焦点性レーザー治療を受けた中心性漿液性絨毛網膜症における適応光学系と眼底自家蛍光を用いた視細胞の評価

Photoreceptor assessment in focal laser-treated central serous chorioretinopathy using adaptive optics and fundus autofluorescence.

• Radu Ochinciuc
• Uliana Ochinciuc
• Horia T Stanca
• Ramona Barac
• Diana Darabus
• Marius Şuţă
• Florian Baltă
• Marian Burcea

抄録

本研究では、焦点性レーザー治療を受けた中心性漿液性絨毛網膜症（CSC）患者のコーン密度、コーンモザイク、眼底自家蛍光（FAF）画像を解析した。FAFとコーンモザイク画像はすべての患者で適応光学眼底カメラを使用して取得されました。脈絡膜厚さの平均は419.95"Zs_200A"±"Zs_200A"110でした。33"Zs_200A"μm、活動性CSCを有する眼では459.09"Zs_200A"±"Zs_200A"90.07"Zs_200A"μm、治療眼では438.61"Zs_200A"±"Zs_200A"107.57"Zs_200A"μmであった。健康な眼における錐体の最高密度は38146"Zs_200A"錐体/mmで、中心から側方700"Zs_200A"μmの位置に5.66μmの細胞間空間(IS)があった。CSCの治療を受けた眼では、最も高い密度は32749"Zs_200A"錐体/mmで、中心から鼻側500"Zs_200A"μmの位置に6.13μmの細胞間空間（IS）を有していた。すべての象限において、コーン密度の最大値の中央値は健常眼で有意に高かった（P"Zs_200A"="Zs_200A".02、P"Zs_200A"="Zs_200A".003、P"Zs_200A"="Zs_200A".0001、P"Zs_200A"="Zs_200A".001）。FAFでは3種類の病変が確認され、コーンモザイク画像の病変と相関していた。最初のFAF画像における低自発光病変の存在と、視細胞密度の最大値の差が大きいこと（r"Zs_200A"="Zs_200A"0.46、P"Zs_200A"="Zs_200A".03）との間に強い相関が認められた。また、低自発光性病変の存在と病理学的期間との間には（r"Zs_200A"="Zs_200A"0.68, P"Zs_200A"<"Zs_200A".001）、低自発光性病変の存在と病理学的期間はCSCの負の予後因子であることが示された。レーザー治療は光受容体の損失を防ぐことができます。

This study analyzed cone density, cone mosaic, and fundus autofluorescence (FAF) images in patients with focal laser-treated central serous chorioretinopathy (CSC).Observational case series.Forty-two eyes of 21 patients with unilateral treated CSC and bilateral best-corrected visual acuity of 1.0 (decimal fraction) were included. FAF and cone mosaic images were obtained in all patients with an adaptive optics fundus camera. Densities were recorded at 20 points throughout the macula, and choroidal thicknesses were measured.Mean choroidal thicknesses were 419.95 ± 110.33 μm in normal eyes, 459.09 ± 90.07 μm in eyes with active CSC, and 438.61 ± 107.57 μm in treated eyes. The highest density of cones in healthy eyes was 38146 cones/mm, with a 5.66-μm intercellular space (IS), at 700 μm temporal to the center. In eyes with treated CSC, the highest density was 32749 cones/mm, with a 6.13-μm IS, at 500 μm nasal to the center. In all quadrants, median values of maximum cone density were significantly higher in healthy eyes (P = .02, P = .003, P = .0001, and P = .001). Three types of lesions were identified on FAF and were correlated with those on cone mosaic images. Strong correlations were detected between the presence of hypoautofluorescent lesions on the first FAF image and a greater difference between maximum values of photoreceptor density (r = 0.46, P = .03), as well as between the presence of hypoautofluorescent lesions and the duration of pathology (r = 0.68, P < .001).The presence of hypoautofluorescent lesions and the duration of pathology were negative prognostic factors in CSC. Laser treatment could prevent photoreceptor loss.