Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
Department of Ophthalmology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
Retina. 2020 Sep;40(9):1724-1733. doi: 10.1097/IAE.0000000000002662.
To investigate the differences in natural course, intravitreal bevacizumab injection (IVB) responsiveness, and optical coherence tomography angiography findings according to the type of pigment epithelial detachment (PED) in patients with central serous chorioretinopathy (CSC).
A retrospective review of angiographically proven CSC patients was conducted. Pigment epithelium detachment was classified as flat irregular or focal. To identify the natural course of CSC, we had observed whether subretinal fluid was improved without any treatment until symptom duration was >3 months. When CSC symptom duration was >3 months, IVB injection was performed. Symptom duration, central subfield thickness, subfoveal choroidal thickness, presence of subretinal fluid, natural course, optical coherence tomography angiography findings, and IVB responsiveness were compared between the PED types.
One hundred eyes were included (64 flat irregular PED vs. 34 focal PED). Flat irregular PED had a longer symptom duration than focal PED (7.20 ± 11.52 vs. 3.69 ± 3.98 months, P = 0.03). In untreated cases, the rate of complete resolution of subretinal fluid was significantly lower in flat irregular PED than in focal PED (34.78% vs. 65.22%, P = 0.017). In contrast to the natural course, responsiveness to IVB was significantly better in flat irregular PED (72.41% vs. 31.58%, P = 0.005). Optical coherence tomography angiography revealed more CNV in flat irregular PED (42.90% vs. 10.00%, P = 0.014). Subfoveal choroidal thickness in flat irregular PED was significantly thicker.
In CSC patients with flat irregular PED, the natural course was poor, but treatment response to IVB was favorable. Flat irregular PED patients showed longer symptom duration and thicker subfoveal choroidal thickness than those with focal PED. Optical coherence tomography angiography revealed more choroidal neovascularization in flat irregular PED. These findings suggest that CSC with flat irregular PED could be considered a form of pachychoroid neovasculopathy.
探讨中心性浆液性脉络膜视网膜病变（CSC）患者不同类型色素上皮脱离（PED）的自然病程、玻璃体内注射贝伐单抗（IVB）反应性以及光学相干断层扫描血管造影（OCTA）表现的差异。
回顾性分析经血管造影证实的 CSC 患者。PED 分为扁平不规则或局灶性。为了确定 CSC 的自然病程，我们观察了在症状持续时间>3 个月之前，是否不经任何治疗就改善了视网膜下积液。当 CSC 症状持续时间>3 个月时，行 IVB 注射。比较了两种 PED 类型之间的症状持续时间、中央视网膜下厚度、中心凹下脉络膜厚度、视网膜下积液的存在、自然病程、OCTA 表现和 IVB 反应性。
共纳入 100 只眼（64 只扁平不规则 PED 与 34 只局灶性 PED）。扁平不规则 PED 的症状持续时间长于局灶性 PED（7.20±11.52 个月与 3.69±3.98 个月，P=0.03）。在未经治疗的情况下，扁平不规则 PED 中视网膜下积液完全消退的比例明显低于局灶性 PED（34.78%与 65.22%，P=0.017）。与自然病程相反，扁平不规则 PED 对 IVB 的反应性明显更好（72.41%与 31.58%，P=0.005）。OCTA 显示扁平不规则 PED 的脉络膜新生血管更多（42.90%与 10.00%，P=0.014）。扁平不规则 PED 的中心凹下脉络膜厚度明显较厚。
在伴有扁平不规则 PED 的 CSC 患者中，其自然病程较差，但 IVB 治疗反应良好。扁平不规则 PED 患者的症状持续时间和中心凹下脉络膜厚度均长于局灶性 PED。OCTA 显示扁平不规则 PED 的脉络膜新生血管更多。这些发现表明，伴有扁平不规则 PED 的 CSC 可能被认为是一种厚脉络膜新生血管病变。
