CAJ | 학술논문

目的探讨频域相干光断层扫描(Optical Coherence Tonography,OCT)在Vogt-小柳原田综合征(VKH)临床诊疗过程中的作用.方法对14例28只眼VKH患者早期行OCT检查,并行荧光素眼底血管造影(FFA).全部病例均应用甲强龙冲击3天后糖皮质激素口服治疗,在用药前、口服药前及口服强的松1周、1个后月均行OCT检查.结果 14例28只眼VKH患者早期OCT检查表现为视网膜神经上皮层及色素上皮层渗出性脱离、隆起呈泡状或多囊状.神经上皮最大脱离高度4058μm,最小脱离高度156 μm,平均(2869±138.65)μm,最大脱离直径超过6 mm扫描范围,最小直径1348 μm,色素上皮单发或多发脱离,应用甲强龙冲击3天后神经上皮脱离快速消退,神经上皮最大脱离高度2058 μm,最小脱离高度49μm,平均(1345±115.85) μm,最大脱离直径2568 μm,最小直径563μm,平均(1078±98.43)μm,与治疗前对比差异有统计学意义(P＜0.05).用药7～10天后神经上皮及色素上皮脱离均消退,视乳头水肿明显减轻,所有患者均恢复至发病前视力,1个月后黄斑区神经上皮及色素上皮恢复正常,合并视乳头水肿者水肿均消退,视力稳定无下降.结论 OCT在VKH临床早期诊断、诊疗效果的评价以及与患者沟通方面均具有重要临床意义.
목적 탐토빈역상간광단층소묘(Optical Coherence Tonography,OCT)재Vogt-소류원전종합정(VKH)림상진료과정중적작용.방법 대14례28지안VKH환자조기행OCT검사,병행형광소안저혈관조영(FFA).전부병례균응용갑강룡충격3천후당피질격소구복치료,재용약전、구복약전급구복강적송1주、1개후월균행OCT검사.결과 14례28지안VKH환자조기OCT검사표현위시망막신경상피층급색소상피층삼출성탈리、륭기정포상혹다낭상.신경상피최대탈리고도4058μm,최소탈리고도156 μm,평균(2869±138.65)μm,최대탈리직경초과6 mm소묘범위,최소직경1348 μm,색소상피단발혹다발탈리,응용갑강룡충격3천후신경상피탈리쾌속소퇴,신경상피최대탈리고도2058 μm,최소탈리고도49μm,평균(1345±115.85) μm,최대탈리직경2568 μm,최소직경563μm,평균(1078±98.43)μm,여치료전대비차이유통계학의의(P＜0.05).용약7～10천후 신경상피급색소상피탈리균소퇴,시유두수종명현감경,소유환자균회복지발병전시력,1개월후황반구신경상피급색소상피회복정상,합병시유두수종자수종균소퇴,시력은정무하강.결론 OCT재VKH림상조기진단、진료효과적평개이급여환자구통방면균구유중요림상의의.
Objective To study the application of clinical diagnosis and treatment with Optical Coherence Tomography (OCT) in Vogt-Koyanagi-Harada (VKH) Syndrome.Methods Fourteen patients (28 eyes) of VKH on the early stage were examined by OCT and fundus fluorescein angiography (FFA) simultaneously.All patients had OCT examination pretreatment,3 days after methylprednisolone injection therapy,1 week and 1 month after oral administration of glucocorticoid.Results Main clinical manifestation were retina nerve layer and pigment epithelium exudative desquamation,upheaval pattern appearing bubbly or polycystic shape by OCT examined for VKH patients in the early stage.Maximum nerve epithelium tissue desquamation ranged from 156μm to 4058μtm,mean error of 2869±138.65 and desquamation diameter scanning was greater than 6mm,minimum was 1348μm.Boundedness or multiple desquamation were found in nerve epithelium tissue.These patients were treated by methylprednisolone injection,the area of retinal detachment were decreased and relieved marketable by OCT examination that demonstrated on nerve epithelium tissue after three days.Nerve epithelium tissue desquamation ranged from 49μm to 20581μm at the highest degree,mean error of 1345±115.85,maximum 2568tm and minimum 563μm,mean of 1078±98.43μm.There were statistically significant differences clinical effect before and after therapy (P ＜ 0.05).Nerve epithelium tissue and pigment epithelium exudative desquamation were decreased and relieved apparently by 7-10 days therapy.Papilledema were improved markedly and visual acuity recovered to as the same as the before illness.Macular area nerve layer and pigment epithelium recuperated after 30 days therapy,papilledema vanished gradually.Conclusions OCT is an important tool in ophthalmologic clinic diagnosis,evaluate curative effect and as a good communication ideas between doctors and patients to Vogt-Koyanagi-Harada Syndrome.