Cohen S Y, Quentel G, Guiberteau B, Delahaye-Mazza C, Gaudric A
Centre d'Imagerie et de Laser, Paris, France.
Ophthalmology. 1998 Oct;105(10):1831-4. doi: 10.1016/S0161-6420(98)91024-7.
To describe a previously unreported complication of tilted disc syndrome: serous retinal detachment, caused by subretinal leakage, that mimics chronic idiopathic central serous chorioretinopathy (ICSC).
Retrospective cohort study.
Five patients (five eyes) participated.
Fluorescein angiographic features were measured.
All patients presented with visual loss and metamorphopsia. Fundus examination showed features typical of tilted disc syndrome, including obliquely directed long axis of the disc, situs inversus, retinal pigment epithelium conus, hypopigmentation and staphylomatous ectasia inferonasal to the optic disc, as well as a serous retinal detachment. Fluorescein angiography showed a site of leakage or multiple focal areas of staining and atrophy of the retinal pigment epithelium that correlated to the linear pigmentary changes observed at the junction with the inferior staphyloma. The fluorescein angiographic pattern was very similar to that of chronic ICSC. Spontaneous healing occurred in one case, and successful photocoagulation of the site of leakage was applied in two cases; two eyes could not be photocoagulated because of diffuse leakage in the macular region.
To the authors' knowledge, macular serous retinal detachment due to subretinal leakage has not been reported as a complication of tilted disc syndrome. The authors hypothesize that choriocapillary and pigment epithelial disturbances at the junction of the inferior staphyloma permit the subretinal leakage, but the pathogenesis of this complication remains unclear. A study of larger series of such patients is needed to identify the most appropriate management of these cases, which first need to be differentiated from a chronic form of ICSC.
描述倾斜盘综合征一种先前未报道的并发症：浆液性视网膜脱离，由视网膜下渗漏引起，酷似慢性特发性中心性浆液性脉络膜视网膜病变（ICSC）。
回顾性队列研究。
5例患者（5只眼）参与。
测量荧光素血管造影特征。
所有患者均出现视力下降和视物变形。眼底检查显示倾斜盘综合征的典型特征，包括视盘长轴斜向、位置反转、视网膜色素上皮圆锥、色素脱失以及视盘鼻下的葡萄肿样扩张，还有浆液性视网膜脱离。荧光素血管造影显示渗漏部位或多个视网膜色素上皮染色及萎缩的局灶性区域，与在下方葡萄肿交界处观察到的线性色素改变相关。荧光素血管造影模式与慢性ICSC非常相似。1例自发愈合，2例对渗漏部位成功进行了光凝治疗；2只眼因黄斑区弥漫性渗漏无法进行光凝治疗。
据作者所知，视网膜下渗漏导致的黄斑浆液性视网膜脱离尚未作为倾斜盘综合征的并发症被报道。作者推测下方葡萄肿交界处的脉络膜毛细血管和色素上皮紊乱导致视网膜下渗漏，但这种并发症的发病机制仍不清楚。需要对更多此类患者进行研究，以确定这些病例的最合适治疗方法，这些病例首先需要与慢性形式的ICSC相鉴别。
