Study on antifibrinolytic agents associated with central serous chorioretinopathy

我们进行了一项临床研究，以验证中心性浆液性脉络膜视网膜病变（CSC）的假设，即血浆纤溶酶原激活物抑制剂1（PAI 1）水平升高，通过脉络膜循环障碍，由于涡静脉血栓形成引起的。对83例CSC急性期患者进行荧光素眼底血管造影和吲哚菁绿色红外眼底血管造影。ELISA法测定PAI 1水平。CSC患者血清PAI 1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。40例（48%）CSC患者血清PAI-1水平高于正常值上限50 ng/ml，提示CSC急性期PAI-1水平升高，可能是与PAI-1水平升高相关的促凝状态所致。我们还发现部分患者PAI-1的升高可持续数月至数年，这可能是导致疾病复发的原因，结合吲哚菁绿色眼底血管造影显示脉络膜循环延迟，本研究的结果可能支持CSC由脉络膜循环中血液凝固增加引起的假设。通过光学相干断层扫描获得的CSC眼中常见的视网膜色素上皮浆液性脱离的横截面图像。浆液性视网膜色素上皮脱离的圆顶状突起比特发性息肉状脉络膜血管病变中观察到的橙红色结节的肿胀性小。

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.