小柳原田氏病脉络膜发病部位探讨  

Exploration of VKH Syndrome choroid pathology location

作　　者：陈晓[1] 李舒茵[1] 牛超[1] 

机构地区：[1]河南省人民医院河南省眼科研究所,郑州450003

出　　处：《医药论坛杂志》2015年第10期16-17,20,共3页Journal of Medical Forum

摘　　要：目的探讨小柳原田氏病(VKH综合征)的脉络膜发病部位。方法对2008年10月至2014年4月在河南省眼科研究所临床确诊VKH综合征的124例患者(248眼)和交感性眼炎的12例患者(12眼)的眼科B超声及OCT等影像结果进行回顾性分析。结果 VKH综合征和交感性眼炎的眼科A/B超检查发现均为玻璃体内中等或大量细小弱光点,后极部球壁弥漫性增厚,多发不同程度视网膜脱离,脱离光带下呈无回声液性暗区或散在少量弱回声光点,同时大部分见视盘隆起、筋膜囊积液或筋膜囊水肿的球壁外"T"形征;少数仅黄斑区局限性视网膜浅脱离。OCT检查都有黄斑区及后极部神经上皮多灶性脱离伴弥漫性水肿,色素上皮不均匀增厚,脉络膜大中血管纹理不清或不见,同时部分伴神经上皮外层劈裂且劈裂腔内散在絮状渗出。治疗后,复查眼科B超发现,玻璃体内中低回声絮状渗出基本消失,后极部球壁增厚及视网膜脱离消失,视盘隆起消失,球壁"T"形征消失。OCT复查发现黄斑区及后极部多灶性神经上皮脱离伴弥漫性水肿消失,上皮下渗出吸收,色素上皮不均匀增厚,脉络膜中大血管纹理显现。结论基于病理研究证明交感性眼炎主要侵犯脉络膜大血管层。通过VKH综合征和交感性眼炎OCT的对比分析发现,两种病变的OCT表现极为相似,所以推测VKH综合征也应该首先侵犯脉络膜大血管层,并累及到毛细血管层及视网膜。Objective To evaluate the diseased parts of the choroid to Vogt- Koyanagi- Harada syndrome（ VKH）.Methods Clinical data,about Vogt- Koyanagi- Harada syndrome patients 124 cases（ 248 eyes）,and Sympathetic ophthalmia patients 12 cases（ 12eyes）,were collected in Henan Eye Institute from October 2008 to April 2014. All patients were optical coherence tomography（ OCT）,ophthalmic B ultrasonic and retrospectively analyzed. Results All VKH and Sympathetic ophthalmia patients by A / B scan showed that all eyes had medium or a largr with fine bright spots in the vitreous humor,thickened of posterior pole,serous detachment of retinal neuroepithelia and subretinal septa that divided the subretinal space into several compartments,choroidal detachment,edema of optic disc bulge,fluid or edema in the menbrance,＂T＂shaped sign. All patients OCT showed retinal detachment with diffuse edema and subretinal septa that divided the subretinal space into several compartments; retinal pigment epithelium（ RPE） with uneven thickening; middle and large vascular layer seen unclear or disappear. After steroid therapy,all patients B scan showed fine bright spots in the vitreous humor,thickened of posterior pole,retinal detachment,edema of optic disc bulge and ＂T＂shaped sign improved. OCT showed serous detachment of retinal neuroepithelia and subretinal septa that divided the subretinal space into several compartments,with uneven thickening; middle and large vascular layer of the choroid showed up. Conclusion Pathological studies have shown that Sympathetic ophthalmia mainly on large vascular layer of choroid. Similar to the findings that B scan and OCT analysis of the VKH and Sympathetic ophthalmia,so VKH mainly on large vascular layer of choroid,capillary layer and retinal involvement.

关 键 词：小柳原田氏病 交感性眼炎 脉络膜 频域光学相干断层扫描 眼科A/B超 

分 类 号：R593[医药卫生—内科学]