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  

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[1] 林冰[1] 孙祖华[1] 郑薇薇[1] 李英姿[1] 周挺业[1] 刘晓玲[1] 

机构地区：[1]温州医科大学附属眼视光医院眼底内科,325027

出　　处：《中华眼底病杂志》2013年第5期474-478,共5页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金青年科学基金（81100672）

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AZOOR38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AZOOR28只眼，Ⅱ型AZOORMEWDS4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AZOOR38只眼中，MEWDS9只眼就诊时眼底均可见后极部或中周部白点。PIC25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。MC4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AZOOR28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AZOORMEWDS9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AZOOR28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AZOORMEWDS4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�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 l] , 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 ~[ cases （28 eyes）, 12 eyes （42.9%） demonstrated depressed seotopic 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 1] AZOOR which were more obvious in FFA. The manifestations of OCT showed IS/OS irregularity or absence in the area corresponding to the lesions.

关 键 词：视网膜疾病 诊断 疾病特征 体层摄影术 光学相干 

分 类 号：R774.1[医药卫生—眼科]