RISK FACTORS FOR RECURRENCES OF CENTRAL SEROUS CHORIORETINOPATHY
RISK FACTORS FOR RECURRENCES OF CENTRAL SEROUS CHORIORETINOPATHY
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DOI：
10.1097/iae.0000000000001729
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发表时间：
2018-07-01
影响因子：
3.3
通讯作者：
Behar-Cohen, Francine
中科院分区：
文献类型：
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作者：
Matet, Alexandre;Daruich, Alejandra;Behar-Cohen, Francine
目的：描述复发模式和调查的候选危险因素复发的中心性浆液性脉络膜视网膜病变。方法：在46例急性中心性浆液性脉络膜视网膜病变和随访。12个月后，首次发病决议，参数影响复发进行了回顾性评估，采用脆弱的考克斯比例风险生存模型。协变量包括基线全身性结果：年龄、性别、皮质类固醇使用、压力、轮班工作、睡眠障碍、抑郁、过敏、心血管风险;基线光学相干断层扫描结果：中心凹下脉络膜厚度、色素上皮脱离模式（规则/肿块/不规则），渗漏部位视网膜下高反射病灶数量;基线血管造影结果：荧光素渗漏强度（强烈/中度/轻微/不存在），吲哚菁绿血管造影显示高通透性模式（局灶性/多灶性）;和发作相关发现：既往发作的持续时间和治疗。46例受试者中有20例（43%）在平均随访29.9 +/- 9.5个月（范围，15-54个月）期间出现≥ 1次复发。随访持续时间在有或无复发病例之间没有差异（P = 0.3）。随访期间，最终视力水平（最小分辨角的对数）越差，发作次数越多（P = 0.032，r = 0.28）。在单因素分析中，高中心凹下脉络膜厚度（P = 0.021），非强荧光素渗漏中度/轻微/无，P = 0.033）、多个视网膜下高反射灶（P = 0.026）和轮班工作（P < 0.0001）与复发显著相关，不规则色素上皮脱离的影响接近显著（P = 0.093）。多因素分析显示，中心凹下脉络膜厚度（P = 0.007）、非强荧光素渗漏（P = 0.003）和轮班工作（P < 0.0001）仍是复发的独立危险因素。这些发现可能有助于识别风险较高的患者，这些患者可以从早期或更密集的治疗中获益。
Purpose: To describe recurrence patterns and investigate candidate risk factors for recurrences of central serous chorioretinopathy.Methods: In 46 patients with acute central serous chorioretinopathy and follow-up.12 months after first episode resolution, parameters influencing recurrences were retrospectively evaluated using a frailty Cox proportional hazard survival model. Covariates included baseline systemic findings: age, gender, corticosteroid use, stress, shift work, sleep disorder, depression, allergy, cardiovascular risk; baseline optical coherence tomography findings: subfoveal choroidal thickness, pigment epithelial detachment pattern (regular/bump/irregular), number of subretinal hyperreflective foci at leakage site; baseline angiographic findings: fluorescein leakage intensity (intense/moderate/subtle/absent), hyperpermeability pattern on indocyanine-green angiography (focal/multifocal); and episode-related findings: duration and treatment of previous episode.Results: Twenty of 46 subjects (43%) presented >= 1 recurrences during a mean follow-up of 29.9 +/- 9.5 months (range, 15-54 months). Follow-up duration did not differ between cases with or without recurrences (P = 0.3). Worse final visual acuity levels (logarithm of the minimal angle of resolution) were associated with a higher number of episodes during follow-up (P = 0.032, r = 0.28). In a univariate analysis, higher subfoveal choroidal thickness (P = 0.021), nonintense fluorescein leakage (= moderate/subtle/absent, P = 0.033), multiple subretinal hyperreflective foci (P = 0.026), and shift work (P < 0.0001) were significantly associated with recurrences, with a near-significant influence of irregular pigment epithelial detachment (P = 0.093). In a multivariate analysis, higher subfoveal choroidal thickness (P = 0.007), nonintense fluorescein leakage (P = 0.003) and shift work (P < 0.0001) remained significant and independent risk factors for recurrences.Conclusion: Multiple factors influence the risk of central serous chorioretinopathy recurrence. These findings may contribute to identify patients at higher risk, who could benefit from earlier or more intensive treatment.