急性区域性隐匿性外层视网膜病变的诊断和鉴别诊断  

Diagnosis and differential diagnosis of acute zonal occult outer retinopathy

作　　者：宋宗明[1] 盛艳娟 陈青山[3] 薛安全[1] 林冰[1] 李英姿[1] 沈丽君[1] 

机构地区：[1]温州医学院附属眼视光医院,325003 [2]济南市第二医院眼科 [3]深圳市眼科医院

出　　处：《中华眼科杂志》2006年第8期717-723,共7页Chinese Journal of Ophthalmology

基　　金：浙江省医药卫生科学基金资助项目(2002A067);浙江省教育厅科研基金资助项目(20020463)

摘　　要：目的探讨急性区域性隐匿性外层视网膜病变(acute zonal occult outer retinopathy, AZOOR)的临床特征、诊断和鉴别诊断特点。方法对近2年来就诊于本院和外院门诊经反复检查确诊为AZOOR的患者6例,进行眼部常规检查和荧光素眼底血管造影、视觉电生理、视野及血常规、免疫和神经系统相关检查,收集患者所有病史和检查资料,进行综合分析。结果6例(12只眼) AZOOR患者中,女性5例,男性1例;年龄26～42岁,平均35岁,均为双眼发病。随访时间4～18个月,平均(7．5±3．2)个月。6只眼发病前有近视。3只眼发病时有眼前闪光感,视力轻度下降,仅有1只眼视力为指数／40 cm。所有患者至少1只眼视野检查发现视野缺损或局部敏感度下降,其中1只眼双眼生理盲点扩大。4只眼见眼前段活动性炎性病变,10只眼伴有玻璃体轻度炎性改变。4只眼可见眼底后极部黄白色斑点状病灶,6只眼为后极部至中周部视网膜灰白色斑点状病灶,病灶位于视网膜外层或色素上皮-玻璃体-脉络膜毛细血管复合体层。1只眼荧光素眼底血管造影显示眼底脱色素改变,其余患者为眼底高荧光斑。1只眼伴黄斑-脉络膜新生血管。所有患者视网膜电图检测均有不同程度异常。在随访过程中除1只眼视力下降外,其他患者症状与初诊相似。5只眼视野无明显改变,1只眼视野缺损范围增大。1例双眼视网膜斑点增加,1例双眼视网膜病灶减少。1例双眼视网膜斑点消失,其他患者随访眼底无明显改变。6例患者初次诊断与随访诊断均不一致。结论AZOOR属于少见眼部疾病,青年女性多见,具有眼前闪光感、视野缺损、视网膜电图改变,眼底轻微病变是AZOOR的共同特点。其鉴别诊断复杂,容易误诊、漏诊。Objective To study the clinical manifestations of acute zonal occult outer retinopathy （AZOOR） and to differentiate it from other retinal diseases. Methods Six patients diagnosed AZOOR had complete eye examinations including fundus photography, fundus fluorescein angiography （FFA）, eleteoretinoagraphy （ERG）, visual evoked potentials and visual field examination. Medical consultation and neurological consultation were performed in those patients. All patients were followed up and the data were collected for analysis, discussion, diagnosis and differential diagnosis. Results Six patients （five female and one male） aged 26-42 years （ mean 35 years） with AZOOR were followed up for 4-18 months[ mean （7. 5 ±3.2） months]. All of them were affected bilaterally and their visual acuity were slightly reduced except one eye was CF/40 cm. Half of them had photopsia. At least one eye of each patient had visual field defect or decreased sensitivity in local area or blind-spot enlargement. Biomicroscopic examination revealed vitreous cells in 10/12 eyes and anterior chamber inflammatory cells and keratic precipitate in 4/12 eyes. Minimal （10/12 eyes） or no （2/12 eyes） fundus changes were found in their initial examination. Funduscopic examination revealed yellow-white dots （4/12 eyes） and gray dots （6/12 eyes） at the posterior pole of deep retina or retinal pigment epithelium-Bruch membrane-choroid capillary complex layer. FFA showed depigmentation （2/12 eyes） or hyperlluorescein spots （ 10/12 eyes） that identical to the retinal lesions. In the follow-up examination, the visual acuity was reduced in one eye and visual field defect enlarged in both eyes of one patient; the number of retinal dots increased in one eye, decreased in one eye and extinguished in one eye. ERG or mERG revealed abnormal in all of their eyes with no changes in their follow-up examination. All of the initial diagnoses of six patients were not consistent with final diagnosis. Conclusions AZOOR is a rare eye d

关 键 词：视网膜疾病 荧光素血管造影术 诱发电位 视觉 视野检查法 诊断 鉴别 

分 类 号：R774.1[医药卫生—眼科]