不同病灶活动程度的中心性浆液性脉络膜视网膜病变患眼脉络膜毛细血管扩张程度、中心凹下脉络膜厚度及其相关性分析

摘要

目的 观察不同病灶活动程度的中心性浆液性脉络膜视网膜病变(CSC)患眼脉络膜毛细血管扩张(CCE)扩张程度与中心凹下脉络膜厚度(SFCT),探讨CSC病灶活动程度、CCE扩张程度与SFCT3者之间的相关性.方法 临床确诊为CSC的40例患者40只眼纳入研究.采用荧光素眼底血管造影(FFA)检查判定患眼CSC病灶的活动程度.其中,活跃型CSC 23只眼(活跃型CSC组),非活跃型CSC17只眼(非活跃型CSC组).两组患眼均行光相干断层扫描血管成像(OCTA)检查,利用计算机图像分析系统对脉络膜毛细血管层图像以黄斑中心凹为中心3 mm×3 mm范围内的CCE面积进行测量.以CCE面积占扫描面积66％以上为高度扩张;33％～66％为中度扩张;33％以下为低度扩张.采用频域光相干断层扫描检查测量患眼SFCT.对比两组患眼CCE扩张程度、SFCT的差异;分析CSC病灶活动程度、CCE扩张程度与SFCT 3者之间的相关性.结果 OCTA检查结果显示,活跃型CSC组23只眼中,CCE呈低度扩张5只眼,中度扩张12只眼,高度扩张6只眼.非活跃型CSC组17只眼中,CCE呈低度扩张11只眼,中度扩张4只眼,高度扩张2只眼.活跃型CSC组患眼CCE扩张程度明显大于非活跃型CSC组.两组患眼CCE扩张程度比较,差异有统计学意义(Z=-2.472,P=0.013).活跃型CSC组、非活跃型CSC组患眼SFCT分别为(418.13±126.15)、(429.76±105.80)μm.两组患眼SFCT比较,差异无统计学意义(t=-0.308,P=0.760).CCE低度扩张、中度扩张、高度扩张患眼SFCT分别为(419.13±105.60)、(381.00±125.12)、(515.13±67.68)μm;3种不同CCE扩张程度患眼之间的SFCT比较,差异有统计学意义(F=4.106,P=0.025).两两比较结果显示,CCE高度扩张患眼SFCT较CCE低度扩张、中度扩张患眼明显增厚,差异均有统计学意义(P=0.007、0.048);CCE中度扩张与CCE低度扩张患眼SFCT比较,差异无统计学意义(P=0.326).相关性分析结果显示,SFCT与CCE扩张程度无线性相关关系(r=0.247,P=0.124).结论 活跃型CSC患眼CCE扩张程度较非活跃型CSC患眼更大;两者之间SFCT无明显差异.CSC患眼的病灶活动程度与CCE扩张程度相关,与SFCT无关;CCE扩张程度更大者SFCT更厚.%Objective To observe the degree of choriocapillary ectasia (CCE) and sub-foveal choroidal thickness (SFCT) in central serous chorioretinopathy (CSC) with different activity and discuss their relations.Methods Forty eyes of 40 CSC patients were recruited.The activity of CSC was determinate by fundus fluorescein angiography (FFA).There were 23 eyes with active CSC (active-CSC group),and 17 eyes with inactive CSC (inactive-CSC group).All eyes in both groups were examined with optical coherence tomography angiography(OCTA),and the CCE area of the choriocapillary layer was measured within a 3 mm× 3 mm zone centered on the central fovea of macula.Ectasia was classified based on CCE area,more than 66％ of examination area was high ectasia,and 33％-66％ as medium ectasia,below 33％ as low ectasia.SFCT was measured with frequency domain optical coherence tomography.The relationship between CCE degree,SFCT and CSC group was analyzed.Results Among the 23 eyes of active-CSC group,there were 5 eyes of low ectasia,12 eyes of medium ectasia,6 eyes of high ectasia.Among 17 eyes of inactive-CSC group,there were 11,4,2 eyes of low,medium and high ectasia respectively.Active-CSC group had more advanced degree of ectasia than that in inactive-CSC group(Z=-2.472,P=0.013).SFCT of active-CSC group and inactive-CSC group were (418.13±-126.15),(429.76±105.80) μm respectively,the difference was not significant (t=-0.308,P=0.760).SFCT in eyes with low ectasia,medium ectasia,high ectasia were (419.13±105.60),(381.00±125.12),(515.13±67.68) μm respectively.The difference among the three group was statistical significant (F=4.106,P=0.025).SFCT in eyes of high ectasia was obviously thicker than low ectasia and medium ectasia,the difference was statistical significant (P=0.007,0.048);the SFCT difference between low ectasia and medium ectasia did not appear statistical significance (P=0.326).There was no linear relation between SFCT and CCE degree (r=0.247,P =0.124).Conclusions Active-CSC eyes has more advanced CCE degree than inactive-CSC eyes,but SFCT is the same between the two groups.High ectasia eyes have thicker SFCT.