急性中心性浆液性脉络膜视网膜病变视网膜外层的SD-OCT表现

doi:10.13281/j.cnki.issn.1004-4469.2022.03.007

眼科 ›› 2022, Vol. 31 ›› Issue (3): 200-204.doi: 10.13281/j.cnki.issn.1004-4469.2022.03.007

急性中心性浆液性脉络膜视网膜病变视网膜外层的SD-OCT表现

张丛史雪辉姚宁刁莉莉魏串串

首都医科大学附属北京同仁医院北京同仁眼科中心眼科学与视觉科学北京市重点实验室 100730

收稿日期:2021-05-09 出版日期:2022-05-25 发布日期:2022-06-07
通讯作者: 史雪辉，Email: shixuehui212@126.com E-mail:shixuehui212@126.com

SD-OCT findings of retina outer layers in acute central serous chorioretinopathy

Zhang Cong，Shi Xuehui，Yao Ning，Diao Lili, Wei Chuanchuan

Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China

Received:2021-05-09 Online:2022-05-25 Published:2022-06-07
Contact: Shi Xuehui, Email: shixuehui212@126.com E-mail:shixuehui212@126.com

摘要/Abstract

摘要： 目的探讨急性中心性浆液性脉络膜视网膜病变（central serous chorioretinopathy，CSC）视网膜外层组织的频域相干光断层扫描（spectral domain optical coherence tomography，SD-OCT）视网膜外层组织表现特征。设计回顾性病例系列。研究对象 首次发病、荧光素眼底血管造影检查（FFA）表现为单眼单个明确渗漏点（LP）的急性CSC患者55例（55眼）。方法分析FFA和SD-OCT同步检查图像对应LP及黄斑中心凹、视网膜神经感觉层脱离（NSRD）区域的视网膜色素上皮（RPE）光反射带及视网膜外层组织形态结构。 主要指标 SD-OCT中色素上皮层脱离（PED）形态特征、视网膜外层组织形态结构特征。结果 41眼（74.5%）LP表现为PED，其中拱形PED（DSPED）15眼（27.3%），扁平不规则PED（FIPED）26眼（47.2%）。与DSPED相比，FIPED更多见于墨渍状渗漏（χ2=11.116，P=0.001）和黄斑中心无血管区外（χ2=4.432，P=0.035）。黄斑中心凹和NSRD区域分别有6眼（10.9%）和9眼（16.4%）表现为FIPED。55眼（100%）NSRD区域外丛状层（OPL）增厚，53眼（96.4%）OPL内可见劈裂形态的梭形或多发不规则低反射腔。外界膜（ELM）光带均清晰完整；44眼（80.0%）光感受器细胞外节（PRL-OS）增厚，椭圆体带（EZ）、嵌合体带（IZ）分界不清；44眼（80.0%）PRL-OS呈颗粒状外观；41眼（74.5%）伴有视网膜内高反射物质（HRD）。结论急性CSC患者已有FIPED发生，PRL-OS增厚、颗粒状外观及EZ和IZ结构破坏多见。NSRD区域OPL增厚且呈劈裂形态为急性CSC高发重要征象。（眼科， 2022， 31： 200-204）

关键词: 急性中心性浆液性脉络膜视网膜病变, 频域相干光断层扫描, 视网膜色素上皮层脱离, 外丛状层劈裂

Abstract: Objective To investigate the features of the retina outer layers on images of spectral domain optical coherence tomography (SD-OCT) in acute central serous chorioretinopathy (CSC). Design Retrospective case series. Participants 55 eyes of 55 patients who were diagnosed as unilateral and initial onset of acute CSC with one obvious leakage point (LP) on fundus fluorescence angiography (FFA) images. Methods The morphology of RPE reflective layer at LP, macular fovea (MF) and neurosensory retinal detachment (NSRD) were investigated, and the morphology features of NSRD were also analyzed on SD-OCT with Spectralis HRA+OCT. Main Outcome Measures The subtypes of PED, the morphologic and structural changes of the retina outer layers on the SD-OCT. Results 41 eyes(74.5%) of LP displayed as PED, among which 15 eyes (27.3%) presented as dome-shaped PED (DSPED) and 26 eyes (47.2%) flat irregular PED (FIPED) . FIPED was prone to display as inkblot leakage (χ2=11.116，P=0.001) and locate outside of foveal avascular zone (FAZ) (χ2=4.432，P=0.035) compored with DSPED. 6 eyes (10.9%) in MF and 9 eyes (16.4%) in NSRD presented as FIPED. 55 eyes (100%) manifested thickening hyper-reflectivity of outer plexiform layer (OPL) and 53 eyes (96.4%) demonstrated with fusiform or multiple irregular hypo-reflective regions within OPL, which seemed as splitting of OPL. The external limiting membrane (ELM) of 55 eyes (100%) was intact and distinct. The outer segments of photoreceptors layer (PRL-OS) of 44 eyes (80.0%) were thickening and with vague ellipsoid zone (EZ) and interdigitation zone (IZ). The boundary of PRL-OS in 44 eyes (80.0%) showed granular appearance and in 41 eyes (74.5%) accompanied with hyperreflective dots (HRD). Conclusion FIPED in acute CSC is not rare, and the thickening of PRL-OS, granular appearance of PRL-OS and indistinction of EZ and IZ are frequently-occurring signs. The appearance of splitting-shaped hypo-reflecitive regions within thickening OPL of NSRD is a common and important sign in acute CSC. (Ophthalmol CHN, 2022, 31: 200-204)

Key words: acute central serous chorioretinopathy, spectral domain optical coherence tomography, pigment epithelium detachment, splitting of outer plexiform layer

张丛史雪辉姚宁刁莉莉魏串串. 急性中心性浆液性脉络膜视网膜病变视网膜外层的SD-OCT表现[J]. 眼科, 2022, 31(3): 200-204.

Zhang Cong, Shi Xuehui, Yao Ning, Diao Lili, Wei Chuanchuan. SD-OCT findings of retina outer layers in acute central serous chorioretinopathy[J]. Ophthalmology in China, 2022, 31(3): 200-204.

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[2]	徐丽娟 Nitter TA 梁远波金雁南刘旭周阳瞿佳. 视网膜神经节细胞复合体厚度检测对原发性开角型青光眼的诊断意义[J]. 眼科, 2015, 24(1): 26-30.

急性中心性浆液性脉络膜视网膜病变视网膜外层的SD-OCT表现

SD-OCT findings of retina outer layers in acute central serous chorioretinopathy

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