摘要
中心性浆液性脉络膜视网膜病变(CSC)好发于20~50岁男性,以浆液性神经视网膜脱离为特征,可分为急性(自限性)与慢性(≥3个月)2种类型。慢性CSC易并发脉络膜新生血管和视网膜色素上皮(RPE)萎缩,导致视力不可逆损伤。CSC发病与遗传易感性(如CFH、NR3C2基因位点)、皮质类固醇暴露、内分泌紊乱、雄激素水平升高及精神压力等因素密切相关,其病理改变以脉络膜增厚和静脉超载为核心,表现为涡静脉吻合及脉络膜毛细血管衰减,进而引发RPE功能障碍。多模影像可显示特征性改变:眼底自发荧光呈重力依赖性颗粒状荧光信号;光学相干断层扫描提示椭圆体带损伤及光感受器外段缩短,与视力预后显著相关。在治疗方面,半剂量光动力疗法在解剖复位和视力改善方面具有优势,而微脉冲激光和盐皮质激素受体拮抗剂的疗效仍需大样本研究验证。未来需深入探索基因-环境互作机制及靶向治疗策略。本文就CSC的研究进展进行综述。
Central serous chorioretinopathy(CSC)predominantly affects males aged 20 to 50.It is characterized by serous neurosensory retinal detachment.CSC can be classified as acute(self-limiting)or chronic(lasting≥3 months)types.Complications of chronic CSC include choroidal neovascularization and retinal pigment epithelium(RPE)atrophy,which can lead to irreversible vision damage.Studies have found that the onset of CSC is associated with genetic predisposition(e.g.,CFH and NR3C2 gene loci),exposure to corticosteroid,endocrine disorders,elevated androgen levels,and psychological stress.Pathological changes center on choroidal thickening and venous overload,manifesting as vortex vein anastomosis and choroidal capillary attenuation.These changes subsequently lead to RPE dysfunction.Multimodal imaging reveals characteristic changes:fundus autofluorescence displays gravity-dependent granular fluorescence signals,while optical coherence tomography indicates damage to the ellipsoid zone and shortening of photoreceptor outer segments,both of which are significantly correlated with visual prognosis.Evidence-based treatment indicates that half-dose photodynamic therapy provides the most advantages in terms of anatomical reattachment and visual improvement.However,the efficacy of micropulse laser and mineralocorticoid receptor antagonists requires validation through large-sample studies.Further exploration of gene-environment interaction mechanisms and targeted treatment strategies is necessary in the future.This article reviews research advances in CSC.
作者
刘培(综述)
杜利平
金学民(审校)
Liu Pei;Du Liping;Jin Xuemin(Department of Ophthalmology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China)
出处
《中华实验眼科杂志(中英文)》
北大核心
2025年第8期754-760,共7页
Chinese Journal Of Experimental Ophthalmology
基金
国家自然科学基金(81970792、82171040)
河南省卫健委医学科技项目(YXKC2020026)。
关键词
中心性浆液性脉络膜视网膜病变
易感因素
病理改变
循证医学
综述
Central serous chorioretinopathy
Susceptible factors
Pathological changes
Evidence-based medicine
Review
作者简介
通信作者:金学民,Email:2740913223@qq.com。
