Study On Etiology And Initial Treatment Of Central Exudative Chorioretinopathy

Objective: To investigate the etiology of central exudative chorioretinopathy (CEC), and to evaluate the curative effect of corresponding therapies.Object and method: From April 2006 to November 2006,32 CEC out-patients in Beijing TongRen Eye Center were investigated, following up 1~6 months, 3.8 months in average. By asking the patient history, examining visual acuity, refract, ocular anterior segment, ocular tension, fundus, FFA and/or ICGA and OCT, to diagnose CEC. According to selecting and removing standard we chose CEC patients. The selected patients would fill in the questionnaire of risk factors and undergo a series of etiological examinations, including PPD and chest X-ray in internal medicine, detecting blood routine test, erythrocyte sedimentation rate, C-reactive protein, Torch test and syphilis test. According to the examin results, the patients would be treated differently:①the patients with active infection would be treated refer to infective diseases;②the patients PPD positive but without tuberculose focus would receive anti-tuberculosis experimental therapy;③the patients without any risk factors would selecte photodynamic therapy (PDT) or retrobulbar injected triamcinolone acetonide (TA). We would follow up all the patients at 1, 3 and 6 month after the treatment and compare the curative effect of these therapies, by the improvement of visual acuity, leakage of CNV, absorption of hemorrhage and edema.Results:1. Routin ophthalmic examination: in the first visit, the worst BCVA was0.05 and the best 0.6, BCVA <0.3 and≥0.3 was in half respectively. 26 patient (81.3%) were myopia of both eyes, and moderate myopia accounted 71.9%. The fundus and FFA of all the patients were typical, and according to the course of disease, there was 90.6% active period, 9.4% convalescent period, no scar period. According to OCT features, there was 78.1% active period, 21.9% intermediate period, no scar period.2. Questionnaire of infective factors: There were 8 men (25.0%), 24 women (75.0%), and the ratio was 1: 3; the ages ranged from 11 to 48 years with a mean of 31.2±10.0 years. The chief complaint was 32 blurred vision, and 30 with dysmorphopsia, 20 with black shadow. The prodrome was 7 overtiredness (21.9%), 6 overstress (18.8%). There were 24(75.0%) living in city and town, and 8(25.0%) in country, no forest region or graze region. No one got in touch with animals in work. 7(21.9%) patients got in close touch with cats or dogs. 4(12.5%) patients smoked. 10(31.3%) patients suffered pharyngitis, 6(18.8%) periodontitis, 4(12.5%) rhinitis.3. Clinical and chemical examinations of infective factors: In the investigation of etiology, the infection rate of tuberculosis was high, but not higher than common people. Almost all the people were normal in chest X-ray, blood routine test, erythrocyte sedimentation rate and C-reactive protein, without evidence of active tuberculosis. There was no results supporting newly infect of toxoplasmosis, rubella virus, cytomegalo virus, herpes simplex viruses or Treponema. There were evidence proving that 3 patients to had already been infected by virus, but the infection rate was lower than the one of mass survey in common women. In briefe, all the results supported that the CNV of CEC be idiopathic further more.4. Treatment:⑴Anti-tuberculosis therapy: There were 8 patients, whose PPD test results were≥10mm, accepted anti-tuberculosis experimental therapy, and the effect was satisfactory: the visual acuity was stable or rising, the leakage of CNV was reducing or stopping and the absorption of hemorrhage and edema was improved. The good effect might be related to the natural course of CEC or the pathogenic organism which was unknown and sensitive to antituberculous drugs.⑵PDT: 12 patients without positive results were treated with PDT, and most of their visual acuity, leakage of CNV, absorption of hemorrhage and edema were improved. When following up 1, 3 and 6 months, the leakage of CNV increased 1/12, 3/12 and 1/6 respectively, and 3 of them got better after twice treatment, and the other 2 patients gave up treatment because of financial straits. In the treatment course of PDT, there was no retinal injury or adverse reaction, which proved its safety.⑶TA therapy: 12 patients without positive results were treated with TA. When following up 1, 3 and 6 months, the visual acuity of 12, 11 and 3 patients was stable or rising, the leakage of CNV and absorption of hemorrhage and edema were improved or stable. In the treatment course of TA, the ocular tension of 1 patient got high, and reverted after stopping going on injecting TA, apart from this, we havn't observe other adverse reaction.Conclusion: 1. The infection rate of tuberculosis in CEC patients was high, but not higher than the common crowd, while anti- tuberculosis therapy was effective, but the mechanisms was not clear, might be related to the pathogenic organism which was unknown and sensitive to antituberculous drugs. 2. The etiology of CEC was no direct relation with infect of toxoplasmosis, rubella virus,cytomegalo virus, herpes simplex viruses or Treponema, so the CNV of CEC might be idiopathic. 3. Almost all the CEC patients treated with PDT or TA had good curative effect, so we suggested choosing TA firstly, but if possible the therapeutic alliance would be more expected.