processes in the outer segment band or the surface of the RPE layer in OCT.③HypoFAF type:observed in 9 eyes (13％),all with SRD.OCT imaging revealed an intact and flat outer segment band that was uniformly distributed.④Mixed type: alternation of hyper- and hypoautofluorescence,observed in 22 eyes (31％).Seventeen of those eyes (77％) displayed regular FAF,normally appearing as hypoFAF surrounding hyperFAF.OCT displayed the arch bulge of the neurosensory layer,with a dark liquid zone underneath.The corresponding outer segment band of the hypoFAF region was smooth and flat,with highly reflective granule-like processes in the hyperFAF region.There were significant difference between all other groups including Normal AF/hypo AF,hyperAF,regular mixed AF and irregular mixed AF (Z=5.380,-3.791,-3.416,-4.049,-3.309,-3.421,P＜0.01).For the corresponding BCVA,there were statistically significant differences between all types (Z=-3.792,-2.676,-2.790,-3.128,-3.311,P＜0.01),except for the difference between the hyperFAF type and the regular mixed type (Z=-2.012,P＜0.05).Conclusion In the early stages of acute CSC,FAF might display normal or decreased autofluorescence.Over time,there was a time-dependent progressive increase in the intensity of FAF.HypoFAF was known to occur in correlation with atrophy that results from a chronic detachment of the retina in patients with chronic and persistent CSC.In areas with altered FAF,SD-OCT imaging revealed marked morphological abnormalities not only of the RPE cell layer but also of the photoreceptor layer.Poor visual prognosis correlated most strongly with the long-term course of the disease.Thereafter,prompt management is highly recommended for treatment of CSC.