| Background and PurposeCentral serous chorioretinopathy(CSC),which is common in young and adult men,is a kind of fundus disease with unknown etiology,and has a self-limiting tendency.It is characterized by serous retinal detachment and/or retinal pigment detachment,most often confined to macular.The course of disease was prolonged for more than 6 months in a few patients,and diffuse retinal pigment epithelium(RPE)decompensation occurred in the lesion area,which is defined as chronic CSC.Most of these patients have more severe lesions,often accompanied by permanent loss of visual function.CSC is a multifactorial disease with unknown etiology.The advances in clinical examination techniques have given us a better understanding of the pathogenesis of CSC and help us better monitor the progress of disease and the response to treatment.Increased cortisol,type A personality,heredity,pregnancy and so on are risk factors for CSC,choroidal circulation abnormality and RPE dysfunction are the basic pathophysiological changes of CSC.Currently,there is no gold standard or clear guideline for the treatment of CSC.Laser photocoagulation,photodynamic therapy,transpupillary thermotherapy,micropulse laser and intravitreal injection of anti-vascular endothelial growth factor are the main methods for the treatment of CSC.However,the use of these methods has some limitations and adverse reactions,requiring large samples,randomized,controlled prospective clinical studies to improve.Laser photocoagulation can accelerate the recovery of visual acuity,but the final result is similar to that without laser therapy,and it is difficult to apply to patients with leakage point near macular fovea.Iatrogenic choroidal neovascularization is also a worrying complication.PDT is the first choice for the treatment of chronic CSC,is also suitable for patients with acute CSC.However,it is expensive and can lead to severe complications such as choroidal ischemia and retinal pigment epithelium atrophy.Intravitreal injection of anti-vascular endothelial growth factor can reduce choroidal hyperosmotic,reduce macular fovea thickness,improve visual acuity and has a low incidence of complications.It has become one of the options for the treatment of chronic,obstinate CSC or patients with diffuse leakage.It can also terminate the choroidal neovascularization(CNV)induced by laser photocoagulation.In this study,patients with chronic CSC were treated by intravitreal injection of Ranibizumab.The efficacy and safety of the treatment were observed.The choroidal thickness was measured at different time points before and after the treatment.Further analysis was made on morphology.Materials and MethodsThe study was designed with self-control series case study.From December 2015 to February 2017,a total of 48 patients with unilateral CSC were enrolled in the first group of ophthalmology,including 37males(37 eyes)and 11 females(11 eyes).The age was 26 ~ 58 years old.The mean age was(41.34 + 6.5)years old.All eyes were treated with intravitreous injection of Ranibizumab.The patients were informed of the risks and complications of the operation and informed consent.All cases received intravitreal injection of Ranibizumab.The visual acuity,intraocular pressure,and other routine ophthalmic examinations was recored before and 2,4,8 weeks after injection.Choroidal thickness at fovea and 1500 μm superior,inferior,nasal and temporal to the fovea were measured by OCT in enhanced depth imaging mode.was recored before and 2,4,8 weeks after injection.All measurements were completed independently by two experienced physicians,each measuring three times and taking the average.Statistical software SPSS 21.0 was used to analyze the data.The data of the measurement indexes in this study were tested by K-S,and were expressed as?x±s.The comparison of choroidal thickness in the same measurement direction and the overall difference of BCVA were analyzed by single factor ANOVA of repeated measurements and further compared with each other by LSD-t test(P < 0.05).The independent sample t test was used to compare the difference of choroid thickness between the eyes before and after injection.ResultsThe visual acuity(Log MAR)was 0.32±0.07,0.23±0.11,0.19±0.09 and 0.17±0.06 before and 2,4,8 weeks after injection.The visual acuity at different time point after injection was better than that before injection.The difference was significant between before and after injection(F=18.501,P<0.001).Subfoveal choroidal thickness(SFCT)before injection was(442.65±98.31)μm,which decreased significantly to(395.55±96.67)μm,(383.53±93.52)μm,(387.33±94.52)μm at 2,4,8 weeks after treatment respectively(F=105.552,P<0.001).The changing trends of choroidal thickness measuring points were similar to the SFCT.At 2 months after treatment,SFCT was slightly thicker than that at the 4 weeks,but no statistical significance was noted(LSD-t test:P=0.083).The changing trends of choroidal thickness at the other 4 measuring points were similar to that of the SFCT.ConclusionThe complication rate of intravitreal injection of Ranibizumab to treat chronic CSC is low,which can obviously improve the vision and promote the absorption of subretinal effusion.In chronic CSC patients,the eye choroid thickness is higher than that of the healthy eyes,and the therapy can reduce the choroid thickness of the macular region,but it cannot restore the thickness to normal.The patients with chronic CSC had higher binocular choroid thickness than normal. |
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