Inhoffen W, Ziemssen F, Bartz-Schmidt K U
Augenklinik, Universitäts-Augenklinik Tübingen.
Klin Monbl Augenheilkd. 2012 Sep;229(9):889-96. doi: 10.1055/s-0032-1315077. Epub 2012 Aug 28.
Central neurosensory detachments (NSD) with time-dependent height constitute a disease called central serous chorioretinopathy (CSC), if not arising from uveitis, choroidal neovascularisations (CNV) or leaking retinal vessels. In 10 % of these patients, CSC develops into a chronic disease with recurrent NSD, atrophy of photoreceptors and severe drop in visual acuity. This review article summarises recent progress in understanding this disease and its appearance in funduscopy, FLA, ICG, OCT, autofluorescence as well as its progress, therapy and possible development into secondary CNV. The provided examples illustrate the progression of acute CSC into chronic CSC and with CNV over years. The different appearance of polypoidal choroidal vasculopathy (PCV) in ICG and some of the signs of atypical chronic CSC are discussed. To distinguish between cCSC and wet AMD--both exhibiting leakage in FLA--typical signs are helpful, e.g., "gravitational tracks", retinal precipitates and missing drusen. However, in small lesions, it may be difficult or almost impossible to ensure the correct diagnosis of the underlying disease. The same holds for occult and classic secondary CNV in cCSC vs. CNV in AMD, where photodynamic therapy (PDT) can be successful only in cCSC-CNV and in cCSC without CNV. Corticosteroids often lead to further impairment, even in cases of atypical cCSC, when frequently misdiagnosed as uveitis. As a duration of NSD of more than 4 months is suspected to induce an impairment of photoreceptors, regular examinations are necessary not only in chronic CSC but also after acute CSC (as this form can develop into chronic CSC), while effective therapies are available to resolve the NSD (PDT, anti-VEGF).
如果不是由葡萄膜炎、脉络膜新生血管（CNV）或视网膜血管渗漏引起的，具有随时间变化高度的中心神经感觉脱离（NSD）构成一种称为中心性浆液性脉络膜视网膜病变（CSC）的疾病。在这些患者中，10%会发展为慢性疾病，伴有复发性NSD、光感受器萎缩和视力严重下降。这篇综述文章总结了在理解这种疾病及其在眼底镜检查、荧光素血管造影（FLA）、吲哚菁绿血管造影（ICG）、光学相干断层扫描（OCT）、自发荧光中的表现，以及其进展、治疗和可能发展为继发性CNV方面的最新进展。所提供的实例说明了急性CSC多年来发展为慢性CSC并伴有CNV的过程。讨论了ICG中息肉样脉络膜血管病变（PCV）的不同表现以及非典型慢性CSC的一些体征。为了区分慢性CSC和湿性年龄相关性黄斑变性（AMD）——两者在FLA中均表现为渗漏——典型体征很有帮助，例如“重力轨迹”、视网膜沉淀物和玻璃膜疣缺失。然而，在小病变中，可能很难或几乎不可能确保对潜在疾病做出正确诊断。对于慢性CSC中的隐匿性和典型继发性CNV与AMD中的CNV也是如此，光动力疗法（PDT）仅在慢性CSC-CNV和无CNV的慢性CSC中可能成功。即使在非典型慢性CSC病例中，当经常被误诊为葡萄膜炎时，皮质类固醇通常也会导致进一步损害。由于怀疑NSD持续超过4个月会导致光感受器受损，因此不仅在慢性CSC中，而且在急性CSC后（因为这种形式可能发展为慢性CSC）都需要定期检查，而有有效的治疗方法可解决NSD（PDT、抗血管内皮生长因子）。
