CAJ | 학술논문

[目的]观察急性区域性隐匿性外层视网膜病变(AZOOR)的临床特征.[方法]临床确诊为AZOOR的18例患者18只眼纳入研究.所有患者均行矫正视力、眼底、视野、视网膜电图(ERG)检查.部分患者同时行荧光素眼底血管造影(FFA)、光相干断层扫描(OCT)、视觉诱发电位(VEP)及多焦视网膜电图(mf-ERG)检查.观察患者的临床特征.对比分析患眼与对侧眼的视觉电生理检查结果.分析同时行OCT、视野和mf-ERG检查者的检测结果一致性.[结果]患者中,男性3例,女性15例;均为单眼发病.其中,正视2只眼,占l1.1％;近视16只眼,占88.9％.无明显眼底改变11只眼,占61.1％；黄斑区附近单发黄白色点状病灶或视网膜色素上皮改变3只眼,占16.7％；颞侧呈区域性脱色素改变4只眼,占22.2％.所有息眼中心视野异常,周边视野正常.行OCT检查的患眼均存在不同程度光感受器细胞内外节连接(IS/OS)光带中断、缺失或毛糙.ERG检查发现,与对侧眼比较,患眼视杆反应b波,最大反应a/b波,视锥反应a、b波及30 Hz闪烁光反应振幅均降低,差异有统计学意义(t=3.516,2.689,3.103,3.517,2.999,3.309；P＜0.05)；除视杆反应b波潜伏期差异无统计学意义外(t=1.023,P=0.306),其余波潜伏期均较对侧眼延长,差异有统计学意义(P＜0.05).VEP检查发现,患眼P100波振幅较对侧眼降低,差异有统计学意义(t=2.040,P=0.041)；患眼与对侧眼P100波潜伏期比较,差异无统计学意义(t=1.687,P=0.092).行mf-ERG检查的患眼均存在振幅改变.OCT与mf-ERG检测结果具有良好的一致性；而中心视野与mf-ERG检测结果不完全一致,其异常区域分布不相吻合.[结论]AZOOR以青年女性、近视眼发病为多见；通常无明显眼底改变；但中心视野及视觉电生理检查存在异常,OCT检查可见其存在不同程度的IS/OS光带中断、缺失或毛糙.
[목적]관찰급성구역성은닉성외층시망막병변(AZOOR)적림상특정.[방법]림상학진위AZOOR적18례환자18지안납입연구.소유환자균행교정시력、안저、시야、시망막전도(ERG)검사.부분환자동시행형광소안저혈관조영(FFA)、광상간단층소묘(OCT)、시각유발전위(VEP)급다초시망막전도(mf-ERG)검사.관찰환자적림상특정.대비분석환안여대측안적시각전생리검사결과.분석동시행OCT、시야화mf-ERG검사자적검측결과일치성.[결과]환자중,남성3례,녀성15례;균위단안발병.기중,정시2지안,점l1.1％;근시16지안,점88.9％.무명현안저개변11지안,점61.1％；황반구부근단발황백색점상병조혹시망막색소상피개변3지안,점16.7％；섭측정구역성탈색소개변4지안,점22.2％.소유식안중심시야이상,주변시야정상.행OCT검사적환안균존재불동정도광감수기세포내외절련접(IS/OS)광대중단、결실혹모조.ERG검사발현,여대측안비교,환안시간반응b파,최대반응a/b파,시추반응a、b파급30 Hz섬삭광반응진폭균강저,차이유통계학의의(t=3.516,2.689,3.103,3.517,2.999,3.309；P＜0.05)；제시간반응b파잠복기차이무통계학의의외(t=1.023,P=0.306),기여파잠복기균교대측안연장,차이유통계학의의(P＜0.05).VEP검사발현,환안P100파진폭교대측안강저,차이유통계학의의(t=2.040,P=0.041)；환안여대측안P100파잠복기비교,차이무통계학의의(t=1.687,P=0.092).행mf-ERG검사적환안균존재진폭개변.OCT여mf-ERG검측결과구유량호적일치성；이중심시야여mf-ERG검측결과불완전일치,기이상구역분포불상문합.[결론]AZOOR이청년녀성、근시안발병위다견；통상무명현안저개변；단중심시야급시각전생리검사존재이상,OCT검사가견기존재불동정도적IS/OS광대중단、결실혹모조.
[Objective] To observe the clinical features of acute zonal occult outer retinopathy (AZOOR).[Methods] Eighteen patients (18 eyes) with AZOOR were enrolled in this study.All the patients were examined for corrected visual acuity,fundus examination,visual field and electroretinography (ERG).For part of these patients,fluorescein angiography (FFA),optic coherence tomography (OCT),visual evoked potential (VEP) and multifocal ERG (mf-ERG) were performed.Clinical features wereobserved.Comparative analysis was performed on the electrophysiological Results between affected eyes and fellow eyes.The consistency of OCT,visual field and mf-ERG results was investigated.[Results]The patients included three males and 15 females.All patients were unilateral involved.16 eyes (88.9％) were myopia,two eyes (11.1％) were emmetropia.11 eyes (61.1％) have normal fundus; single yellow-white punctuate lesion or old RPE lesion near macular were found in three eyes (16.7％) ; depigmented zones in temporal retina were found in four eyes (22.2％).All central visual field results were abnormal,but peripheral visual field results were normal.OCT findings included irregularity,absence or breaks of the photoreceptor inner segment/outer segment (IS/OS) junction.Amplitudes of full-field ERG were reduced in the affected eyes (t=3.516,2.689,3.103,3.517,2.999,3.309;P＜0.05),and implicit times were delayedin most responses except for rod response (t1=1.023,P=0.306).Amplitudes of P100 wave of visual evoked potential were reduced statistically (t=2.04,P=0.041),but the differences of implicit times between the affected eyes and the fellow eyes were not statistically significant (t =1.687,P =0.092).Amplitude reduction of multifocal ERG existed in all affected eyes.Coincidence was found between results of OCT and mf-ERG.But abnormal zones found by central visual field did not always coincide with those by mf-ERG.[Conclusion]s The majority of patients who develop AZOOR are young women with myopia.Most patients have normal fundus.Central visual field and electrophysiological examinations are always abnormal.Irregularity,absence or breaks of the photoreceptor 1S/OS junction can be proved by OCT.