Department of Ophthalmology, Leiden University Medical Center, Department J3-S, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands.
Sci Rep. 2021 Feb 2;11(1):2748. doi: 10.1038/s41598-021-82536-2.
Multiple case series have provided evidence for a relatively high incidence of central serous chorioretinopathy (CSC) in patients with active Cushing's syndrome (CS). We describe the ophthalmological status in detail of consecutive patients with active endogenous CS (either de novo or recurrent active endogenous CS) in this prospective cohort study. All patients underwent complete ophthalmological examination, including multimodal imaging, which was performed shortly after establishing the diagnosis of active CS in hypercortisolemic state. Eleven CS patients (4 men, 7 women) with active hypercortisolism were included. Abnormalities reminiscent of (subclinical) CSC were found in 3 patients. Optical coherence tomography (OCT) revealed macular subretinal fluid in 1 patient, who was diagnosed as having active CSC and was successfully treated with half-dose photodynamic therapy. Two other patients showed CSC-like abnormalities: an unilateral pseudovitelliform lesion on OCT and hyperfluorescent changes on fluorescein angiography in one patient, and unilateral leakage on fluorescein angiography in the other patient. Mean subfoveal choroidal thickness on enhanced depth imaging OCT was 270 ± 40 μm (range, 178 - 357 μm). Retinal abnormalities resembling (subclinical) CSC may be more common than previously thought in patients with active CS, and may exist even in patients without visual complaints. Clinicians should have a low threshold for ophthalmological evaluation in case of a CS patient with visual symptoms since there may be therapeutic opportunities to prevent vision loss.
多例病例系列研究为活性库欣综合征（CS）患者中中心性浆液性脉络膜视网膜病变（CSC）的相对高发提供了证据。在这项前瞻性队列研究中，我们详细描述了连续患有活动性内源性 CS（无论是新发还是复发性活动性内源性 CS）的患者的眼科状况。所有患者均接受了完整的眼科检查，包括多模态成像，这些检查是在皮质醇升高状态下确诊为活动性 CS 后不久进行的。本研究纳入了 11 例患有活动性高皮质醇血症的 CS 患者（4 名男性，7 名女性）。3 例患者出现类似于（亚临床）CSC 的异常。1 例患者的光学相干断层扫描（OCT）显示黄斑下视网膜积液，被诊断为活动性 CSC，并成功接受半剂量光动力疗法治疗。另外 2 例患者表现出 CSC 样异常：1 例患者 OCT 上单侧假性类 vitelliform 病变和荧光素血管造影上的高荧光改变，另 1 例患者荧光素血管造影上单侧渗漏。增强深度成像 OCT 下的平均中心凹下脉络膜厚度为 270±40μm（范围，178-357μm）。在活动性 CS 患者中，类似于（亚临床）CSC 的视网膜异常可能比以前认为的更为常见，甚至可能存在于没有视觉主诉的患者中。如果 CS 患者出现视觉症状，临床医生应该对眼科评估持低阈值，因为可能存在治疗机会来预防视力丧失。
