急性中心性浆液性脉络膜视网膜病变激光治疗前后渗漏灶视网膜色素上皮形态变化观察

摘要

目的 观察急性中心性浆液性脉络膜视网膜病变(CSC)激光光凝治疗前后渗漏灶视网膜色素上皮(RPE)形态变化.方法 临床确诊为急性CSC并行激光光凝治疗的24例患者24只眼纳入研究.其中,男性22例22只眼,女性2例2只眼;平均年龄(39.2±7.2)岁;平均病程(1.1±0.6)个月.所有患眼均经荧光素眼底血管造影(FFA)检查发现黄斑中心凹无血管区外荧光素渗漏,频域光相干断层扫描(SD-OCT)检查发现浆液性视网膜神经上皮脱离而确诊.激光光凝治疗前,FFA检查共发现荧光素渗漏灶26个.其中,渗漏灶呈炊烟状改变5个,占19.2％;渗漏灶呈墨迹样改变21个,占80.8％.对FFA检查发现的26个渗漏灶行SD-OCT检查,发现均存在RPE形态异常.RPE形态异常可分为RPE脱离(PED)、突起样RPE改变、不规则样RPE改变及RPE缺损4种类型.26个渗漏灶中,SD-OCT中形态异常表现为PED 16个,占61.5％;突起样RPE改变5个,占19.2％;不规则样RPE改变5个,占19.2％.未见RPE缺损者.采用多波长眼底激光治疗仪,根据FFA检查结果对患眼行视网膜激光光凝治疗.激光波长561 nm,能量80～100 mW,光斑直径100 μm,曝光时间0.1 s,Ⅰ级光斑反应.激光光凝治疗后2周、2个月再针对原渗漏灶行SD-OCT检查.对比分析治疗前后患眼渗漏灶RPE形态变化.结果 激光光凝治疗后2周,患眼渗漏灶处浆液性视网膜神经上皮脱离程度较治疗前明显减轻.26个渗漏灶中,SD-OCT形态异常表现为PED 7个,占26.9％;突起样RPE改变3个,占11.5％;不规则样RPE改变16个,占61.5％.未见RPE缺损者.激光光凝治疗后2个月,患眼渗漏灶处均未见明显的PED及浆液性视网膜神经上皮脱离.26个渗漏灶中,SD-OCT形态异常表现为突起样RPE改变3个,占11.5％;不规则样RPE改变5个,占19.2％;RPE缺损2个,占7.7％;RPE形态恢复正常16个,占61.5％.结论 急性CSC患眼渗漏灶处存在PED、突起样RPE改变、不规则样RPE改变等形态异常.激光光凝治疗后,PED可以向不规则RPE转变并且出现了RPE局限性缺损.%Objective To observe the morphologic alterations of retina pigment epithelial around fluorescein leakage site using spectral-domain optical coherence tomography (SD-OCT) in acute central serous chorioretinopathy (CSC) before and after laser coagulation.Methods Twenty-four eyes of 24 consecutive patients with unilateral acute CSC who underwent laser photocoagulation (wave length:561 nm,energy:80-100 mW,spot diamteter:100 μm,exposure time:0.1 s) were enrolled in this retrospective study.The patients included 22 males and 2 females,with an average age of (39.2± 7.2) years and an average duration of (1.1 ± 0.6) months.The fluorescein leakage outside the foveal avascular zone and serous retinal detachment were found in all the eyes by fluorescein fundus angiography (FFA) and SD-OCT.Twenty-six leakage sites were observed in 24 eyes on FFA.There were 5 smoky leakage points (19.2％),21 inky leakage points (80.8 ％).The retinal pigment epithelial (RPE) layer at leakage points were scanned by SD-OCT before and at 2 weeks,2 months after treatment.SD-OCT showed that the RPE abnormalities were detected at all of the fluorescein leakage points,including serous pigment epithelial detachment (PED) in 16 leakage points (64.5％),protruding RPE in 5 leakage points (19.5％),and irregular RPE in 5 leakage points (19.2％).The morphologic alterations of RPE around fluorescein leakage point before and after laser coagulation were observed.Results At 2 weeks after laser photocoagulation,PED existed in 7 leakage points (26.9％),protruding RPE in 3 leakage points (11.5％),and irregular RPE in 16 leakage points (61.5％).At 2 months after laser photocoagulation,protruding RPE existed in 3 leakage points (11.5％),and irregular RPE in 5 leakage points (19.2％),including RPE defect in 2 leakage points.And there were undetectable RPE abnormalities in other 16 leakage points (61.5％).Conclusions In acute CSC,SD-OCT shows that morphologic features of the RPE layer are changed,including PED,protruding RPE,irregular RPE around the leakage point.After laser photocoagulation the abnormalities of RPE can also be altered from PED to irregular RPE,and RPE defect is observed in restricted regions.