Framme Carsten, Walter Andreas, Gabler Bernhard, Roider Johann, Sachs Helmut G, Gabel Veit-Peter
University Eye Hospital Regensburg, Regensburg, Germany.
Acta Ophthalmol Scand. 2005 Apr;83(2):161-7. doi: 10.1111/j.1600-0420.2005.00442.x.
Central serous chorioretinopathy (CSC) affects mostly young and middle-aged adults. Typically, a serous retinal detachment occurs with a focal leakage point in fluorescein angiography. Fundus autofluorescence (AF) is related to the lipofuscin within the retinal pigment epithelium (RPE). As CSC is thought to be associated with RPE disorders, AF measurements might be able to detect distinct changes within the RPE level. The purpose of this study was to compare AF patterns in acute and chronic-recurrent CSC and to evaluate the potential value of AF as a non-invasive monitoring tool.
From 85 patients diagnosed with CSC (mean age 43 years), AF images were retrospectively evaluated and compared with angiographic and ophthalmoscopic findings. Fluorescein angiography and AF measurements were performed using a Heidelberg retina angiograph. Autofluorescence was excited at a wavelength of 488 nm and detected above 500 nm.
Acute CSC as determined by an acute decrease in visual acuity (VA) within the last 6 weeks, focal point leakage and neurosensory retinal detachment was diagnosed in 39 patients. In 36 of those patients (92%), a significantly decreased AF at the leakage point (72%) and/or decreased AF in the area of neurosensory detachment (77%) were observed. Regarding chronic-recurrent CSC as determined by a decrease in VA for longer than 6 weeks and mottled hyperfluorescent appearance in angiography, abnormalities in AF were observed in 44/46 patients (96%). In those patients, decreased or mottled AF was observed at the leakage point itself (76%), whereas significantly increased AF was seen in the area of residual neurosensory retinal detachment (85%).
In acute CSC, decreased AF is presumably due to a blockage caused by oedema, whereas in chronic-recurrent forms, irregular and increased AF is observed, possibly reflecting reactive RPE changes secondary to RPE defects and neurosensory detachment. If these findings could be systematically underlined by prospective clinical studies, AF might be an interesting non-invasive tool for monitoring RPE changes in CSC and for performing differential diagnosis.
中心性浆液性脉络膜视网膜病变（CSC）主要影响中青年成年人。典型情况下，荧光素血管造影显示浆液性视网膜脱离伴有一个局灶性渗漏点。眼底自发荧光（AF）与视网膜色素上皮（RPE）内的脂褐素有关。由于CSC被认为与RPE疾病相关，AF测量或许能够检测出RPE水平的明显变化。本研究的目的是比较急性和慢性复发性CSC的AF模式，并评估AF作为一种非侵入性监测工具的潜在价值。
对85例诊断为CSC的患者（平均年龄43岁）的AF图像进行回顾性评估，并与血管造影和检眼镜检查结果进行比较。使用海德堡视网膜血管造影仪进行荧光素血管造影和AF测量。自发荧光在488nm波长下激发，并在500nm以上进行检测。
39例患者被诊断为急性CSC，其依据是在过去6周内视力（VA）急性下降、局灶性渗漏点和神经感觉性视网膜脱离。在这些患者中的36例（92%），观察到渗漏点处AF显著降低（72%）和/或神经感觉性脱离区域AF降低（77%）。对于由视力下降超过6周以及血管造影中斑驳状高荧光外观所确定的慢性复发性CSC，44/46例患者（96%）观察到AF异常。在这些患者中，在渗漏点本身观察到AF降低或斑驳状改变（76%），而在残余神经感觉性视网膜脱离区域观察到AF显著增加（85%）。
在急性CSC中，AF降低可能是由于水肿导致的阻塞，而在慢性复发性形式中，观察到不规则且增加的AF，这可能反映了继发于RPE缺陷和神经感觉性脱离的反应性RPE变化。如果这些发现能够被前瞻性临床研究系统地证实，AF可能是一种用于监测CSC中RPE变化和进行鉴别诊断的有趣的非侵入性工具。
