频域OCT在急性Vogt-小柳原田病和急性中心性浆液性脉络膜视网膜病变鉴别诊断中的应用  

Distinguishing acute Vogt-Koyanagi-Harada disease from acute central serous chorioretinopathy with spectral domain OCT

作　　者：林杜生[1] 张贵华[1] 陈浩宇[1] 岑令平[1] 陈伟奇[1] 

机构地区：[1]汕头大学/香港中文大学联合汕头国际眼科中心,广东省汕头市515041

出　　处：《眼科新进展》2015年第6期557-560,共4页Recent Advances in Ophthalmology

基　　金：广东省医学科研基金立项课题(编号:B2013288)~~

摘　　要：目的评价频域光学相干断层扫描(optical coherence tomography,OCT)鉴别急性Vogt-小柳原田病(Vogt-KoyanagiHarada,VKH)和急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSCR)的诊断能力。方法收集急性VKH和急性CSCR病例,所有病例均接受详细的病史采集以及视力、裂隙灯显微镜、散瞳眼底检查、频域OCT和眼底荧光血管造影检查。运用频域OCT(SD-OCT)的5线光栅扫描和黄斑三维扫描进行SD-OCT黄斑区扫描,计算各种OCT形态特征对鉴别诊断两种疾病的敏感性、特异性、漏诊率和误诊率。结果入选急性VKH患者40例(40眼),急性CSCR患者32例(32眼);急性VKH组的最佳矫正视力较急性CSCR组差(P<0.001);急性VKH组的黄斑中心凹视网膜厚度为(771.6±419.2)μm,而急性CSCR组为(451.7±157.9)μm,两组差异有统计学意义(P<0.001);两组所有患者均有视网膜神经上皮层脱离,而膜样结构、视网膜色素上皮层皱褶和内界膜波浪样改变仅见于急性VKH组,它们对鉴别急性CSCR的敏感性分别是85.0%、62.5%和55.0%,膜样结构对鉴别两种疾病的敏感性最高,且其特异性为100.0%,假阳性率(误诊率)为0,假阴性率(漏诊率)为15.0%。结论 SD-OCT可以有效区分急性VKH和急性CSCR,膜样结构是鉴别两者敏感性最高的OCT形态特征。Objective To evaluate the diagnostic efficacy of SD-OCT between a- cute Vogt-Koyanagi-Harada （VKH） and acute central serous chorioretinopathy （CSCR）. Methods Subjects with acute VKH and acute CSCR were collected. All sub- jects received comprehensive ophthalmic examinations including best-corrected visual acuity （BCVA）, intraocular pressure, slit lamp biomicroscopy of anterior segment and retina with mydriasis, fundus fluorescein angiography and spectral domain-OCT. All macular regions were scanned with five lines raster scans and macular cube 512 x 128 combination programs. Diagnostic performances included sensitivity, specificity, false positive rate and false negative rate were evaluated for all OCT characteristics. Results Forty cases with acute VKH and 32 cases with acute CSCR were included in this stud- y. BCVA was significantly worse in acute VKH group than in acute CSCR group （P 〈 0. 001）. Thickness of fovea was significantly higher in acute VKH （771.6 ±419.2） μm than acute CSCR （451.7 ± 157.9 ） μm （ P 〈 0. 001 ）. All eyes with acute VKH and CSCR had neuroseusory retinal detachment. Membrane structure, retinal pigment epithelial fold and fluctuation of internal limiting membrane were only found in acute VKH. Their sensitivity of clinical diagnosis were 85.0% ,62.5% and 55.0% , respectively. Membrane structure had the highest sensitivity to diagnostic acute VKH from acute CSCR, with spe- cificity,false positive rate and false negative rate of 100.0% ,0% and 15.0% ,respective- ly. Conclusion SD-OCT can effectively distinguish acute VKH and acute CSCR objec- tives. Membrane structure has the most excellent diagnostic performance among all OCT characteristics.

关 键 词：VOGT-小柳原田病 中心性浆液性脉络膜视网膜病变 光学相干断层扫描 鉴别诊断 

分 类 号：R774.1[医药卫生—眼科]