基线视网膜光感受器层完整性与中心性浆液性脉络膜视网膜病变视力预后的相关性研究

目的 分析中心性浆液性脉络膜视网膜病变（central serous chorioretinopathy，CSC）患者基线黄斑中心凹视网膜光感受器层完整性与治疗后视力预后的相关性。设计 回顾性病例系列。研究对象 北京同仁医院眼科门诊确诊并临床治愈的CSC患者136例（148眼），平均年龄（49.7±8.6）岁。方法 所有患者均采用 Spectralis HRA一体机进行荧光素眼底血管造影（fundus fluorescence angiography，FFA）、吲哚青绿血管造影（indocyanine green angiography，ICGA）及 相干光断层扫描（optical coherence tomography，OCT）检查，半自动分析患者基线OCT形态学指标。定义光感受器层损伤严重程度：神经视网膜脱离区内表面光滑、结构完整，为0级；脱离区光感受器细胞外节部分缺失，但肌样体带、椭圆体带完整为1级；光感受器外节广泛缺失，椭圆体带不清晰，但肌样体带部分可见为2级；光感受器外节、椭圆体带及肌样体带广泛缺失，外界膜隐约可见或结构不清为3级。所有患者根据FFA+ICGA结果采用半剂量光动力治疗或激光视网膜光凝或微脉冲光凝。采用混合线性回归分析评价各分析因素与患者治疗后最佳矫正视力（best corrected visual acuity，BCVA）的关系。主要指标 视网膜光感受器层损伤严重程度，黄斑中心凹视网膜外核层厚度，BCVA（LogMAR）。结果148眼中，CSC患眼基线光感受器层损伤0级90眼、1级29眼、2级18眼、3级11眼；基线33眼（22.3%）LogMAR视力<0.2，治疗后80眼（54.1%）LogMAR视力<0.2。混合效应线性模型分析显示，基线光感受器层损伤严重程度与患者终末BCVA具有关联性（β=-0.242，P<0.001）。结论 CSC患者治疗前黄斑中心凹光感受器层损伤严重程度是影响患者治疗后获得良好视力预后的关键因素：损伤越轻视力预后越好。黄斑中心凹光感受器层损伤可能是提示CSC应接受干预性治疗的生物标记物。

Correlation between photoreceptor layer integrity in baseline and visual prognosis in central serous chorioretinopathy

Objective To evaluate the correlations between baseline morphological changes in optical coherence tomography (OCT) in patients with central serous chorioretinopathy (CSC) and their visual prognosis. Design Retrospective case series. Participants 136 patients (148 eyes) with resolved CSC in Beijing Tongren Hospital. Methods All the patients underwent routine fundus fluorescence angiography (FFA) + indocyanine green angiography (ICGA) and OCT examination using Spetralis HRA-OCT. According to the results of FFA+ICGA, the CSC patients received half dose photodynamic therapy or laser photocoagulation or micropulse photocoagulation respectively. Baseline changes of outer nuclear layer thickness in OCT were semi-automatically analyzed, and the integrity of photoreceptor layer in OCT was qualitatively analyzed. Severity of photoreceptor layer defect was defined as 4 grades: grade 0, in which the detached retina was detected in continuity with well-preserved photoreceptor layer; grade 1, in which the outer segment defects could be seen while the ellipsoid zone and myoid zone were well preserved; grade 2, in which the outer segment and the ellipsoid zone were heavy damaged and the myoid zone defects can be detected; and grade 3, in which the outer photoreceptor layer atrophy was detected. The linear mixture regression was used to analyze the relationship between macular morphologic changes in OCT and best corrected visual acuity (BCVA) at final visit. Main Outcome Measures Severity of photoreceptor layer defect, outer nuclear layer thickness, BCVA (LogMAR). Results Among 148 eyes, the severity of photoreceptor layer defect of 90 eyes was grade 0, of 29 eyes was grade 1, of 18 eyes was grade 2, and of 11 eyes was grade 3, while the percentage of them with LogMAR <0.2 at baseline was 22.3% (33 eyes), and 54.1% (80 eyes) at final visit after treatment. The results of linear mixture regression analysis showed that the severity of photoreceptor layer defect correlates to better BCVA (β=-0.242, P<0.001). Conclusion The severity of photoreceptor layer defect in CSC is the key factor correlated to better visual prognosis, and can be a biomarker that indicates the interference treatment.