Vogt-小柳-原田综合征葡萄膜炎期荧光素钠及吲哚菁绿同步眼底血管造影特征分析  

Analysis of simultaneous fundus fluorescein and indocyanine green angiography in uveitis stage of Vogt-Koyanagi-Harada disease

作　　者：史雪辉[1] 杨丽红[1] 丁宁[1] 田蓓[1] 魏文斌[1] 

机构地区：[1]首都医科大学附属北京同仁医院,北京同仁眼科中心,北京市眼科学与视觉科学重点实验室,北京市100730

出　　处：《眼科新进展》2011年第10期941-944,共4页Recent Advances in Ophthalmology

基　　金：国家自然科学基金资助(编号:81041018);北京市自然科学基金资助(编号:7092021)~~

摘　　要：目的探讨Vogt-小柳-原田综合征(Vogt-Koyanagi-Harada disease,VKH)葡萄膜炎期荧光素钠及吲哚菁绿同步眼底血管造影的影像学特征及其临床意义,为诊断及病程监测提供依据。方法回顾性分析11例22眼VKH葡萄膜炎期患者应用海德堡HRA2共焦激光扫描眼底血管造影系统进行的荧光素钠眼底血管造影(fundus fluorescein angiography,FFA)和吲哚菁绿血管造影(indocyanine green angiography,ICGA)同步检查资料,比较2种检查的影像学特征。结果 11例22眼中,FFA检查8眼(36.36%)后极部多处脉络膜充盈迟缓;9眼(40.91%)视盘渗漏水肿;22眼(100.00%)后极部视网膜色素上皮密集针尖状高荧光渗漏,18眼(81.82%)后极部神经上皮脱离部位FFA晚期形成多囊样或多湖状荧光积存;13眼(59.09%)静脉期散在、均匀脉络膜炎性病灶,呈斑点状低荧光。ICGA检查15眼(68.18%)脉络膜充盈迟缓;14眼(63.64%)脉络膜血管扩张;16眼(72.73%)播散状分布、斑点状脉络膜炎性低荧光病灶;18眼(81.82%)后极部神经上皮脱离区大多呈现持续低荧光,晚期部分囊样病灶呈中强荧光;9眼(40.91%)视盘水肿晚期显示视盘及盘周低荧光。FFA和ICGA同步检查结果:FFA检查100.00%患眼静脉期视盘周及后极部密集点状高荧光渗漏,而在ICGA上无此征象;FFA检查视盘表面毛细血管扩张比ICGA显示更明显;ICGA检查脉络膜充盈迟缓15眼(68.18%)及斑点状炎性病灶16眼(72.73%),均高于FFA检查结果的8眼(36.36%)和13眼(59.09%),而且ICGA早期脉络膜血管扩张显示更清晰;后极部神经上皮脱离病灶在FFA静脉期表现为低荧光,晚期形成荧光积存,而病变区域ICGA检查相应部位多为持续低荧光。结论 VKH葡萄膜炎期FFA清晰显示视网膜色素上皮损伤特征以及炎症累及视盘、视网膜的程度和范围;ICGA能够清晰显示脉络膜循环改变及脉络膜炎症的活动性和范围。FFA和ICGA同步检查对VKH诊断及发病机制有重要的指导意义。Objective To investigate the iconographic characteristics of fundus fluorescein angiography（FFA） and indocyanine green angiography（ICGA） in uveitis stage of Vogt-Koyanagi-Harada disease,and provide the evidence for diagnosis and disease course monitoring.Methods Eleven patients（22 eyes） in uveitis stage of Vogt-Koyanagi-Harada disease were examined by FFA and ICGA simultaneously with HRA2 confocal scanning laser ophthalmoscope.The iconographic characteristics were retrospectively analyzed.Results In the 22 eyes of 11 patients,FFA showed diffuse delayed choroidal perfusion in 8 eyes（36.36%）,disc leakage in 9 eyes（40.90%）,pin-point leakage that dued to retinal pigment epithelium（RPE） damage in 22 eyes（100.00%）,dye pooling at late phase in 18 eyes（81.82%）,and choroiditis dark dots in 13 eyes（59.09%）.ICGA showed delayed choroidal perfusion in 15 eyes（68.18%）,choroidal vessel dilatation in 14 eyes（63.64%）,choroiditis dark dots in 16 eyes（72.73%）,persistent hypofluorescent in most serous retinal detachment areas in 18 eyes（81.82%）,and disc hypofluorescence corresponding to disc edema in 9 eyes（40.91%）.In the simultaneous FFA and ICGA images,the most frequent feature in FFA was pinpoint hyperfluorescence（100.00%）,the disc leakage was more obvious in FFA than in ICGA;The characteristic features in ICGA were delayed choroidal perfusion（68.18%） and choroiditis dark dots（72.73%）,which were more frequently seen than those in FFA（36.36% and 59.09% respectively）.Choroidal vessel dilation was more obvious at the early phase in ICGA.The retinal detachment appeared hypofluorescence in vein phase and dye pooling at late phase in FFA,but persistent hypofluorescence in ICGA.Conclusions In uveitis stage of Vogt-Koyanagi-Harada disease,FFA shows the RPE injury,the disc and retinal vessel leakage involve.ICGA shows the choroidal pathological conditions and the choroiditis activity.Simultaneous FFA and ICGA would be helpful in the diagnosis and mechanism study of Vo

关 键 词：VOGT-小柳-原田综合征 眼底血管造影 荧光素钠 吲哚菁绿 

分 类 号：R773.9[医药卫生—眼科]