慢性中心性浆液性脉络膜视网膜病变的长期视力结果和致盲原因。

Long-term Visual Outcomes and Causes of Vision Loss in Chronic Central Serous Chorioretinopathy.

机构信息

Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Quinze-Vingts Hospital, DHU SightMaintain, INSERM-DHOS CIC 1423, Paris, France.

Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York; Department of Physiology and Pharmacology, Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Australia; Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Australia.

出版信息

Ophthalmology. 2019 Apr;126(4):576-588. doi: 10.1016/j.ophtha.2018.12.048. Epub 2019 Jan 17.

DOI:10.1016/j.ophtha.2018.12.048

PMID:30659849

Abstract

PURPOSE

To evaluate the long-term visual outcomes and causes of vision loss in chronic central serous chorioretinopathy (CSC).

DESIGN

Retrospective, longitudinal study.

PARTICIPANTS

A total of 133 participants (217 eyes) with chronic CSC.

METHODS

A retrospective review of clinical and multimodal imaging data of patients with chronic CSC managed by 3 of the authors between May 1977 and March 2018. Multimodal imaging comprised color photography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence (FAF), and OCT.

MAIN OUTCOME MEASURES

Best-corrected visual acuity (BCVA) at the final visit; change in BCVA between first visit and 1-, 5-, and 10-year follow-up visits; and causes of vision loss at final visit.

RESULTS

Data from 6228 individual clinic visits were analyzed. Mean age of patients at the first visit was 60.7 years, and mean period of follow-up from first to last visit was 11.3 years. The cohort included 101 male patients (75.9%). At the final visit, 106 patients (79.7%) maintained driving-standard vision with BCVA of 20/40 or better in at least 1 eye, and 17 patients (12.8%) were legally blind with BCVA of 20/200 or worse in both eyes. Mean BCVA at first visit was not significantly different from mean BCVA at 1- or 5-year follow-up visits (both P ≥ 0.65) but was significantly better than the mean BCVA at the 10-year follow-up visit (P = 0.04). Seventy-nine percent of eyes with 20/40 or better vision at the first visit maintained the same level of vision at the 10-year follow-up visit. Ninety-two percent of eyes with 20/200 or worse vision at the first visit maintained the same level of vision at the 10-year follow-up visit. Cystoid macular degeneration, choroidal neovascularization (CNV), outer retinal disruption on OCT, and FAF changes were associated with poorer vision at the final visit (all P ≤ 0.001). Multivariable analysis revealed that greater age at first visit was associated with greater BCVA change at the 10-year follow-up visit (P = 0.001).

CONCLUSIONS

Chronic CSC can be a sight-threatening disease leading to legal blindness. Age at presentation and outer retinal changes on multimodal imaging were associated with long-term BCVA changes and may be predictors of long-term visual outcomes.

摘要

目的

评估慢性中心性浆液性脉络膜视网膜病变（CSC）的长期视力结果和致盲原因。

设计

回顾性、纵向研究。

参与者

共有 133 名（217 只眼）慢性 CSC 患者参与研究。

方法

对 3 位作者在 1977 年 5 月至 2018 年 3 月间诊治的慢性 CSC 患者的临床和多模态影像学数据进行回顾性分析。多模态成像包括彩色摄影、荧光素血管造影、吲哚青绿血管造影、眼底自发荧光（FAF）和 OCT。

主要观察指标

末次随访时最佳矫正视力（BCVA）；首次就诊与 1 年、5 年和 10 年随访时 BCVA 的变化；末次随访时视力丧失的原因。

结果

共分析了 6228 次门诊就诊数据。患者的平均年龄为 60.7 岁，首次就诊至末次就诊的平均随访时间为 11.3 年。该队列包括 101 名男性患者（75.9%）。末次随访时，106 名患者（79.7%）保持了驾驶标准视力，至少有 1 只眼的 BCVA 为 20/40 或更好，17 名患者（12.8%）因双眼 BCVA 均为 20/200 或更差而失明。首次就诊时的平均 BCVA 与 1 年或 5 年随访时的平均 BCVA 无显著差异（均 P≥0.65），但明显优于 10 年随访时的平均 BCVA（P=0.04）。首次就诊时视力为 20/40 或更好的 79%的眼在 10 年随访时保持相同的视力水平。首次就诊时视力为 20/200 或更差的 92%的眼在 10 年随访时保持相同的视力水平。黄斑囊样水肿、脉络膜新生血管（CNV）、OCT 上的外视网膜破坏和 FAF 改变与最终随访时的视力较差相关（均 P≤0.001）。多变量分析显示，首次就诊时年龄越大，10 年随访时的 BCVA 变化越大（P=0.001）。