CAJ | 학술논문

目的初步探讨急性黄斑区视神经视网膜病(AMNR)的临床特征、治疗和预后.方法回顾性病例研究.分析自2007年12月至2012年3月临床上诊断为AMNR的患者16例(25眼).其中男12例,女4例,年龄24～72岁,平均年龄(51.1±12.7)岁.视力光感(LP)～1.2.观察其眼底彩照、OCT、FFA及ICGA的表现特征,分析其相关发病因素并探讨其发病机制及治疗预后.结果 16例患者中9例双眼发病,7例单眼发病.16例(25眼)眼底均表现为黄斑区视网膜深层灰黄色污秽样改变.FFA显示视盘不等程度的染色,部分病例黄斑区微小血管扩张渗漏,ICGA显示黄斑区低灌注性弱荧光.所有患者OCT均显示不同程度的黄斑区外层视网膜水肿、增厚,视细胞内节/外节-脉络膜毛细血管(IS/OS-CC)带的局灶性缺损,部分患者伴有局限神经上皮脱离.16例患者血清学检查均显示梅毒阳性,其中1例伴有HIV感染.10例患者(14眼)积极接受抗梅毒治疗,随访时间为2周～2年,除1例(2眼)随访时间只有2周视力无明显改善外,其余9例(12眼)视力均有明显好转,其中9眼视力恢复到1.0,眼底表现均明显改善.余6例(11眼)建议抗梅毒治疗后失访.结论 AMNR病因很多,梅毒感染是其中之一,主要的病理改变是外层视网膜及视细胞的IS/OS受到破坏.系统性的免疫学检查如梅毒螺旋体、HIV等相当重要.治疗主要是抗梅毒治疗,视力预后较好.
목적 초보탐토급성황반구시신경시망막병(AMNR)적림상특정、치료화예후.방법 회고성병례연구.분석자2007년12월지2012년3월림상상진단위AMNR적환자16례(25안).기중남12례,녀4례,년령24～72세,평균년령(51.1±12.7)세.시력광감(LP)～1.2.관찰기안저채조、OCT、FFA급ICGA적표현특정,분석기상관발병인소병탐토기발병궤제급치료예후.결과 16례환자중9례쌍안발병,7례단안발병.16례(25안)안저균표현위황반구시망막심층회황색오예양개변.FFA현시시반불등정도적염색,부분병례황반구미소혈관확장삼루,ICGA현시황반구저관주성약형광.소유환자OCT균현시불동정도적황반구외층시망막수종、증후,시세포내절/외절-맥락막모세혈관(IS/OS-CC)대적국조성결손,부분환자반유국한신경상피탈리.16례환자혈청학검사균현시매독양성,기중1례반유HIV감염.10례환자(14안)적겁접수항매독치료,수방시간위2주～2년,제1례(2안)수방시간지유2주시력무명현개선외,기여9례(12안)시력균유명현호전,기중9안시력회복도1.0,안저표현균명현개선.여6례(11안)건의항매독치료후실방.결론 AMNR병인흔다,매독감염시기중지일,주요적병리개변시외층시망막급시세포적IS/OS수도파배.계통성적면역학검사여매독라선체、HIV등상당중요.치료주요시항매독치료,시력예후교호.
Objective To investigate the clinical characteristics of acute macular neuroretinopathy (AMNR) and the therapy to treat it.Methods This was a retrospective study.The clinical data of 16 patients (25 eyes) diagnosed with acute macular neuroretinopathy from December 2007 to March 2012 were analyzed.The patients (12 males and 4 females) ranged in age from 24 to 72 years with an average age of 51.1±12.7 years.Visual acuity ranged from light perception (LP) to 1.2.Color fundus photography,optical coherence tomography (OCT),fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed on these patients.The etiology and the pathogenesis as well as the therapy and visual prognosis of AMNR were evaluated.Results Among the 16 patients,9 patients were bilateral and 7 were unilateral.All 16 patients (25 eyes) showed grey-yellow lesions in the macular area.FFA revealed that the optic disc was stained in the late stages.Some patients showed the dilatation of micro-retinal veins with dye leakage in the late phases of FFA.ICGA revealed poor perfusion in the macula and the posterior area of the retina.The OCTs of all patients showed the inner segment/outer segment-choriocapillary (IS/OS-CC) band was partially absent with a thickened outer plexiform layer overlying these areas in different degrees.Some patients showed local neurosensory epithelium detachment in OCT images.The resilient packet ring (RPR)and treponema pallidum hemagglutination assay (TPHA) tests were positive in all 16 patients.HIV was simultaneously positive in one patient.Ten patients (14 eyes) agreed to anti-syphilis therapy.The follow-up ranged from 2 weeks to 2 years.The grey-yellow lesions disappeared in 9 patients (12 eyes) and visual acuity improved to 1.0 in 9 eyes.Only one patient (2 eyes) did not have an improvement in visual acuity due to a short follow-up of 2 weeks.Six other patients (11 eyes) were lost and failed to return for unknown reasons.Conclusion Syphilis infection is one of the many causes of AMNR.The main pathological abnormality is located at the outer retina and IS-OS junction.Immunologic examinations such as spirochaeta pallida and HIV are very important in the fundus clinic.Treatment with penicillin resulted in a rapid cure and always had a good prognosis.