急性黄斑区视神经视网膜病的临床特征及治疗和预后  

Clinical characteristics of acute macular neuroretinopathy

作　　者：孙祖华[1] 汪村 王萌[1] 孙心铨[2] 林冰[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 [2]北京中日友好医院眼科,100029

出　　处：《中华眼视光学与视觉科学杂志》2014年第4期233-238,共6页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：基金项目：温州市科技局科研基金项目（Y20110092）

摘　　要：目的 初步探讨急性黄斑区视神经视网膜病（AMNR）的临床特征、治疗和预后.方法 回顾性病例研究.分析自2007年12月至2012年3月临床上诊断为AMNR的患者16例（25眼）.其中男12例,女4例,年龄24～72岁,平均年龄（51.1±12.7）岁.视力光感（LP）～1.2.观察其眼底彩照、OCT、FFA及ICGA的表现特征,分析其相关发病因素并探讨其发病机制及治疗预后.结果 16例患者中9例双眼发病,7例单眼发病.16例（25眼）眼底均表现为黄斑区视网膜深层灰黄色污秽样改变.FFA显示视盘不等程度的染色,部分病例黄斑区微小血管扩张渗漏,ICGA显示黄斑区低灌注性弱荧光.所有患者OCT均显示不同程度的黄斑区外层视网膜水肿、增厚,视细胞内节/外节-脉络膜毛细血管（IS/OS-CC）带的局灶性缺损,部分患者伴有局限神经上皮脱离.16例患者血清学检查均显示梅毒阳性,其中1例伴有HIV感染.10例患者（14眼）积极接受抗梅毒治疗,随访时间为2周～2年,除1例（2眼）随访时间只有2周视力无明显改善外,其余9例（12眼）视力均有明显好转,其中9眼视力恢复到1.0,眼底表现均明显改善.余6例（11眼）建议抗梅毒治疗后失访.结论 AMNR病因很多,梅毒感染是其中之一,主要的病理改变是外层视网膜及视细胞的IS/OS受到破坏.系统性的免疫学检查如梅毒螺旋体、HIV等相当重要.治疗主要是抗梅毒治疗,视力预后较好.Objective To investigate the clinical characteristics of acute macular neuroretinopathy （AMNR） and the therapy to treat it.Methods This was a retrospective study.The clinical data of 16 patients （25 eyes） diagnosed with acute macular neuroretinopathy from December 2007 to March 2012 were analyzed.The patients （12 males and 4 females） ranged in age from 24 to 72 years with an average age of 51.1±12.7 years.Visual acuity ranged from light perception （LP） to 1.2.Color fundus photography,optical coherence tomography （OCT）,fundus fluorescein angiography （FFA） and indocyanine green angiography （ICGA） were performed on these patients.The etiology and the pathogenesis as well as the therapy and visual prognosis of AMNR were evaluated.Results Among the 16 patients,9 patients were bilateral and 7 were unilateral.All 16 patients （25 eyes） showed grey-yellow lesions in the macular area.FFA revealed that the optic disc was stained in the late stages.Some patients showed the dilatation of micro-retinal veins with dye leakage in the late phases of FFA.ICGA revealed poor perfusion in the macula and the posterior area of the retina.The OCTs of all patients showed the inner segment/outer segment-choriocapillary （IS/OS-CC） band was partially absent with a thickened outer plexiform layer overlying these areas in different degrees.Some patients showed local neurosensory epithelium detachment in OCT images.The resilient packet ring （RPR）and treponema pallidum hemagglutination assay （TPHA） tests were positive in all 16 patients.HIV was simultaneously positive in one patient.Ten patients （14 eyes） agreed to anti-syphilis therapy.The follow-up ranged from 2 weeks to 2 years.The grey-yellow lesions disappeared in 9 patients （12 eyes） and visual acuity improved to 1.0 in 9 eyes.Only one patient （2 eyes） did not have an improvement in visual acuity due to a short follow-up of 2 weeks.Six other patients （11 eyes） were lost and failed to return for unknown reasons.Conclusion Syphili

关 键 词：急性黄斑区视神经视网膜病 梅毒 体层摄影术 光学相干 荧光素眼底血管造影 吲哚青绿血管造影 

分 类 号：R774.1[医药卫生—眼科]