全身应用皮质类固醇激素致中心性浆液性脉络膜视网膜病变的临床特征

摘要

目的 探讨全身应用皮质类固醇激素致中心性浆液性脉络膜视网膜病变(CSC)的临床特征,指导临床诊断及治疗.方法 回顾性病例研究.分析经眼底检查、荧光素眼底血管造影(FFA)及光学相干断层扫描(OCT)确诊并结合全身疾病诊断为全身应用皮质类固醇激素致CSC 12例患者的临床资料.结果 12例患者均为双眼发病.眼底检查见视网膜后极部均有神经上皮脱离,伴有色素上皮脱离者6眼,伴有视网膜色素上皮多发性萎缩2眼,伴有黄色纤维素样渗出14眼,伴有大泡性视网膜脱离4眼.FFA后极部见单个渗漏点4眼,多个渗漏点20眼；伴有色素上皮萎缩条带2眼,伴有视网膜下大量积液4眼.OCT检查提示24眼存在单发或多发的神经上皮脱离伴/不伴有色素上皮脱离,其中6例患者有神经上皮脱离伴下方高反射信号.12例患者中,肾脏移植术后2例,多发性硬化3例,系统性红斑狼疮2例,肾病综合征2例,脱髓鞘疾病1例,另外2例患者因发热或者其他原因在当地输注过大剂量激素.结论全身应用皮质类固醇激素致CSC对患者视力的损害极大,其典型的眼底特征可帮助诊断,对此类患者应定期进行眼底检查,便于早期发现,避免出现不可逆的视力损害.%Objective To discuss the clinical features of central serous chorioretinopathy (CSC)caused by systemic corticosteroid application,and to guide the clinical diagnosis and treatment.Methods This was a retrospective study.The clinical data and fundus characteristics of the 12 cases diagnosed as CSC were analyzed.These patients were diagnosed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT),as well as a previous history of corticosteroid application.Results All the 12 CSC cases secondary to corticosteroid treatment were bilateral.Sensory retinal detachment was found in all the eyes and retinal pigment epithelial (RPE) detachment was found in 6 eyes.Multifocal atrophy of RPE was detected in 2 eyes,14 eyes had yellow fibirinoid exudation and 4 eyes had bullous retinal detachment.Fluorescein angiography (FFA) showed 4 eyes with single fluorescein leaking,20 eyes with multiple leaking,2 eyes with window defect hyperfluorescence corresponding to the areas of atrophy of the RPE,and 4 eyes with a large amount of fluid below the pigment epithelium or sensory retina.SD-OCT indicated most of the eyes had single or multifocal sensory retinal detachment with or without RPE detachment,and 6 eyes with hypereflective spots below the sensory retina.Among these patients,there were 2 who had undergone renal transplantation,3 had multiple sclerosis,2 had systemic lupus erythematosus,2 had nephrotic syndrome,1 had demyelinating disease,and 2 had a history of a large dosage of systemic corticosteroid application because of fever or other disease.Conclusion CSC caused by systemic corticosteroid therapy may lead to severe vision loss.The classic fundus features of this disease can help us to diagnose correctly.Regular follow-up should be performed for these patients in case of permanent visual impairment.