Lyu Yanan, Li Xinxin, Gong Yuanyuan
Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.
Ophthalmologica. 2020;243(5):360-369. doi: 10.1159/000504052. Epub 2020 Jan 31.
AIMS: To analyze ocular fundus characteristics of patients finally diagnosed with fibrinous central serous chorioretinopathy (CSC) using multimodal imaging and compare the characteristics with images of other confusable exudative maculopathies. METHODS: We retrospectively reviewed the records from 189 patients with CSC and found records on 16 patients with fibrinous CSC. Some of these 16 patients were misdiagnosed with another exudative maculopathy and were treated inappropriately. Multimodal imaging comprised fundus photography, spectral-domain optical coherence tomography (OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), and OCT angiography (OCTA), and the results were compared with those of other exudative maculopathy patients from this study. RESULTS: Twenty-one eyes of 16 patients with a mean age of 45.44 ± 10.66 years were included in the study. The mean central choroidal thickness was 401.6 ± 47.6 μm. Eight of the 16 patients with fibrinous CSC had initially been misdiagnosed (such as with uveitis or exudative retinal detachment). On fundoscopy, a typical dark spot was seen in 19 eyes, surrounded by yellow-white exudate, corresponding to the site of leakage on FA. A hyporeflective oval-shaped vacuole-like area was observed in 14 patients. All patients showed FA signs of dye leakage and dilated choroidal vessels on ICGA. Among the patients misdiagnosed with choroidal neovascularization (CNV), OCTA showed a legible branching vessel and no signs of a blood flow signal breaking Bruch's membrane. CONCLUSIONS: A dark spot on fundus photography images and a hyporeflective vacuole on OCT are important clinical signs that can help avoid misdiagnosing fibrinous CSC. With some small confusing lesions suspected as CNV or chronic CSC in elderly patients, OCTA may help in their identification. FA/ICGA still helps to show dye leakage sites and typical dilated choroidal vessels in fibrinous CSC, similar to other common CSCs. Multimodal imaging is mandatory in order to establish an appropriate diagnosis.
目的：使用多模态成像分析最终诊断为纤维蛋白性中心性浆液性脉络膜视网膜病变（CSC）患者的眼底特征，并将这些特征与其他易混淆的渗出性黄斑病变的图像进行比较。 方法：我们回顾性分析了189例CSC患者的记录，发现了16例纤维蛋白性CSC患者的记录。这16例患者中有一些被误诊为其他渗出性黄斑病变并接受了不恰当的治疗。多模态成像包括眼底照相、光谱域光学相干断层扫描（OCT）、荧光素血管造影（FA）、吲哚菁绿血管造影（ICGA）和OCT血管造影（OCTA），并将结果与本研究中其他渗出性黄斑病变患者的结果进行比较。 结果：本研究纳入了16例平均年龄为45.44±10.66岁患者的21只眼。平均中心脉络膜厚度为401.6±47.6μm。16例纤维蛋白性CSC患者中有8例最初被误诊（如葡萄膜炎或渗出性视网膜脱离）。眼底检查时，19只眼中可见典型的暗点，周围有黄白色渗出物，对应于FA上的渗漏部位。14例患者观察到低反射椭圆形空泡样区域。所有患者FA均显示染料渗漏，ICGA显示脉络膜血管扩张。在误诊为脉络膜新生血管（CNV）的患者中，OCTA显示清晰的分支血管，且没有血流信号突破布鲁赫膜的迹象。 结论：眼底照相图像上的暗点和OCT上的低反射空泡是重要的临床体征，有助于避免纤维蛋白性CSC的误诊。对于老年患者中一些疑似CNV或慢性CSC的小的易混淆病变，OCTA可能有助于识别。与其他常见CSC相似，FA/ICGA仍有助于显示纤维蛋白性CSC中的染料渗漏部位和典型的脉络膜血管扩张。为了做出准确诊断，多模态成像是必不可少的。
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