Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea; Translational Genome Informatics Laboratory, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Ophthalmol Retina. 2022 Oct;6(10):939-948. doi: 10.1016/j.oret.2022.04.015. Epub 2022 Apr 25.
To compare the clinical features, treatments, and outcomes between bullous and chronic variants of central serous chorioretinopathy (CSC).
Retrospective, observational case series.
Sixty-two eyes of 44 patients with bullous-variant CSC (bvCSC) and 97 eyes of 85 patients with nonbullous CSC.
We conducted a national survey between September 1, 2020, and March 31, 2021, of members of the Korean Retina Society and obtained data of patients with bvCSC from 11 retinal centers. A comparator group comprised consecutive chronic CSC patients without bullous detachment.
Baseline demographics and patient characteristics were compared between groups. Secondary outcomes included factors associated with visual prognosis within the bvCSC group.
Compared with the nonbullous CSC group, the bvCSC group presented at a younger age (49 vs. 52 years; P = 0.047) and with more bilateral involvement (41% vs. 14%; P < 0.001). Systemic corticosteroid use was more prevalent in the bvCSC group, both in terms of any exposure (50% vs. 20%; P = 0.001) and long-term exposure (36% vs. 9%; P < 0.001). The bvCSC group had distinct imaging features (all P < 0.05): retinal folding (64% vs. 1%), subretinal fibrin (75% vs. 13%), multiple retinal pigment epithelium tears (24% vs. 2%), and multifocal fluorescein leakages with terminal telangiectasia (36% vs. 1%). Although bvCSC patients had worse vision at diagnosis (20/80 vs. 20/44; P = 0.003), treatment response was more robust (fluid resolution by final follow-up, 84% vs. 68%; P = 0.034) even with conservative management, resulting in similar final vision (20/52 vs. 20/45; P = 0.52). History of kidney-related (odds ratio [OR] 5.4; 95% confidence interval [CI] 1.3-18.5; P = 0.045) and autoimmune/rheumatoid diseases (OR 25.4, 95% CI 2.8-195.0; P = 0.004) showed associations with the bvCSC group. Apart from vision at diagnosis (OR 0.1, 95% CI 0.05-0.36; P < 0.001), a history of renal transplantation was most predictive of visual prognoses for bvCSC eyes (OR 0.2, 95% CI 0.04-0.75; P = 0.020).
Bullous-variant CSC may be associated with pathogenic risk factors based on underlying medical conditions and systemic corticosteroid use. Poor vision at diagnosis and history of renal transplantation were associated with poor visual outcome.
比较中心性浆液性脉络膜视网膜病变（CSC）的大疱性和慢性变异型的临床特征、治疗和结局。
回顾性、观察性病例系列研究。
44 例大疱性 CSCR（bvCSC）患者的 62 只眼和 85 例非大疱性 CSCR 患者的 97 只眼。
我们于 2020 年 9 月 1 日至 2021 年 3 月 31 日期间对韩国视网膜学会的成员进行了一项全国性调查，并从 11 个视网膜中心获得了 bvCSC 患者的数据。对照组由连续的无大疱性脱离的慢性 CSC 患者组成。
比较两组患者的基线人口统计学和患者特征。次要结局包括 bvCSC 组内与视力预后相关的因素。
与非大疱性 CSC 组相比，bvCSC 组患者就诊时年龄更小（49 岁比 52 岁；P=0.047），双侧受累更常见（41%比 14%；P<0.001）。bvCSC 组患者更常接受全身皮质类固醇治疗，无论是否暴露（50%比 20%；P=0.001）或长期暴露（36%比 9%；P<0.001）。bvCSC 组具有明显的影像学特征（均 P<0.05）：视网膜折叠（64%比 1%）、视网膜下纤维蛋白（75%比 13%）、多发性视网膜色素上皮撕裂（24%比 2%）和多发性荧光素渗漏伴终末毛细血管扩张（36%比 1%）。尽管 bvCSC 患者的诊断时视力较差（20/80 比 20/44；P=0.003），但治疗反应更强烈（最终随访时的液体分辨率，84%比 68%；P=0.034），即使采用保守治疗，最终视力也相似（20/52 比 20/45；P=0.52）。肾脏相关疾病史（比值比 [OR] 5.4；95%置信区间 [CI] 1.3-18.5；P=0.045）和自身免疫/类风湿性疾病史（OR 25.4，95%CI 2.8-195.0；P=0.004）与 bvCSC 组相关。除了诊断时的视力（OR 0.1，95%CI 0.05-0.36；P<0.001），肾脏移植史是预测 bvCSC 眼视力预后的最主要因素（OR 0.2，95%CI 0.04-0.75；P=0.020）。
大疱性 CSCR 可能与潜在的医疗状况和全身皮质类固醇使用有关的致病危险因素有关。诊断时视力差和肾脏移植史与视力预后不良有关。
