急性区域性隐匿性外层视网膜病变的临床表现及频域光相干断层扫描图像特征

doi:10.3760/cma.j.issn.1005-1015.2013.05.007

科研成果详情

题名	急性区域性隐匿性外层视网膜病变的临床表现及频域光相干断层扫描图像特征
其他题名	Clinical analysis of spectral-domain optical coherence tomography imaging in the diagnosis and follow-up of acute zonal occult outer retinopathy
作者	周容; 林冰; 孙祖华; 郑薇薇; 李英姿; 周挺业; 刘晓玲
发表日期	2013-09-25
发表期刊	中华眼底病杂志影响因子和分区
语种	中文
原始文献类型	学术期刊
关键词	视网膜疾病/诊断疾病特征体层摄影术光学相干
其他关键词	Retinal diseases/diagnosis ; Disease attributes ; Tomography,optical coherence
摘要	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15d~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,MEWDS 9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。
其他摘要	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.
资助项目	国家自然科学基金青年科学基金（81100672）
ISSN	1005-1015
卷号	29 期号:05 页码:474-478
DOI	10.3760/cma.j.issn.1005-1015.2013.05.007
页数	5
收录类别	CNKI ; 万方 ; 维普 ; 北大核心 ; ISTIC ; CSCD ; PKU
学科领域	医药、卫生 ; 眼科学
URL	查看原文
CSCD记录号	CSCD:4934777
引用统计
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/53228
专题	眼视光学院（生物医学工程学院）、附属眼视光医院_眼底内科
作者单位	温州医科大学附属眼视光医院眼底内科
第一作者单位	眼视光学院（生物医学工程学院）、附属眼视光医院_眼底内科
第一作者的第一单位	眼视光学院（生物医学工程学院）、附属眼视光医院_眼底内科
推荐引用方式 GB/T 7714	周容,林冰,孙祖华,等. 急性区域性隐匿性外层视网膜病变的临床表现及频域光相干断层扫描图像特征[J]. 中华眼底病杂志,2013,29(05):474-478.
APA	周容., 林冰., 孙祖华., 郑薇薇., 李英姿., ... & 刘晓玲. (2013). 急性区域性隐匿性外层视网膜病变的临床表现及频域光相干断层扫描图像特征. 中华眼底病杂志, 29(05), 474-478.
MLA	周容,et al."急性区域性隐匿性外层视网膜病变的临床表现及频域光相干断层扫描图像特征".中华眼底病杂志 29.05(2013):474-478.