CAJ | 학술논문

目的观察急性区域性隐匿性外层视网膜病变(acute zonal occult outer retinopathy,AZOOR)的光相干断层扫描(optical coherence tomography,OCT)特征及评价糖皮质激素的疗效.方法将2009年3月至2013年7月在山西省眼科医院确诊的30例32只AZOOR患者眼纳入研究对象,观察OCT特征.并将其中随访≥3个月的17只眼按照治疗方法的不同,分为实验组11只眼(10例)与对照组6只眼(5例).实验组球侧注射曲安奈德20 mg/次,同时服用递法明和甲钴胺.对照组仅服用递法明和甲钴胺.测量黄斑中心凹为中心30×25°区域内31条扫描线上光感受器细胞内外连接带(IS/OS层)病变长度总和,并将治疗后的病变恢复率作为统计指标.结果 AZOOR的OCT特征:所有患眼均累及黄斑区,表现为IS/OS层毛糙、变薄及局限性缺损;但随着时间的延长,IS/OS层毛糙、变薄及局限性缺损恢复,进而痊愈.多发性一过性白点综合征(multiple evanescent white dot syndrome,MEWDS)也具有上述AZOOR的OCT特征,其患眼眼底黄白点状病灶处IS/OS层表现为颗粒状或局限性增厚.发病1～2周后眼底黄白色病灶开始减少,3～4周基本消失,OCT提示相应处IS/OS层病变好转.实验组与对照组治疗后1、3个月IS/OS层的病变长度总和,均较治疗前减小.实验组治疗后1个月和3个月的恢复率均高于对照组,差异有统计学意义(F =12.140,P=0.003).结论 AZOOR主要累及视网膜光感受器细胞层,OCT检查可见IS/OS层毛糙、变薄及局限性缺损;MEWDS眼底检查呈黄白点状病灶处,OCT检查表现为IS/OS层颗粒状或局限性增厚.观察随访3个月,糖皮质激素治疗AZO-OR的疗效,明显优于非糖皮质激素的疗效.
목적 관찰급성구역성은닉성외층시망막병변(acute zonal occult outer retinopathy,AZOOR)적광상간단층소묘(optical coherence tomography,OCT)특정급평개당피질격소적료효.방법 장2009년3월지2013년7월재산서성안과의원학진적30례32지AZOOR환자안납입연구대상,관찰OCT특정.병장기중수방≥3개월적17지안안조치료방법적불동,분위실험조11지안(10례)여대조조6지안(5례).실험조구측주사곡안내덕20 mg/차,동시복용체법명화갑고알.대조조부복용체법명화갑고알.측량황반중심요위중심30×25°구역내31조소묘선상광감수기세포내외련접대(IS/OS층)병변장도총화,병장치료후적병변회복솔작위통계지표.결과 AZOOR적OCT특정:소유환안균루급황반구,표현위IS/OS층모조、변박급국한성결손;단수착시간적연장,IS/OS층모조、변박급국한성결손회복,진이전유.다발성일과성백점종합정(multiple evanescent white dot syndrome,MEWDS)야구유상술AZOOR적OCT특정,기환안안저황백점상병조처IS/OS층표현위과립상혹국한성증후.발병1～2주후안저황백색병조개시감소,3～4주기본소실,OCT제시상응처IS/OS층병변호전.실험조여대조조치료후1、3개월IS/OS층적병변장도총화,균교치료전감소.실험조치료후1개월화3개월적회복솔균고우대조조,차이유통계학의의(F =12.140,P=0.003).결론 AZOOR주요루급시망막광감수기세포층,OCT검사가견IS/OS층모조、변박급국한성결손;MEWDS안저검사정황백점상병조처,OCT검사표현위IS/OS층과립상혹국한성증후.관찰수방3개월,당피질격소치료AZO-OR적료효,명현우우비당피질격소적료효.
Objective To characterize the pathological change of acute zonal occult outer retinopathy (AZOOR) by optical coherence tomography (OCT) and its responses to clinical treatment with corticosteroids.Methods Thirty-two eyes of 30 patients with AZOOR during the March 2009 to July 2013 from Shanxi eye hospital were enrolled in this study.Seventeen eyes (15 patients) completed following up for the three months.According to the treatment regimen,the patients were assigned to two groups.Patients in group one (G1,11 eyes,n =10) were treated with triamcinolone acetonide (20mg,peribulbar injection),oral mecobalamin and difrarel,while patients of group 2 (G2,6 eyes,n =5) were treated with only oral mecobalamin and difrarel.The OCT scan (volume mode) covered the area of 30×25° region centered by foveal with 31 scanlines.The result was presented as the sum of the length of the inner and outer segments (IS/OS) of photoreceptor,and calculated recovery rates.Analysis was made by comparing the difference in the responses to the treatments between the patients of the two groups.Results It was observed that the IS/OS layers were becoming irregular,thinner,focal absence or broken in all the 30 patients with AZOOR.However,the alterations in IS/OS junction were gradually attenuated even disappeared.Multiple evanescent white dot syndrome (MEWDS) showed the same characteristics.The focal thickness in IS/OS junction was in spotting patterns in fundus examination,presenting small punctuate white lesions.It was observed that number of the small point-like white lesions started to reduce in 1 to 2 weeks and disappeared in 3 to 4 weeks,indicating an improvement in the IS/OS.The lengths of IS/OS junction lesion were reduced in both of the groups in 1 and 3 months after treatment.Significantly higher recovery rates were observed in group 1 at one and three months after treatment,compared to that in group 2 (F =12.140,P =0.003).Conclusions The pathological alterations mainly involve retinal photoreceptor in AZOOR patients,which is characterized as irregularity,thinner,absence or broken of the IS/OS junction in all eyes detected by OCT.MEWDS showed focal thickness in IS/OS junction,in spotting patterns presenting small punctuate white lesions.Corticosteroids hormone therapy presents more effective than non-Corticosteroids therapy in patients with AZOOR in the 3 months of treatment.