Shinojima Ari, Mori Ryusaburo, Fujita Kyoko, Yuzawa Mitsuko
Nihon University Hospital, Chiyoda-ku, Tokyo, Japan.
Aerosp Med Hum Perform. 2016 Dec 1;87(12):1041-1044. doi: 10.3357/AMHP.4671.2016.
Central serous chorioretinopathy (CSC), which has the characteristics of a serous retinal detachment (SRD) in the macular area, affects mostly men in the 30- to 50-yr age range. Some patients have persistent SRD, which may cause retinal thinning and photoreceptor impairment. CSC symptoms are gradual vision loss and/or metamorphopsia. Some commercial airline pilots are concerned about CSC symptoms, which can disqualify them from flying for months and can also reoccur. Thus, careful monitoring and treatment of CSC are critical for pilots, especially those with chronic or recurrent CSC. The Federal Aviation Administration requires uncorrected distant visual acuity in the better eye to be 20/200 or better, with correction to 20/20 or better employing lenses of no greater power than ± 3.5 diopters spherical equivalent. Multimodal imaging modalities such as spectral domain optical coherence tomography (SD-OCT) allow early detection of CSC noninvasively. Moreover, half-dose verteporfin photodynamic therapy (PDT) can cure CSC in the early stage.
Five male Japanese commercial airline pilots with CSC are presented. Four of these five pilots had been disqualified from flying for several months, but after receiving half-dose PDT, they were ultimately able to resume flying commercial aircraft.
Half-dose PDT can rapidly reduce serous subretinal fluid in CSC eyes. Recurrent and/or chronic CSC is seen in clinical cases. Therefore, continuous observation by SD-OCT after half-dose PDT is essential, even if the patient's vision recovers. Early, i.e., before visual acuity decreases, treatment is highly recommended.Shinojima A, Mori R, Fujita K, Yuzawa M. Treatment and monitoring of central serous chorioretinopathy in pilots. Aerosp Med Hum Perform. 2016; 87(12):1041-1044.
中心性浆液性脉络膜视网膜病变（CSC）具有黄斑区浆液性视网膜脱离（SRD）的特征，主要影响30至50岁年龄段的男性。一些患者存在持续性SRD，这可能导致视网膜变薄和光感受器损伤。CSC的症状是逐渐的视力丧失和/或视物变形。一些商业航空公司飞行员担心CSC症状，这可能使他们数月无法飞行，而且症状还可能复发。因此，对CSC进行仔细监测和治疗对飞行员至关重要，尤其是那些患有慢性或复发性CSC的飞行员。美国联邦航空管理局要求较好眼的未矫正远视力为20/200或更好，使用球镜当量不超过±3.5屈光度的镜片矫正后视力达到20/20或更好。多模态成像方式，如光谱域光学相干断层扫描（SD - OCT），能够无创地早期检测CSC。此外，半剂量维替泊芬光动力疗法（PDT）可以在早期治愈CSC。
介绍了5名患有CSC的日本男性商业航空公司飞行员。这5名飞行员中有4名曾被停飞数月，但在接受半剂量PDT治疗后，最终能够恢复驾驶商用飞机。
半剂量PDT可以迅速减少CSC眼中的浆液性视网膜下液。临床病例中可见复发性和/或慢性CSC。因此，即使患者视力恢复，在半剂量PDT后通过SD - OCT进行持续观察也至关重要。强烈建议在视力下降之前尽早进行治疗。
筱岛A，森R，藤田K，汤泽M。飞行员中心性浆液性脉络膜视网膜病变的治疗与监测。航空航天医学与人类表现。2016；87（12）：1041 - 1044。
