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中心性浆液性脉络膜视网膜病变的生物标志物

Biomarkers for central serous chorioretinopathy.

作者信息

Nkrumah Gideon, Paez-Escamilla Manuel, Singh Sumit Randhir, Rasheed Mohammed Abdul, Maltsev Dmitri, Guduru Abhilash, Chhablani Jay

机构信息

School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

出版信息

Ther Adv Ophthalmol. 2020 Aug 24;12:2515841420950846. doi: 10.1177/2515841420950846. eCollection 2020 Jan-Dec.

Abstract

Central serous chorioretinopathy (CSCR) is a common chorioretinal disease characterized by serous retinal detachment that most commonly involves the macular region. Although the natural history of the acute form shows a self-limiting course, a significant number of patients suffer from recurrent episodes leading to chronic disease, often leaving patients with residual visual impairment. Visual morbidity is often worsened by a delay in the diagnosis due to the incorrect understanding of the particular biomarkers of the disease. The aim of this review is to provide clinical understanding of the biomarkers of CSCR with an emphasis on the most recent findings in patient demographics, risk factors, clinical imaging findings, and management options. Patients with these biomarkers, age 30-44 years, male gender, increased stress levels, hypercortisolism (endogenous and exogenous exposures), sleep disturbance, pregnancy, and genetic predisposition have increased susceptibility to CSCR. Also, biomarkers on optical coherence tomography (OCT) such as choroidal thickness (CT) and choroidal vascularity index (CVI) showed good diagnostic and prognostic significance in the management of CSCR. There are nonspecific features of CSCR on OCT and OCT angiography such as choroidal neovascularization, photoreceptor alteration/cone density loss, and flat irregular pigment epithelium detachment. We described rare complications of CSCR such as cystoid macular edema (CME) and cystoid macular degeneration (CMD). Patients with CME recovered some vision when treated with anti-vascular endothelial growth factors (anti-VEGFs). Patients with CMD had irreversible macular damage even after treatment with anti-VEGFs.

摘要

中心性浆液性脉络膜视网膜病变(CSCR)是一种常见的脉络膜视网膜疾病,其特征为浆液性视网膜脱离,最常累及黄斑区。尽管急性形式的自然病程呈自限性,但相当数量的患者会反复发作导致慢性病,常使患者遗留视力损害。由于对该疾病特定生物标志物的错误认识导致诊断延迟,视力损害往往会加重。本综述的目的是提供对CSCR生物标志物的临床理解,重点关注患者人口统计学、危险因素、临床影像学表现和治疗选择方面的最新发现。具有这些生物标志物的患者,年龄在30 - 44岁、男性、压力水平升高、皮质醇增多症(内源性和外源性暴露)、睡眠障碍、妊娠以及遗传易感性,对CSCR的易感性增加。此外,光学相干断层扫描(OCT)上的生物标志物,如脉络膜厚度(CT)和脉络膜血管指数(CVI),在CSCR的管理中显示出良好的诊断和预后意义。OCT和OCT血管造影上CSCR有非特异性特征,如脉络膜新生血管、光感受器改变/视锥细胞密度丧失以及扁平不规则色素上皮脱离。我们描述了CSCR的罕见并发症,如黄斑囊样水肿(CME)和黄斑囊样变性(CMD)。CME患者接受抗血管内皮生长因子(抗VEGF)治疗后视力有所恢复。CMD患者即使接受抗VEGF治疗后仍有不可逆的黄斑损害。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61a5/7448152/a066662b2e0f/10.1177_2515841420950846-fig1.jpg

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