急性黄斑区神经视网膜病变的临床及OCT特征  

Clinical and OCT image characteristics of acute macular neuroretinopathy

作　　者：滕羽菲[1,2] 郑轶[3] 于旭辉[3] 滕岩[3] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科研究所 [2]眼科学与视觉科学北京市重点实验室,100005 [3]哈尔滨医科大学第一临床医学院附属眼科医院,150001

出　　处：《眼科》2016年第6期391-395,共5页Ophthalmology in China

摘　　要：目的探讨急性黄斑区神经视网膜病变(acute macular neuroretinopathy,AMN)临床及OCT影像学特征。设计回顾性病例系列。研究对象2009-2015年哈尔滨医科大学第一临床医学院眼科医院AMN患者5例5眼。方法回顾患者的病史、临床表现、眼底像、频域相干光断层扫描(SD-OCT)检查的结果。主要指标眼底表现,SD-OCT图像特征。结果 5例患者中4例为年轻女性,骤然出现视力下降或暗点。1例患者患病前1周有感冒发热史。3眼后极部圆形暗红色病变;1眼黄斑中心偏颞下方暗红色分叶状病变。SD-OCT显示4眼黄斑区局灶性椭圆体带和嵌合带缺失。2例外核层外侧一高反射病变。1例外核层变薄,内、外丛状层增厚。1例陈旧病变,外界膜缺失断端与色素上皮层相连,外核层变薄,内、外丛状层增厚。视野、ERG未见明显异常,FFA未见特异性改变。结论 AMN患者多为年轻女性,急性发病。眼底表现多为黄斑区暗红色病灶。SD-OCT表现多为黄斑区局灶性椭圆体带和嵌合带缺失,早期可伴有光感受器层高反射,晚期为椭圆体带和嵌合带的缺失、破坏。Objective To investigate the clinical and image features of acute macular neuroretinopathy （AMN）. Design Retrospective case series. Participants Five eyes of 5 patients with AMN recruited from First Clinical Medical College Affiliated Hospital of Harbin Medical University from 2009 to 2015. Methods The clinical data and ocular examination results were collected for comprehensive analysis. Main Outcome Measures Clinical features, ocular fundus changes, spectral-domain optical coherence tomography （SD-OCT） images. Results 4 patients were young women, who had an acute onset of visual symptoms at presentation, including blurred vision and shadows. One patient had a preceding cold and fever. Fundoscopic examination revealed a round-shape, dark reddish-brown lesion at posterior area in 3 affected eyes, circular light orange pigmentary changes at the macula in 1 eye; a dark-red lobulated intraretinal subtle irregularities in inferior temporal macula in 1 eye. SD-OCT at presentation disclosed the focal loss of the ellipsoid zone and interdigitation zone in all affected eyes. Two patients showed a high reflective lesion in lateral outer nuclear layer. One patient showed a complete disruption of the ellipsoid zone and a focal disruption of the interdigitation zone, a hyperreflectivity in the outer side of the external limiting membrane and the outer nuclear layer was thinner. In one case with unknown onset time, SD-OCT exhibited the end of the disrupted external limiting membrane was connected to the RPE layer. The outer nuclear layer was thinned with the thickened inner and outer plexiform layers overlying. A focal depression in inner and outer plexiform layer and inner nuclear layer was found as well. Conclusion The 4 cases of AMN happened in young women. Fundus examination showed a dark-red lesion in macular area. SD-OCT revealed the focal loss of the ellipsoid zone and interdigitation zone with hyperreflectivity in photoreceptor layer in early stage. And late stage showed the loss and damage of the ellipsoid zo

关 键 词：急性黄斑区神经视网膜病变 相干光断层扫描 

分 类 号：R774[医药卫生—眼科]