Eye Unit, Southampton General Hospital, Southampton, UK.
Eye (Lond). 2010 Dec;24(12):1743-56. doi: 10.1038/eye.2010.130. Epub 2010 Oct 8.
Central serous chorioretinopathy (CSC) is a chorioretinal disease, incompletely understood with systemic associations, a multifactorial aetiology, and a complex pathogenesis. Increased permeability from the choriocapillaris leads to focal or diffuse dysfunction of the retinal pigment epithelium causing a detachment of the neurosensory retina. CSC has been described in patients with endogenously high levels of corticosteroids as well as in patients with hypercortisolism due to the treatment of ocular or systemic diseases. It is therefore the only 'inflammatory' choroiditis, not proven to be associated with infection that is precipitated or worsened by glucocorticoids. Foveal attenuation, chronic macular oedema, and damage of the foveal photoreceptor layer have been reported as causes of visual loss in CSC. Photoreceptor atrophy in the fovea, despite successful retinal reattachment, typically occurs after a duration of symptoms of approximately 4 months. Treatment should therefore be considered after 3 months if there is angiographic evidence of ongoing foveal leakage in recurrent chronic CSC or in a single CSC episode accompanied by signs of chronic CSC alterations. Based on results of trials conducted so far, it appears that photodynamic therapy with verteporfin is effective and safer than argon laser treatment and should be considered as the treatment of choice, whereas micropulse diode laser photocoagulation seems to be an effective alternative. Glucocorticoid inhibitors are an interesting alternative treatment. Clinical trials are ongoing to test their efficacy. In addition, it is important, where possible, to discontinue any corticosteroid treatment. The possible association of CSC with stress should also be discussed with patients.
中心性浆液性脉络膜视网膜病变（CSC）是一种脉络膜视网膜疾病，其发病机制尚未完全阐明，与全身性疾病有关，具有多种病因和复杂的发病机制。脉络膜毛细血管通透性增加导致视网膜色素上皮层的局灶性或弥漫性功能障碍，引起神经感觉视网膜脱离。CSC 可见于内源性皮质类固醇水平升高的患者，也可见于因眼部或全身疾病治疗而导致皮质醇过高的患者。因此，CSC 是唯一一种“炎症性”脉络膜炎症，没有证据表明其与感染有关，而是由糖皮质激素引发或加重。黄斑中心凹萎缩、慢性黄斑水肿和黄斑区光感受器层损伤已被报道为 CSC 导致视力丧失的原因。尽管视网膜成功复位，但在症状持续约 4 个月后，通常会出现黄斑中心凹处的光感受器萎缩。因此，如果在复发性慢性 CSC 或伴有慢性 CSC 改变迹象的单次 CSC 发作中存在持续的黄斑中心凹渗漏的血管造影证据，应在 3 个月后考虑进行治疗。基于迄今为止进行的试验结果，光动力疗法联合维替泊芬似乎比氩激光治疗更有效且更安全，应被视为首选治疗方法，而微脉冲二极管激光光凝似乎是一种有效的替代治疗方法。糖皮质激素抑制剂是一种很有前途的治疗选择。正在进行临床试验以测试其疗效。此外，尽可能停用任何皮质类固醇治疗也很重要。还应与患者讨论 CSC 与应激的可能关联。
