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Centrální serózní chorioretinopatie. Přehled

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Central Serous Chorioretinopathy. A Review

Central serous chorioretinopathy (CSC) is a disease characterized by serous detachment of the neuroretina, especially in the posterior pole of the eye. It is often accompanied by serous detachment of the retinal pigment epithelium (RPE) and associated with the leakage of fluid into the subretinal space through the defective RPE. CSC most often affects men of working age. The exact pathophysiology of the disease is not completely known. Based on indocyanine green angiography (ICG), which revealed increased permeability of choroidal vessels, and optical coherence tomography (OCT) showing increased choroidal thickness, choroidal vasculopathy is assumed to be the primary cause of CSC. In most cases, CSC has a good prognosis with spontaneous resorption of the subretinal fluid (SRF) and improvement of visual functions. However, in a small percentage of patients the disease progresses to a chronic or recurrent course, and can lead to irreversible functional and anatomical changes of the retina with a final clinical picture of diffuse retinal pigment epitheliopathy (DRPE). The optimal treatment approach for patients with CSC remains controversial. In recent decades, myriad therapeutic approaches have been used in the treatment of chronic forms of CSC (cCSC); these included for example laser photocoagulation, pharmaceutical treatment, standard photodynamic therapy (PDT) or anti-VEGF. In recent years a less destructive method, specifically PDT in reduced dose regimens, either with a reduced dose of verteporfin or the laser beam energy used, has been preferred in the treatment of cCSC. Comparable efficacy and safety has been demonstrated using reduced-dose or reduced-fluence PDT regimens in patients with cCSC, with an improvement in best-corrected visual acuity and reduction of SRF.

Keywords:

Retinal degeneration – photodynamic therapy – central serous chorioretinopathy – choroidal neovascularization – multimodal imaging

Autoři: Manethová Myslík;  Kateřina 1,2
Působiště autorů: Oční oddělení, Fakultní Thomayerova nemocnice, Praha 1;  Fakultní nemocnice Královské Vinohrady a 3. lékařská fakulta Univerzity Karlovy, Praha 2
Vyšlo v časopise: Čes. a slov. Oftal., 80, 2024, No. 2, p. 59-75
Kategorie: Přehledový článek
doi: https://doi.org/10.31348/2023/27

Souhrn

Centrální serózní chorioretinopatie (CSC) je onemocnění charakterizované serózním odchlípením neuroretiny zejména v zadním pólu oka. Často je doprovázené serózním odloučením retinálního pigmentového epitelu (RPE) a sdružené s prosakováním tekutiny do subretinálního prostoru skrze defektní RPE. CSC nejčastěji postihuje muže v produktivním věku. Přesná patofyziologie onemocnění není zcela známa. Na základě angiografického vyšetření s indocyaninovou zelení (ICG), která odhalila zvýšenou permeabilitu choroidálních cév, a optické koherenční tomografie (OCT) ukazující zvýšenou tloušťku choroidey se předpokládá choroidální vaskulopatie jako primární příčina vzniku CSC. Ve většině případů má CSC dobrou prognózu se spontánní resorpcí subretinální tekutiny (SRT) a úpravou zrakových funkcí. U malého procenta pacientů však onemocnění přechází do chronického či rekurentního průběhu a může vést k nevratným funkčním i anatomickým změnám sítnice s konečným klinickým obrazem difuzní retinální pigmentové epitelopatie (DRPE). Optimální léčebný přístup k pacientům s CSC zůstává kontroverzní. V posledních dekádách se v léčbě chronických forem CSC (cCSC) používalo nespočet léčebných přístupů; tyto zahrnovaly například laserovou fotokoagulaci, medikamentózní léčbu, standardní fotodynamickou terapii (PDT) či anti-VEGF. V posledních letech se v léčbě cCSC preferuje méně destruktivní metoda, kterou je PDT v redukovaných dávkovacích schématech, ať už s redukovanou dávkou verteporfinu nebo použité energie laserového paprsku. Je prokázána srovnatelná účinnost a bezpečnost při použití redukovaných schémat PDT u pacientů s cCSC, u kterých došlo ke zlepšení nejlépe korigované zrakové ostrosti i redukci SRT. 

Klíčová slova:

Choroidální neovaskularizace – centrální serózní chorioretinopatie – retinální degenerace – multimodální zobrazení – fotodynamická terapie

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