造血干细胞移植术后激素致继发中心性浆液性脉络膜视网膜病变临床分析

Clinical features of steroid-induced central serous chorioretinopathy after hematopoietic stem cells transplantation

  • 摘要: 目的 探讨血液病患者造血干细胞移植术后全身应用糖皮质激素致中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的临床特点。 方法 回顾性分析经眼底检查、荧光素眼底血管造影(fundus fluorescein angiography,FFA)及光学相干断层扫描(optical coherence tomography,OCT)确诊并结合全身用药诊断为糖皮质激素致CSC的8例(11只眼)血液病造血干细胞移植术后患者的临床资料。 结果 发病时视力为0.1~0.5有5眼,0.6~1.0有6眼。眼底检查5眼后极部可见黄色纤维素样渗出,4眼伴有大泡状视网膜脱离。OCT检查见7眼单发神经上皮脱离,4眼多发神经上皮脱离,6眼伴有色素上皮脱离,5眼神经上皮脱离伴下方高反射信号。激素减量后患者视网膜下积液及渗出完全或部分吸收,视力有所恢复。 结论 造血干细胞移植术后CSC对患者视力损害极大。OCT检查可早期诊断,激素减量或停用可改善症状。

     

    Abstract: Objective To discuss the manifestations of central serous chorioretinopathy (CSC) induced by systemic application of steroid after hematopoietic stem cells transplantation. Methods Medical records of 8 patients (11 eyes) who were diagnosed as CSC induced by corticosteroid following hematopoietic stem cells transplantation and examined by fundoscopy, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were retrospectively analyzed. Results The best-corrected vision acuity (BCVA) in five eyes was 0.1-0.5, and 0.6-1.0 in six eyes on admission. Fundoscopy results showed yellow fibirinoid exudation in five eyes and bullous retinal detachment in four eyes. SD-OCT showed single sensory retinal detachment in seven eyes, and multifocal sensory retinal detachment in four eyes; retinal pigment epithelia detachment in six eyes, and five eyes with hypereflective spots below the sensory retina. Fluid and exudation below the sensory retina reduced after the decrease of corticosteroid dose, meanwhile the visual acuity improved. Conclusion CSC followed hematopoietic stem cells transplantation may damage the vision of patients. OCT may be helpful in early diagnosis. Stopping or reducing the doses of corticosteroids can improve the clinical symptoms.

     

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