摘要目的 研究急性浆液性脉络膜视网膜病变(CSC)的频域相干光断层扫描(OCT)图像特征.方法 回顾性病例系列研究.对29例(29只眼)急性CSC患者的临床资料进行回顾性分析.所有患者均应用频域OCT三维切面观察黄斑部视网膜显微结构变化,测量黄斑中心凹外核层厚度及光感受器细胞层内外节长度,分析其与最佳矫正logMAR视力的关系.CSC患者组与正常对照组间黄斑中心凹外核层厚度比较采用Mann-Whitney U检验,CSC患者组光感受器细胞层规则和不规则眼与正常对照组间内外节长度比较采用Kruskal-Wallis H检验,CSC患者光感受器细胞层内外节是否均匀与最佳矫正logMAR视力间的相关性采用Spearman相关分析法.结果 29例(29只眼)患者均有黄斑部视网膜浆液性脱离,黄斑中心凹外核层形态无明显变化,厚度(96.94±23.72)μm,与正常对照组(104.15±11.90)μm比较,差异无统计学意义(U＝43.61,P=0.33).光感受器细胞全层厚度均匀一致者11只眼(31.9%),光感受器细胞全层厚度均匀一致伴内外节缺损者6只眼(20.7%),内外节厚薄不均者4只眼(13.8%),内外节明显凸起增厚者6只眼(20.7%),内节与外节剥离者2只眼(6.9%);但CSC患者组光感受器细胞层规则和不规则眼与正常对照组间内外节长度差异无统计学意义(χ2=5.483,P=0.06),可能与观察样本量较少有关.有86.2%的CSC患眼出现视网膜素色上皮(RPE)异常,包括RPE脱离21只眼(72.4%),RPE不规则凸起10只眼(34.5%),RPE层颗粒状沉积6只眼(20.7%),RPE缺损3只眼(10.3%).5例同时行荧光素眼底血管造影检查,有3例荧光素渗漏点在RPE凸起部.患者光感受器细胞层内外节是否均匀与最佳矫正logMAR视力显著相关(r=0.382,P=0.026),与病程无显著相关性(r=0.294,P=0.057);RPE脱离和RPE凸起与最佳矫正logMAR视力间无显著相关性(r=0.234,P=0.127).结论 频域OCT能清晰显示急性CSC患者的细微病理结构改变,是诊断及判断急性CSC患者预后的可靠手段.(中华眼科杂志,2011,47:508-515)

abstractsObjective To describe the pathologic changes of macular in acute central serous chorioretinopathy (CSC) using spectral domain optical coherence tomography (SD-OCT). Methods It was a retrospective case series study. This study included 29 eyes of 29 patients with CSC. The fundus examination was conducted followed by SD-OCT to observe foveal microstructure changes. We evaluated the correlation between the thickness of the outer nuclear layer (ONL), the length of photoreceptors and best-corrected visual acuity (BCVA). Results Serous retinal detachment was found in all 29 eyes with SD-OCT. There was no obvious morphology change in ONL, the thickness of ONL was (96.94±23.72) μm and did not different from that in normal control eyes (104.15±11.90) μm. The thickness of photoreceptors was uniform in 11 eyes (31.9%), uniform but with defects in 6 eyes (20.7%), uneven in 4 eyes (13.8%), protruding of outer segments (OS) was observed in 6 eyes (20.7%) and flaking OS in 2 eyes (6.9%). The length from external limiting membrane to the longest outer segment in CSC eyes was 84 (52 to 148) μm and was not statistically different from that in normal eyes (69 to 82)μm. Morphology changes of retinal pigment epithelium (RPE) were found in 25 eyes, including pigment epithelial detachment of RPE (PED) in 21 eyes (72.4%), small bulge of RPE in 10 eyes (34.5%), granular deposition epi-RPE in 6 eyes (20.7%), defects of RPE in 3 eyes(10.3%). Fluorescein angiography (FA) was performed in 5 eyes and bulging RPE detected by SD-OCT seemed to correspond precisely to the leakage point on FA in 3 eyes. Age, course of disease and thickness of the ONL did not influence BCVA (logMAR). Uneven of thickness of OS was negative prognostic factors for BCVA (r=0.382,P=0.026). Conclusions SD-OCT can demonstrate finer pathologic changes in acute CSC. Furthermore, 3-D image allows localization of these pathologic features to specific site using ELM line as landmark. SD-OCT is a valuable tool for the diagnosis and for predicting visual recovery in CSC.