Investigating the role of vortex vein anastomoses in central serous chorioretinopathy (CSC)

研究涡静脉吻合术在中心性浆液性脉络膜视网膜病变 (CSC) 中的作用

• 批准号: 504925416
• 负责人: Dr. Laurenz Pauleikhoff
• 金额: --
• 依托单位: Klinik und Poliklinik für Augenheilkunde
• 依托单位国家: 德国
• 项目类别: WBP Fellowship
• 财政年份: 2022
• 资助国家: 德国
• 起止时间: 2021-12-31 至 2022-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/504925416?language=en
• 关键词: Investigating; role; vortex; vein; anastomoses

Background: Central serous chorioretinopathy (CSC) is the fourth most common maculopathy worldwide and can lead to irreversible vision loss. It primarily affects men between 20 and 60 years of age. Large prospective randomized controlled trials (e.g. SPECTRA and PLACE trial) have shed new light upon the treatment of the disease. They have established photodynamic therapy (PDT) as the most effective treatment option for CSC, which induces a local hypoperfusion of choroidal vessels and a consequent vascular remodelling. However, about 20 to 30% of patients treated with PDT do not show a sufficient treatment response. The reason for this lack of therapeutic efficacy is ill defined and was suggested to depend on choroidal vascular characteristics that may impact response to PDT.Recently, it has been postulated that CSC patients show dilated choroidal anastomoses between the eye’s vortex veins. In a retrospective study of 37 patients with CSC, Pang et al. detected dilated choroidal vessels and congested vortex vein ampullas in 83% of eyes with CSC using ultra-widefield ICG angiography. Two further retrospective studies have also found larger choroidal anastomoses in CSC patients compared to healthy controls using SS-OCT imaging, which is limited to the visualization of the choroidal anatomy, but does not reflect choroidal blood flow. While the above mentioned hypothesis is intriguing and could have major clinical implications, prospective controlled studies on this subject using the current gold-standard ICGA are lacking. Furthermore, it is to date unclear if the observed vascular choroidal changes may be associated with an increased risk of CSC recurrences, chronicity or even PDT treatment response.Aim: The aim of the proposed project is a) to investigate choroidal vascular anatomy, in particular the occurrence of choroidal anastomosis, in CSC patients in a prospective and controlled manner and b) to determine their relevance as a potential prognostic factor for recurrence, chronicity and PDT treatment success.Plan: Part A: Prospective comparison of vortex vein anastomoses and other aspects of choroidal anatomy and physiology in CSC patients and controls using ultra-widefield ICG angiography and optical coherence tomography (OCT). 100 patients with a clinically confirmed diagnosis of CSC will undergo ultra-widefield ICG angiography,. 100 control patients will be recruited from non-CSC patients that undergo extensive multimodal imaging. Choroidal vascular characteristics will be compared between these groups.Part B: Multicentre retrospective analysis of widefield ICG angiography images to identify possible prognostic factors.Retrospective Analysis of widefield ICGAs from Amsterdam and Freiburg. The correlation of the identified factors with long-term visual acuity, therapy response, disease recurrence and chronicity will be analysed. Moreover, the pre- and postoperative choroidal flow in the area that received PDT treatment will be analyzed.

背景：中央浆液性脉络膜炎（CSC）是全球第四个最常见的大斑点病，可能导致视力丧失。它主要影响20至60岁之间的男性。大型前瞻性随机对照试验（例如光谱和地点试验）为疾病的治疗提供了新的启示。他们已经建立了光动力疗法（PDT）作为CSC最有效的治疗选择，它诱发了脉络膜血管的局部灌注不足和随之而来的血管重塑。但是，大约20％至30％的PDT患者没有表现出足够的治疗反应。缺乏治疗效率的原因是不明的，并建议取决于可能影响对PDT反应的脉络膜血管特征。 Pang等人对37例CSC患者的回顾性研究。使用Ultra Widefield ICG血管造影，在83％的CSC中检测到的脉络膜脉络视频和拥挤的涡流静脉。与使用SS-OCT成像的健康对照组相比，CSC患者中的另外两项回顾性研究还发现，CSC患者的脉络膜吻合率较大，这仅限于脉络膜解剖结构的可视化，但不反映脉络膜血流。尽管上述假设很有趣，并且可能具有重大的临床意义，但缺乏使用当前金标准ICGA对该主题的前瞻性对照研究。此外，迄今为止尚不清楚观察到的血管脉络膜变化是否可能与CSC复发，慢性甚至PDT治疗的风险增加有关。IAM：aim：拟议项目的目的是a）研究脉络性血管解剖结构的目的是研究脉络膜解剖结构，尤其是在脉络性拼叠的患者中，脉络性厌氧症的发生因素，并且是脉络性厌氧的发生因素，并且是脉络性厌氧的因素，并且是脉络性厌氧的因素。平面图：A部分：涡流静脉吻合术以及CSC患者中脉络膜解剖学和生理学的其他方面的前瞻性比较，以及使用超宽菲尔德ICG血管造影和光学相干性术（OCT）。有100例临床确认的CSC诊断患者将接受超宽的ICG血管造影。从非CSC患者中招募100名对照患者，这些患者接受了广泛的多模式成像。这些组之间将比较脉络膜血管特征。部分：广场ICG血管造影图像的多中心回顾性分析，以鉴定可能的预后因素。对阿姆斯特丹和弗莱堡的广场ICGA的反映性分析。确定因素与长期视力，治疗反应，疾病复发和慢性的相关性将被分析。此外，将分析接受PDT治疗区域的术前和术后脉络膜流。