Department of Ophthalmology, OphtalmoPôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université Paris 5, Sorbonne Paris Cité, Paris, France.
Department of Endocrinology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, AP-HP, Université Paris 5, Sorbonne Paris Cité, Paris, France.
Acta Ophthalmol. 2021 Aug;99(5):533-537. doi: 10.1111/aos.14664. Epub 2020 Nov 16.
Glucocorticoid intake is a well-established risk factor for central serous chorioretinopathy that belongs to the pachychoroid spectrum disease (PSD). The study aimed to assess the prevalence of PSD and analyse the choroidal phenotype in patients with Cushing syndrome.
A cross-sectional study was performed in Ophtalmopôle hôpital Cochin, Paris, France, with a systematic evaluation of hospitalized patients with Cushing syndrome, between November 2017 and July 2018. 56 eyes from 28 Cushing syndrome patients and 56 eyes of 28 age and gender-matched, and close spherical equivalent healthy participants were included. All patients underwent a complete ophthalmic examination including Enhanced-Depth Imaging (EDI)-Optical Coherence Tomography (OCT). Measures of subfoveal, 1000 µm nasal and 1000 µm temporal choroidal thicknesses were realized, and the presence of choroidal pachyvessels was evaluated. Hormonal tests evaluated the corticotropic axis.
The number of eyes with PSD was significantly higher in Cushing syndrome patients as compared to controls (21.4% versus 3.6%, p = 0.004). In Cushing patients' eyes, 17.9% had a pachychoroid pigment epitheliopathy (PPE) and 3.6% had a polypoidal choroidal vasculopathy. Pachyvessels were more common in Cushing syndrome patients than in healthy subjects (71.4% versus 42.9%, p = 0.002). Mean subfoveal choroidal thickness was 331 ± 110 µm in Cushing patients, with no statistical difference between the two groups. There was no correlation between choroidal thickness and urinary and salivary cortisol levels.
Patients with Cushing syndrome have a higher prevalence of PDS. An ophthalmologic specialized follow-up of these patients with EDI-OCT could detect chorioretinal abnormalities and adapt the surveillance of these patients.
糖皮质激素的摄入是导致中心性浆液性脉络膜视网膜病变的一个明确的危险因素，这种疾病属于肥厚脉络膜谱疾病（PSD）。本研究旨在评估 PSD 的患病率，并分析库欣综合征患者的脉络膜表型。
本研究为在法国巴黎 Cochin 医院眼科中心进行的横断面研究，对 2017 年 11 月至 2018 年 7 月期间住院的库欣综合征患者进行了系统评估。纳入了 28 例库欣综合征患者的 56 只眼，以及 28 名年龄和性别匹配、且近视等效球镜相近的健康对照者的 56 只眼。所有患者均接受了全面的眼科检查，包括增强深度成像（EDI）-光学相干断层扫描（OCT）。测量了黄斑中心凹下、鼻侧 1000μm 和颞侧 1000μm 脉络膜厚度，并评估了脉络膜肥厚血管的存在情况。激素检测评估了促皮质激素轴。
与对照组相比，库欣综合征患者中 PSD 眼的数量明显更高（21.4%比 3.6%，p=0.004）。在库欣患者的眼中，17.9%患有肥厚脉络膜色素上皮病变（PPE），3.6%患有息肉样脉络膜血管病变。肥厚血管在库欣综合征患者中比在健康受试者中更常见（71.4%比 42.9%，p=0.002）。库欣患者的黄斑中心凹下脉络膜平均厚度为 331±110μm，两组间无统计学差异。脉络膜厚度与尿和唾液皮质醇水平之间无相关性。
库欣综合征患者 PSD 的患病率较高。对这些患者进行 EDI-OCT 眼科专科随访可以检测到脉络膜视网膜异常，并调整这些患者的监测。
