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：中心性浆液性脉络膜视网膜病变（CSC）是全球第四大常见黄斑病变，可导致不可逆的视力丧失。它主要影响20至60岁的男性。大型前瞻性随机对照试验（如SPECTRA和PLACE试验）为该病的治疗提供了新的思路。他们已经建立了光动力疗法（PDT）作为CSC的最有效的治疗选择，其诱导脉络膜血管的局部灌注不足和随后的血管重塑。然而，约20 - 30%的PDT治疗患者没有显示出足够的治疗反应。这种缺乏治疗效果的原因是不明确的，并建议依赖于脉络膜血管的特点，可能会影响响应PDT.Recently，它已被假定，CSC患者显示眼睛的涡静脉之间的脉络膜血管扩张。在对37例CSC患者进行的一项回顾性研究中，Pang等人使用超宽视野ICG血管造影术在83%的CSC患者中检测到脉络膜血管扩张和涡旋静脉壶腹充血。另外两项回顾性研究也发现，与健康对照相比，CSC患者的脉络膜病变更大，使用SS-OCT成像，其仅限于脉络膜解剖结构的可视化，但不反映脉络膜血流。虽然上述假设是有趣的，可能有重大的临床意义，前瞻性对照研究，这一主题使用目前的金标准ICGA缺乏。此外，目前尚不清楚所观察到的血管脉络膜变化是否可能与CSC复发、慢性或甚至PDT治疗反应的风险增加有关。目的：拟议项目的目的是a）研究脉络膜血管解剖，特别是脉络膜吻合的发生，在CSC患者中以前瞻性和对照的方式进行，以及B）确定它们作为复发、慢性化和PDT治疗成功的潜在预后因素的相关性。使用超宽视野ICG血管造影术和光学相干断层扫描（OCT）对CSC患者和对照组的涡状静脉瘤病以及脉络膜解剖学和生理学的其他方面进行前瞻性比较。100例临床确诊CSC的患者将接受超宽视野ICG血管造影。将从接受广泛多模式成像的非CSC患者中招募100名对照患者。B部分：多中心回顾性分析宽视野ICG血管造影图像，以确定可能的预后因素。回顾性分析宽视野ICGA从阿姆斯特丹和弗赖堡。将分析所确定的因素与长期视力、治疗反应、疾病复发和慢性的相关性。此外，将分析接受PDT治疗的区域的术前和术后脉络膜血流。