18例急性区域性隐匿性外层视网膜病变的临床分析  

Clinical analysis of 18 patients with acute zonal occult outer retinopathy

作　　者：陈倩[1] 常青[1] 王文吉[1] 王敏[1] 周旻[1] 俞笳[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中华眼底病杂志》2012年第4期363-367,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的 观察急性区域性隐匿性外层视网膜病变（AZOOR）的临床特征。方法 临床确诊为AZOOR的18例患者18只眼纳入研究。所有患者均行矫正视力、眼底、视野、视网膜电图（ERG）检查。部分患者同时行荧光素眼底血管造影（FFA）、光相干断层扫描（OCT）、视觉诱发电位（VEP）及多焦视网膜电图（mf-ERG）检查。观察患者的临床特征。对比分析患眼与对侧眼的视觉电生理检查结果。分析同时行OCT、视野和mf-ERG检查者的检测结果一致性。结果 患者中，男性3例，女性15例；均为单眼发病。其中，正视2只眼，占11.1%；近视16只眼，占88.9%。无明显眼底改变11只眼，占61.1%；黄斑区附近单发黄白色点状病灶或视网膜色素上皮改变3只眼，占16.7%；颞侧呈区域性脱色素改变4只眼，占22.2%。所有患眼中心视野异常，周边视野正常。行OCT检查的患眼均存在不同程度光感受器细胞内外节连接（IS/OS）光带中断、缺失或毛糙。ERG检查发现，与对侧眼比较，患眼视杆反应b波，最大反应a、b波，视锥反应a、b波及30 Hz闪烁光反应振幅均降低，差异有统计学意义（t=3.516，2.689，3.103，3.517，2.999，3.309；P＜0.05）；除视杆反应b波潜伏期差异无统计学意义外（t=1.023，P=0.306），其余波潜伏期均较对侧眼延长，差异有统计学意义（P＜0.05）。VEP检查发现，患眼P100波振幅较对侧眼降低，差异有统计学意义（t=2.040，P=0.041）；患眼与对侧眼P100波潜伏期比较，差异无统计学意义（t=1.687，P=0.092）。行mf-ERG检查的患眼均存在振幅改变。OCT与mf-ERG检测结果具有良好的一致性；而中心视野与mf-ERG检测结果不完全一致，其异常区域分布不相吻合。结论 AZOOR以青年女性、近视眼发病为多见；通常无明显眼底改变；但中心视野及视觉电生理检查存在异常，OCT检查可见其存在不同程度的IS/OS光带中�Objective To observe the clinical features of acute zonal occult outer retinopathy （AZOOR）.Methods Eighteen patients （18 eyes） with AZOOR were enrolled in this study. All the patients were examined for corrected visual acuity, fundus examination, visual field and electroretinography （ERG）. For part of these patients, fluorescein angiography （FFA）, optic coherence tomography （OCT）, visual evoked potential （VEP） and multifocal ERG （mf-ERG） were performed. Clinical features were observed. Comparative analysis was performed on the electrophysiological results between affected eyes and fellow eyes. The consistency of OCT, visual field and mf-ERG results was investigated.Results The patients included three males and 15 females. All patients were unilateral involved. 16 eyes （88.9%） were myopia, two eyes （11.1%） were emmetropia. 11 eyes （61.1%） have normal fundus; single yellow-white punctuate lesion or old RPE lesion near macular were found in three eyes （16.7%）; depigmented zones in temporal retina were found in four eyes （22.2%）. All central visual field results were abnormal, but peripheral visual field results were normal. OCT findings included irregularity, absence or breaks of the photoreceptor inner segment/outer segment （IS/OS） junction. Amplitudes of full-field ERG were reduced in the affected eyes （t=3.516,2.689,3.103,3.517,2.999,3.309;P〈0.05）, and implicit times were delayed in most responses except for rod response （t=1.023,P=0.306）. Amplitudes of P100 wave of visual evoked potential were reduced statistically （t=2.04,P=0.041）, but the differences of implicit times between the affected eyes and the fellow eyes were not statistically significant （t=1.687,P=0.092）. Amplitude reduction of multifocal ERG existed in all affected eyes. Coincidence was found between results of OCT and mf-ERG. But abnormal zones found by central visual field did not always coincide with those by mf-ERG. Conclusions The majority of patients who develop AZOOR are y

关 键 词：视网膜疾病/诊断 视网膜电描记术/利用 体层摄影术 光学相干/利用 

分 类 号：R774.1[医药卫生—眼科]