中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2012年
4期
333-336
,共4页
俞笳%姜春晖%徐格致%黎蕾%张勇进
俞笳%薑春暉%徐格緻%黎蕾%張勇進
유가%강춘휘%서격치%려뢰%장용진
葡萄膜脑膜脑炎综合征%体层摄影术,光学相干%诊断显像
葡萄膜腦膜腦炎綜閤徵%體層攝影術,光學相榦%診斷顯像
포도막뇌막뇌염종합정%체층섭영술,광학상간%진단현상
Uveomeningoencephalitic syndrome%Tomography,optical coherence%Diagnostic imaging
[目的]观察急性期Vogt-Koyanagi-Harada(VKH)综合征患眼治疗前后的频域光相干断层扫描(OCT)图像特征.[方法]经裂隙灯显微镜、B型超声及荧光素眼底血管造影(FFA)检查确诊为急性期VKH综合征的28例患者56只眼纳入研究.所有患者确诊后均接受糖皮质激素冲击治疗;治疗前后均行频域OCT检查.治疗后随访观察12～32周,平均随访时间(21.30±8.53)周.对比分析治疗前后OCT检查所见的中心凹视网膜脱离高度、光感受器细胞内外节连接(IS/OS)光带及血管弓内视网膜结构的变化情况.[结果]治疗前OCT检查结果显示,所有患眼均存在神经上皮脱离,中心凹处平均神经上皮脱离高度为(635.44±340.04)μm.视网膜下腔中有各类渗出性改变43只眼,占76.8％；伴点状中强反射41只眼,占73.2％；旁中心凹部分节段外核层增厚呈“指状”突起与膜样结构相连22只眼,占39.3％;视网膜色素上皮(RPE)光带呈波浪状33只眼,占58.9％.治疗后不同观察时间的OCT检查结果显示,1周内所有患眼神经上皮下腔膜样结构及无定形中弱反射消失,同时可见RPE表面大量中强反射颗粒,RPE光带恢复平滑.治疗后平均(2.33±0.82)周时,所有患眼后极部神经上皮下积液完全吸收,黄斑复位,中心凹下IS/OS光带恢复连续,中心凹周围IS/OS光带和外界膜不连续.治疗后平均(5.01±6.71)周时,所有患眼整个水平扫描线上外界膜恢复连续,IS/OS光带恢复区域逐渐扩大.治疗后平均(11.40±7.89)周时,整个水平扫描线上IS/OS光带恢复连续45只眼,占80.4％；IS/OS光带仍有部分缺损11只眼,占19.6％.整个后极部扫描区域内IS/OS光带仍有缺损46只眼,占82.1％整个后极部扫描区域内IS/OS光带完整10只眼,占17.9％.有区域性外核层变薄,且在这些区域视网膜外层的外界膜和IS/OS光带缺失11只眼,占19.6％.[结论]急性期VKH综合征患眼OCT检查图像特征为,治疗前存在神经上皮脱离,脱离下腔可有多种类型的渗出性改变,RPE光带呈波浪状；治疗后渗出性改变迅速溶解,但视网膜下腔的中强反射颗粒仍然存在,RPE光带恢复平滑,且外界膜连续性的恢复早于IS/OS光带.
[目的]觀察急性期Vogt-Koyanagi-Harada(VKH)綜閤徵患眼治療前後的頻域光相榦斷層掃描(OCT)圖像特徵.[方法]經裂隙燈顯微鏡、B型超聲及熒光素眼底血管造影(FFA)檢查確診為急性期VKH綜閤徵的28例患者56隻眼納入研究.所有患者確診後均接受糖皮質激素遲擊治療;治療前後均行頻域OCT檢查.治療後隨訪觀察12～32週,平均隨訪時間(21.30±8.53)週.對比分析治療前後OCT檢查所見的中心凹視網膜脫離高度、光感受器細胞內外節連接(IS/OS)光帶及血管弓內視網膜結構的變化情況.[結果]治療前OCT檢查結果顯示,所有患眼均存在神經上皮脫離,中心凹處平均神經上皮脫離高度為(635.44±340.04)μm.視網膜下腔中有各類滲齣性改變43隻眼,佔76.8％；伴點狀中彊反射41隻眼,佔73.2％；徬中心凹部分節段外覈層增厚呈“指狀”突起與膜樣結構相連22隻眼,佔39.3％;視網膜色素上皮(RPE)光帶呈波浪狀33隻眼,佔58.9％.治療後不同觀察時間的OCT檢查結果顯示,1週內所有患眼神經上皮下腔膜樣結構及無定形中弱反射消失,同時可見RPE錶麵大量中彊反射顆粒,RPE光帶恢複平滑.治療後平均(2.33±0.82)週時,所有患眼後極部神經上皮下積液完全吸收,黃斑複位,中心凹下IS/OS光帶恢複連續,中心凹週圍IS/OS光帶和外界膜不連續.治療後平均(5.01±6.71)週時,所有患眼整箇水平掃描線上外界膜恢複連續,IS/OS光帶恢複區域逐漸擴大.治療後平均(11.40±7.89)週時,整箇水平掃描線上IS/OS光帶恢複連續45隻眼,佔80.4％；IS/OS光帶仍有部分缺損11隻眼,佔19.6％.整箇後極部掃描區域內IS/OS光帶仍有缺損46隻眼,佔82.1％整箇後極部掃描區域內IS/OS光帶完整10隻眼,佔17.9％.有區域性外覈層變薄,且在這些區域視網膜外層的外界膜和IS/OS光帶缺失11隻眼,佔19.6％.[結論]急性期VKH綜閤徵患眼OCT檢查圖像特徵為,治療前存在神經上皮脫離,脫離下腔可有多種類型的滲齣性改變,RPE光帶呈波浪狀；治療後滲齣性改變迅速溶解,但視網膜下腔的中彊反射顆粒仍然存在,RPE光帶恢複平滑,且外界膜連續性的恢複早于IS/OS光帶.
[목적]관찰급성기Vogt-Koyanagi-Harada(VKH)종합정환안치료전후적빈역광상간단층소묘(OCT)도상특정.[방법]경렬극등현미경、B형초성급형광소안저혈관조영(FFA)검사학진위급성기VKH종합정적28례환자56지안납입연구.소유환자학진후균접수당피질격소충격치료;치료전후균행빈역OCT검사.치료후수방관찰12～32주,평균수방시간(21.30±8.53)주.대비분석치료전후OCT검사소견적중심요시망막탈리고도、광감수기세포내외절련접(IS/OS)광대급혈관궁내시망막결구적변화정황.[결과]치료전OCT검사결과현시,소유환안균존재신경상피탈리,중심요처평균신경상피탈리고도위(635.44±340.04)μm.시망막하강중유각류삼출성개변43지안,점76.8％；반점상중강반사41지안,점73.2％；방중심요부분절단외핵층증후정“지상”돌기여막양결구상련22지안,점39.3％;시망막색소상피(RPE)광대정파랑상33지안,점58.9％.치료후불동관찰시간적OCT검사결과현시,1주내소유환안신경상피하강막양결구급무정형중약반사소실,동시가견RPE표면대량중강반사과립,RPE광대회복평활.치료후평균(2.33±0.82)주시,소유환안후겁부신경상피하적액완전흡수,황반복위,중심요하IS/OS광대회복련속,중심요주위IS/OS광대화외계막불련속.치료후평균(5.01±6.71)주시,소유환안정개수평소묘선상외계막회복련속,IS/OS광대회복구역축점확대.치료후평균(11.40±7.89)주시,정개수평소묘선상IS/OS광대회복련속45지안,점80.4％；IS/OS광대잉유부분결손11지안,점19.6％.정개후겁부소묘구역내IS/OS광대잉유결손46지안,점82.1％정개후겁부소묘구역내IS/OS광대완정10지안,점17.9％.유구역성외핵층변박,차재저사구역시망막외층적외계막화IS/OS광대결실11지안,점19.6％.[결론]급성기VKH종합정환안OCT검사도상특정위,치료전존재신경상피탈리,탈리하강가유다충류형적삼출성개변,RPE광대정파랑상；치료후삼출성개변신속용해,단시망막하강적중강반사과립잉연존재,RPE광대회복평활,차외계막련속성적회복조우IS/OS광대.
[Objective] To observe the spectral domain optical coherence tomography (SD-OCT)features of acute Vogt Koyanagi-Harada (VKH) eyes before and after treatment.[Methods] Twenty-eight patients (56 eyes) with acute VKH diagnosed by slit-lamp microscopy,B mode ultrasound and fundus fluorescein angiography (FFA) were enrolled in this study.All the patients were treated with steroid after diagnosis.SD-OCT was performed in all the patients before and after treatment.The follow-up was ranged from 12 to 32 weeks with a mean of (21.30±8.53) weeks.The foveal retinal detachment height,inner and outer segments (IS/OS) of photoreceptors,and the changes in retinal structure within the vascular arcades before and after treatment were comparatively analyzed.[Results] OCT examination results showed that before treatment,all eyes had retinal neural epithelial detachment.The average neural epithelial detachment height in the fovea was (635.44±340.04) μm.Forty-three eyes (76.8％) had different types of subretinal exudates; 41 eyes (73.2％) had strong granular reflection in the subretinal space.Twenty-two eyes (39.3％) had paraforveal outer nuclear layer (ONL) thickening with finger-like protrusions attached with membrane-like structure.Thirty-three eyes (58.9％) had wavy lines of the retinal pigment epithelium(RPE).After the treatment,these exudates dissolved within one week and RPE line became straight.Theretina reattached after (2.33±0.82) weeks.In most patients external limiting membrane and IS/OS became intact after (5.01 ± 6.71) weeks and (11.40 ± 7.89) weeks respectively.However,at the end of follow-up,46 eyes (82.1％) still had focal areas of IS/OS defect and 11 eyes (19.6％) had focal ONL thinning.[Conclusion]s Before the treatment,the OCT features of acute VKH are serous retinal detachment at fovea,different types of subretinal exudates and wavy RPE.After the treatment,the OCT features of acute VKH are exudates dissolving,straight RPE line and early recovery of external limiting membrane.
