Corvi Federico, Capuano Vittorio, Benatti Lucia, Bandello Francesco, Souied Eric, Querques Giuseppe
*MD †MD, FEBO ‡MD, PhD Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy(FC, LB, FB, GQ); and Department of Ophthalmology, University Paris Est Creteil, Centre Hospitalier Intercommunal de Creteil, Creteil, France(VC, ES, GQ).
Optom Vis Sci. 2016 Oct;93(10):1304-14. doi: 10.1097/OPX.0000000000000953.
Chorioretinal folds are undulations that anatomically include the inner choroid, Bruch's membrane, and the retinal pigment epithelium, and secondarily affect the overlying neurosensory retina. We analyzed clinical data and management of six patients diagnosed with chorioretinal folds-related maculopathy with atypical presentations.
The mean age of the six patients (five women) was 77 years. Best-corrected visual acuity (BCVA) ranged between 20/200 and 20/80. None of the patients had history of hypertension, cardiovascular diseases, or autoimmune disease, and they were all diagnosed with idiopathic chorioretinal folds. Case 1, 2, and 3 received intravitreal antivascular endothelial growth factor (VEGF) therapy; case 4 received intravitreal anti-VEGF and photodynamic therapy; case 5 received only photodynamic therapy; and case 6 received intravitreal injections of sustained-release dexamethasone implant (Ozurdex). In case 1 and 2, the use of ranibizumab resulted in BCVA improvement and resolution of sub-/intraretinal exudation. In case 3, ranibizumab led to a mild reduction of the intraretinal exudation but no changes in BCVA. In case 4 and 5, six intravitreal injections of ranibizumab with two photodynamic therapies and three photodynamic therapies, respectively, led to a mild reduction of the sub-/intraretinal exudation but no changes in BCVA. In case 6, five intravitreal injections of Ozurdex in both eyes led to reduction of the subretinal or intraretinal fluid accumulation and BCVA improvement.
Choroidal vessel dilation and hyperpermeability may be involved in atypical presentations of chorioretinal folds-related maculopathy characterized by sub-/intraretinal fluid accumulation. Dilated and hyperpermeable choroidal vessels may result in focal retinal pigment epithelium alterations that can progress to choroidal neovascularization or chronic central serous chorioretinopathy-like maculopathy with or without telangiectatic retinal capillaries. Intravitreal anti-VEGF administration seems effective to treat choroidal neovascularization in stage 3 chorioretinal folds-related maculopathy, both anti-VEGF and photodynamic therapy seem to have only limited efficacy on chronic central serous chorioretinopathy-like maculopathy (and telangiectatic retinal capillaries), whereas intravitreal injection of Ozurdex seems efficacious to treat chronic central serous chorioretinopathy-like maculopathy.
脉络膜视网膜皱褶是一种解剖学上累及脉络膜内层、布鲁赫膜和视网膜色素上皮的波动，继而影响上方的神经感觉视网膜。我们分析了6例诊断为脉络膜视网膜皱褶相关黄斑病变且表现不典型患者的临床资料及治疗情况。
6例患者（5名女性）的平均年龄为77岁。最佳矫正视力（BCVA）在20/200至20/80之间。所有患者均无高血压、心血管疾病或自身免疫性疾病史，均被诊断为特发性脉络膜视网膜皱褶。病例1、2和3接受玻璃体内抗血管内皮生长因子（VEGF）治疗；病例4接受玻璃体内抗VEGF和光动力治疗；病例5仅接受光动力治疗；病例6接受玻璃体内注射缓释地塞米松植入物（Ozurdex）。在病例1和2中，使用雷珠单抗使BCVA提高，视网膜下/视网膜内渗出液消退。在病例3中，雷珠单抗使视网膜内渗出液轻度减少，但BCVA无变化。在病例4和5中，分别进行6次玻璃体内注射雷珠单抗联合2次光动力治疗和3次光动力治疗，使视网膜下/视网膜内渗出液轻度减少，但BCVA无变化。在病例6中，双眼进行5次玻璃体内注射Ozurdex导致视网膜下或视网膜内液体积聚减少，BCVA提高。
脉络膜血管扩张和高通透性可能与以视网膜下/视网膜内液体积聚为特征的脉络膜视网膜皱褶相关黄斑病变的不典型表现有关。扩张和高通透性的脉络膜血管可能导致局灶性视网膜色素上皮改变，进而发展为脉络膜新生血管或慢性中心性浆液性脉络膜视网膜病变样黄斑病变，伴或不伴有视网膜毛细血管扩张。玻璃体内注射抗VEGF似乎对治疗3期脉络膜视网膜皱褶相关黄斑病变中的脉络膜新生血管有效，抗VEGF和光动力治疗对慢性中心性浆液性脉络膜视网膜病变样黄斑病变（及视网膜毛细血管扩张）似乎仅有有限疗效，而玻璃体内注射Ozurdex似乎对治疗慢性中心性浆液性脉络膜视网膜病变样黄斑病变有效。
