中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2013年
5期
474-478
,共5页
周容%林冰%孙祖华%郑薇薇%李英姿%周挺业%刘晓玲
週容%林冰%孫祖華%鄭薇薇%李英姿%週挺業%劉曉玲
주용%림빙%손조화%정미미%리영자%주정업%류효령
视网膜疾病/诊断%疾病特征%体层摄影术,光学相干
視網膜疾病/診斷%疾病特徵%體層攝影術,光學相榦
시망막질병/진단%질병특정%체층섭영술,광학상간
Retinal diseases/diagnosis%Disease attributes%Tomography,optical coherence
目的 观察急性区域性外层视网膜病变(AZOOR)的临床特点以及频域光相干断层扫描(SD-OCT)的图像特征,探讨OCT在评估AZOOR发生、发展中的临床价值.方法 临床检查确诊的AZOOR患者52例66只眼纳入研究.其中,男性8例10只眼,女性44例56只眼；年龄15～65岁.均以视力下降、闪光感、暗点及眼前遮挡感为主述就诊.根据眼底有无改变将患者分为Ⅰ、Ⅱ型AZOOR,分别为28、38只眼.Ⅱ型AZOOR 38只眼中,多发性一过性白点综合征(MEWDS)9只眼、点状内层脉络膜病变(PIC)25只眼、多灶性脉络膜炎(MC)4只眼.所有患者均行视力、裂隙灯显微镜、眼底彩色照相、SD-OCT检查.行视野检查37只眼；视网膜电图(ERG)检查32只眼,其中Ⅰ型AZOOR 28只眼,Ⅱ型AZOOR MEWDS 4只眼；荧光素眼底血管造影(FFA)检查48只眼,其中联合吲哚青绿血管造影(ICGA)检查22只眼.随访15 d～2年.回顾分析患者的临床资料和OCT图像特征.结果 Ⅱ型AZOOR 38只眼中,MEWDS 9只眼就诊时眼底均可见后极部或中周部白点.PIC 25只眼眼底均可见后极部散在黄白色、边界清楚,周围有色素的点状萎缩病灶,其中并发脉络膜新生血管(CNV) 13只眼.MC 4只眼玻璃体腔均可见少量炎性细胞,眼底后极部可见散在分布的多处圆形或椭圆形黄白色病灶.视野检查结果显示,Ⅰ型AZOOR 28只眼中,中心和旁中心暗点15只眼；生理盲点扩大或与生理盲点相连的局部视野损害9只眼；非特异性视野改变,散在暗点4只眼.Ⅱ型AZOOR MEWDS 9只眼主要表现为暗点和局部多处视野缺损.ERG检查结果显示,Ⅰ型AZOOR 28只眼中,眼暗视及明视ERG振幅均较对侧眼降低,暗视ERG振幅下降更明显12只眼；仅表现为暗视ERG振幅下降9只眼；无明显改变7只眼.Ⅱ型AZOOR MEWDS4只眼均可见暗视及明视ERG振幅下降,潜伏期轻度延长.FFA和(或)ICGA检查结果显示,Ⅱ型AZOOR 26只眼中,MEWDS9只眼FFA检查可见后极部或中周部视网膜外层或视网膜色素上皮(RPE)层强荧光灶,晚期荧光略增强但无渗漏,其中ICGA检查可见后极部或中周部圆点状弱荧光灶3只眼.PIC13只眼可见血管弓附近点状病灶呈透见荧光改变及黄斑区活动性CNV病灶.MC 4只眼FFA可见早期中周部点状病灶呈弱荧光,晚期荧光增强,轻度渗漏.OCT检查结果显示,Ⅰ型AZOOR 28只眼主要表现为后极部光感受器内外节连接(IS/OS)层紊乱,局部缺失；COST(cone outer segment tip)带反射减弱.Ⅱ型AZOOR MEWDS 9只眼表现为与眼底点状病灶相对应的视网膜外层IS/OS带局部反射减弱,COST带不可见；PIC患者中并发CNV者黄斑区神经视网膜下可见强反射团块突破RPE层.末次随访时,Ⅰ型AZOOR 28只眼中,IS/OS层连续性恢复22只眼；未恢复6只眼.Ⅱ型AZOOR 38只眼中,MEWDS 9只眼均在患病后1～2个月IS/OS层随病情好转而逐渐恢复；PIC 25只眼IS/OS层连续性无改变；MC 4只眼IS/OS层连续性恢复.结论 AZOOR急性期发病隐匿；SD-OCT可动态监测IS/OS层的改变,反映AZOOR的发生、发展的不同程度.
目的 觀察急性區域性外層視網膜病變(AZOOR)的臨床特點以及頻域光相榦斷層掃描(SD-OCT)的圖像特徵,探討OCT在評估AZOOR髮生、髮展中的臨床價值.方法 臨床檢查確診的AZOOR患者52例66隻眼納入研究.其中,男性8例10隻眼,女性44例56隻眼；年齡15～65歲.均以視力下降、閃光感、暗點及眼前遮擋感為主述就診.根據眼底有無改變將患者分為Ⅰ、Ⅱ型AZOOR,分彆為28、38隻眼.Ⅱ型AZOOR 38隻眼中,多髮性一過性白點綜閤徵(MEWDS)9隻眼、點狀內層脈絡膜病變(PIC)25隻眼、多竈性脈絡膜炎(MC)4隻眼.所有患者均行視力、裂隙燈顯微鏡、眼底綵色照相、SD-OCT檢查.行視野檢查37隻眼；視網膜電圖(ERG)檢查32隻眼,其中Ⅰ型AZOOR 28隻眼,Ⅱ型AZOOR MEWDS 4隻眼；熒光素眼底血管造影(FFA)檢查48隻眼,其中聯閤吲哚青綠血管造影(ICGA)檢查22隻眼.隨訪15 d～2年.迴顧分析患者的臨床資料和OCT圖像特徵.結果 Ⅱ型AZOOR 38隻眼中,MEWDS 9隻眼就診時眼底均可見後極部或中週部白點.PIC 25隻眼眼底均可見後極部散在黃白色、邊界清楚,週圍有色素的點狀萎縮病竈,其中併髮脈絡膜新生血管(CNV) 13隻眼.MC 4隻眼玻璃體腔均可見少量炎性細胞,眼底後極部可見散在分佈的多處圓形或橢圓形黃白色病竈.視野檢查結果顯示,Ⅰ型AZOOR 28隻眼中,中心和徬中心暗點15隻眼；生理盲點擴大或與生理盲點相連的跼部視野損害9隻眼；非特異性視野改變,散在暗點4隻眼.Ⅱ型AZOOR MEWDS 9隻眼主要錶現為暗點和跼部多處視野缺損.ERG檢查結果顯示,Ⅰ型AZOOR 28隻眼中,眼暗視及明視ERG振幅均較對側眼降低,暗視ERG振幅下降更明顯12隻眼；僅錶現為暗視ERG振幅下降9隻眼；無明顯改變7隻眼.Ⅱ型AZOOR MEWDS4隻眼均可見暗視及明視ERG振幅下降,潛伏期輕度延長.FFA和(或)ICGA檢查結果顯示,Ⅱ型AZOOR 26隻眼中,MEWDS9隻眼FFA檢查可見後極部或中週部視網膜外層或視網膜色素上皮(RPE)層彊熒光竈,晚期熒光略增彊但無滲漏,其中ICGA檢查可見後極部或中週部圓點狀弱熒光竈3隻眼.PIC13隻眼可見血管弓附近點狀病竈呈透見熒光改變及黃斑區活動性CNV病竈.MC 4隻眼FFA可見早期中週部點狀病竈呈弱熒光,晚期熒光增彊,輕度滲漏.OCT檢查結果顯示,Ⅰ型AZOOR 28隻眼主要錶現為後極部光感受器內外節連接(IS/OS)層紊亂,跼部缺失；COST(cone outer segment tip)帶反射減弱.Ⅱ型AZOOR MEWDS 9隻眼錶現為與眼底點狀病竈相對應的視網膜外層IS/OS帶跼部反射減弱,COST帶不可見；PIC患者中併髮CNV者黃斑區神經視網膜下可見彊反射糰塊突破RPE層.末次隨訪時,Ⅰ型AZOOR 28隻眼中,IS/OS層連續性恢複22隻眼；未恢複6隻眼.Ⅱ型AZOOR 38隻眼中,MEWDS 9隻眼均在患病後1～2箇月IS/OS層隨病情好轉而逐漸恢複；PIC 25隻眼IS/OS層連續性無改變；MC 4隻眼IS/OS層連續性恢複.結論 AZOOR急性期髮病隱匿；SD-OCT可動態鑑測IS/OS層的改變,反映AZOOR的髮生、髮展的不同程度.
목적 관찰급성구역성외층시망막병변(AZOOR)적림상특점이급빈역광상간단층소묘(SD-OCT)적도상특정,탐토OCT재평고AZOOR발생、발전중적림상개치.방법 림상검사학진적AZOOR환자52례66지안납입연구.기중,남성8례10지안,녀성44례56지안；년령15～65세.균이시력하강、섬광감、암점급안전차당감위주술취진.근거안저유무개변장환자분위Ⅰ、Ⅱ형AZOOR,분별위28、38지안.Ⅱ형AZOOR 38지안중,다발성일과성백점종합정(MEWDS)9지안、점상내층맥락막병변(PIC)25지안、다조성맥락막염(MC)4지안.소유환자균행시력、렬극등현미경、안저채색조상、SD-OCT검사.행시야검사37지안；시망막전도(ERG)검사32지안,기중Ⅰ형AZOOR 28지안,Ⅱ형AZOOR MEWDS 4지안；형광소안저혈관조영(FFA)검사48지안,기중연합신타청록혈관조영(ICGA)검사22지안.수방15 d～2년.회고분석환자적림상자료화OCT도상특정.결과 Ⅱ형AZOOR 38지안중,MEWDS 9지안취진시안저균가견후겁부혹중주부백점.PIC 25지안안저균가견후겁부산재황백색、변계청초,주위유색소적점상위축병조,기중병발맥락막신생혈관(CNV) 13지안.MC 4지안파리체강균가견소량염성세포,안저후겁부가견산재분포적다처원형혹타원형황백색병조.시야검사결과현시,Ⅰ형AZOOR 28지안중,중심화방중심암점15지안；생리맹점확대혹여생리맹점상련적국부시야손해9지안；비특이성시야개변,산재암점4지안.Ⅱ형AZOOR MEWDS 9지안주요표현위암점화국부다처시야결손.ERG검사결과현시,Ⅰ형AZOOR 28지안중,안암시급명시ERG진폭균교대측안강저,암시ERG진폭하강경명현12지안；부표현위암시ERG진폭하강9지안；무명현개변7지안.Ⅱ형AZOOR MEWDS4지안균가견암시급명시ERG진폭하강,잠복기경도연장.FFA화(혹)ICGA검사결과현시,Ⅱ형AZOOR 26지안중,MEWDS9지안FFA검사가견후겁부혹중주부시망막외층혹시망막색소상피(RPE)층강형광조,만기형광략증강단무삼루,기중ICGA검사가견후겁부혹중주부원점상약형광조3지안.PIC13지안가견혈관궁부근점상병조정투견형광개변급황반구활동성CNV병조.MC 4지안FFA가견조기중주부점상병조정약형광,만기형광증강,경도삼루.OCT검사결과현시,Ⅰ형AZOOR 28지안주요표현위후겁부광감수기내외절련접(IS/OS)층문란,국부결실；COST(cone outer segment tip)대반사감약.Ⅱ형AZOOR MEWDS 9지안표현위여안저점상병조상대응적시망막외층IS/OS대국부반사감약,COST대불가견；PIC환자중병발CNV자황반구신경시망막하가견강반사단괴돌파RPE층.말차수방시,Ⅰ형AZOOR 28지안중,IS/OS층련속성회복22지안；미회복6지안.Ⅱ형AZOOR 38지안중,MEWDS 9지안균재환병후1～2개월IS/OS층수병정호전이축점회복；PIC 25지안IS/OS층련속성무개변；MC 4지안IS/OS층련속성회복.결론 AZOOR급성기발병은닉；SD-OCT가동태감측IS/OS층적개변,반영AZOOR적발생、발전적불동정도.
Objective To investigate the clinical manifestations and spectral-domain optical coherence tomography (SD-OCT) imaging features of acute zonal occult outer retinopahy (AZOOR) and to explore the role of SD-OCT in the diagnosis and follow-up of AZOOR.Methods Retrospective analysis of clinical data of 52 cases (66 eyes) who were diagnosed through comprehensive eye examinations including best corrected visual acuity,fundus exam,OCT,electroretinogram (ERG),fluorescein angiography (FFA) and indocyanine green angiography (ICGA).Results A total of 52 cases of AZOOR (66 eyes) were collected.The majority of patients complained of blurred vision,photopsia and acute onset of a scotoma.In this group,24 cases (28 eyes) with normal fundus were defined as AZOOR type Ⅰ,while the other 28 cases (38 eyes) with fundus changes were AZOOR type Ⅱ,including 9 eyes of multiple evanescent white dot syndrome (MEWDS),25 eyes of punctate inner choroidopathy (PIC),4 eyes of multifocal choroiditis (MC).All type Ⅰ cases went through visual field,ERG and OCT tests.The most common visual field defect was central and paracentral scotoma,which was seen in 15 eyes (53.6％).Nine eyes (32.1％) presented with blind spot enlargement or even associated with other visual field defects.Four eyes (14.3 ％) showed scattered scotoma.In the series of 24 type Ⅰ cases (28 eyes),12 eyes (42.9％) demonstrated depressed scotopic and photopic amplitudes,and nine eyes only yielded reduced scotopic amplitudes,while seven eyes showed normal.All OCT showed an absence of both the inner and outer segment (IS/OS) line,and (or) the cone outer segment tip (COST) line between the IS/OS line and RPE.Many grey-white or yellowish white punctuate lesion of different sizes were found in posterior pole of the fundus in all of type] AZOOR which were more obvious in FFA.The manifestations of OCT showed IS/OS irregularity or absence in the area corresponding to the lesions.At final follow up from 15 days to two years,the IS/OS line became discernible in 13 of 24 type Ⅰ cases got discernible IS/OS line,while it was still absent in the other 11 case.During one to two month follow up period,nine eyes of MEWDS and four eyes of MC showed the presence of the a continuous IS/OS line in their OCT images after treatment,but there is no significant change for 25 eyes of PIC.Conclusions OCT showed abnormalities in the microstructures of the outer retina,e.g.,IS/OS line.The high resolution of OCT images has allowed better evaluations of the intraretinal IS/OS line in AZOOR,which presented a significant correlation with different stage in the course of AZOOR.In conclusions,OCT plays an important role in the diagnosis and follow up in AZOOR.
