Study on antifibrinolytic agents associated with central serous chorioretinopathy

我们进行了一项临床研究，以证实中心性浆液性脉络膜视网膜病变(CSC)是由于涡旋静脉血栓形成导致脉络膜循环障碍，导致血清纤溶酶原激活物抑制物1(PAI1)水平升高所致。采集83例CSC急性期患者的血样，进行荧光素眼底血管造影和吲哚青绿红外血管造影。采用双抗体夹心法测定血浆纤溶酶原激活物1水平。CSC患者血清PAI1水平为11~579 ng/ml，中位数为45 ng/ml，明显高于年龄匹配的正常对照组(7~84 ng/ml)，中位数为36 ng/ml，其中40例(48%)血清PAI水平高于正常值上限50 ng/ml，提示CSC急性期血清PAI1水平升高，可能与血清PAI1水平升高相关的促凝状态有关。结合吲哚青绿眼底血管造影显示的脉络膜循环延迟，我们的研究结果可能支持CSC是由于脉络膜循环中凝血增加所致的假说。我们还研究了CSC患者中常见的浆液性视网膜色素上皮脱离的光学相干断层扫描所获得的断层图像。浆液性RPE脱离的圆顶状突起比特发性息肉状脉络膜血管病的橙红色结节更不突出。

We performed a clinical study to verify the hypothesis that the central serous chorioretinopathy (CSC) is caused by increased serum level of plasminogen activator inhibitor 1 (PAI1) through the choroidal circulatory disturbance due to vortex Vein thrombosis. Blood sample was collected from 83 patients with acute stage of CSC, in whom fluorescein fundus angiogram and indocyanine green infrared angiogram were obtained. PAI1 level was determined by ELISA. Serum level of PAI1 in the patients with CSC ranged from 11 to 579 ng/ml with the median of 45 ng/ml, which was significantly higher than that in the age-matched normal control ranging from 7 to 84 ng/ml with the median of 36 ng/ml. Serum level of Pal in 40 patients (48%) with CSC was higher than 50 ng/ml that is the upper limit of the normal value.These results indicate that the serum level of PAI1 is elevated in the acute phase of CSC and that the disease may be caused from the procoagulant conditions associated with the elevated serum PAI1 level. We also found that the elevated serum level of PAI1 is maintained for several months to years in some patients, which may be responsible for the high tendency toward the disease recurrence.In combination with the delayed choroidal circulation revealed by the indocyanine green fundus angiegram, the results of the present study may support the hypothesis that CSC results from increased blood coagulation in the choroidal circulation.We also investigated the cross-sectional image obtained by the optical coherent tomography of serous detachment of retinal pigment epithelium frequently seen in eyes with CSC. The dome shaped prominence of the serous RPE detachment was less protrusive than the orange-red nodules observed in eyes with idiopathic polypoidal choroidal vasculopathy.