Multimodal assessment of patients with chronic central serous chorioretinopathy

ABSTRACT Purpose: To examine differences between fluorescein angiography (FA) and indocyanine green angiography (ICG) findings in patients with chronic central serous chorioretinopathy (CSC), comparing these with optical coherence tomography (OCT) findings. Methods: Ten consecutive patients with chronic CSC (19 eyes; 7 men; mean age, 50.7 ± 8.4 years) underwent multimodal evaluation that included FA, ICG, and OCT (Spectralis HRA-OCT, Heidelberg Engineering, Heidelberg, Germany). Changes such as hyperfluorescence (caused by increased transmission of the normal choroidal fluorescence, staining, or "pooling") and hypofluorescence (caused by a blockage or vascular filling defect) were evaluated in the early (4 min), middle (4-8 min) and late (>8 min) angiography phases and compared to OCT findings. Results: Bilateral disease was present in nine of the 10 patients. Areas of discontinuation or attenuation of the hyporeflective layer of the retinal pigment epithelium (RPE) on OCT were observed at the same locations as hyperfluorescent angiography window defects on FA and ICG within examination phases. In areas of serous or RPE detachment, the hyperfluorescence pattern was similar on FA and ICG. However, ICG demonstrated areas of hyperfluorescence secondary to choriocapillaris hyperpermeability, with no corresponding change on FA in 12 (70%) of the 19 eyes. This finding was more evident in the middle and late phases of the examinations and there was no evident change in retinal architecture on OCT in these hyperpermeable choroidal regions. Conclusion: In patients with chronic CSC, ICG may reveal choroidal abnormalities that are not evident on FA. This finding may help optimize the monitoring and treatment of CSC.

摘要：目的：探讨慢性中心性浆液性脉络膜视网膜病变（chronic central serous chorioretinopathy, CSC）患者的荧光素眼底血管造影（fluorescein angiography, FA）与吲哚菁绿血管造影（indocyanine green angiography, ICG）表现差异，并将其与光学相干断层扫描（optical coherence tomography, OCT）结果进行对比分析。方法：连续纳入10例慢性CSC患者（共19只患眼，其中男性7例，平均年龄50.7±8.4岁），采用多模态影像技术完成评估，涵盖FA、ICG及光学相干断层扫描（Spectralis HRA-OCT，海德堡工程公司，德国海德堡）。分别于血管造影早期（4 min）、中期（4~8 min）及晚期（＞8 min）阶段，对高荧光（由正常脉络膜荧光透射增强、染色或“渗漏积存”所致）与低荧光（由遮挡或血管充盈缺损所致）等病变特征进行评估，并与OCT影像结果对比。结果：10例患者中9例存在双侧病变。光学相干断层扫描下视网膜色素上皮（retinal pigment epithelium, RPE）低反射层断裂或衰减的区域，与各造影阶段FA及ICG显示的窗样缺损高荧光区域位置完全一致。在浆液性脱离或RPE脱离区域，FA与ICG的高荧光表现模式较为相似。但在19只患眼中的12只（70%），ICG可检出因脉络膜毛细血管高通透性继发的高荧光区域，而此类区域在FA上无对应改变；该表现在造影中期及晚期更为显著，且此类高通透性脉络膜区域的OCT视网膜结构未出现明显异常。结论：针对慢性CSC患者，ICG可发现FA无法显现的脉络膜异常，该发现有助于优化慢性CSC的监测与治疗策略。