癌症相关性视网膜病变的临床特征  

Clinical features of cancer-associated retinopathy

作　　者：李蕙[1] 杨丽珠[1] 邹绚[1] 孙子系 睢瑞芳[1] Li Hui;Yang Lizhu;Zou Xuan;Sun Zixi;Sui Ruifang(Department of Ophthalmology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院眼科,北京100730

出　　处：《中华实验眼科杂志》2018年第10期786-790,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：中国医学科学院医学与健康科技创新工程经费项目（2016-12M-1-002）

摘　　要：目的分析总结癌症相关性视网膜病变（CAR）患者眼部临床特征。方法对2012年1月至2017年3月北京协和医院确诊的10例CAR患者的临床资料进行回顾性分析，患者均行详细眼部检查，包括症状的记录、间接检眼镜检查、光相干断层扫描（OCT）、全视野视网膜电图（ffERG）、视野及自发荧光（AF）检查。结果10例患者均经手术及病理诊断证实为癌症/肿瘤，其中胸腺瘤3例、肺癌3例及甲状腺癌、上颌窦肿瘤、鼻咽癌和直肠癌各1例。患者表现为双眼急性或亚急性进行性视力下降，3例伴夜盲。最佳矫正视力（BCVA）<0.1者3眼，BCVA≥0.1~<0.5者7眼，≥0.5者10眼。OCT检查提示，6例患者黄斑区正常，但周边椭圆体带消失，RPE层变薄；4例患者黄斑区全层变薄。8例患者ffERG显示所有反应波形均中度到重度降低，峰时延长，2例表现为负波型。视野特征为环形或弓形缺损。眼底AF表现为仅中周部点状低、高荧光或黄斑区不规则低荧光区合并中周部散在低荧光。结论CAR可呈现多种临床和眼底表现。视力下降伴或不伴夜盲、视野缺损及ffERG异常是CAR的共同特征。Objective To analyze the clinical features of cancer-associated retinopathy(CAR).Methods The clinical data of 10 patients who diagnosed as CAR during 5 years were retrospectively analyzed.All patients underwent detailed ocular examinations,including electroretinogram(ERG),optical coherence tomography(OCT),visual field(VF)and autofluorescence(AF).Results The primary malignancy was lung carcinoma in 3 patients,thymoma in 3 patients,thyroid carcinoma in 1 patients,maxillary sinus tumor in 1 patients,nasopharyngeal carcinoma in 1 patients and rectal cancer in 1 patients.All patients complained progressive visual reducing.Three patients manifested night blindness.The best corrected visual acuity(BCVA)<0.1 was in three eyes,≤0.1-<0.5 in seven eyes,and≥0.5 in ten eyes.Patients showed normal fundi or mild abnormality.OCT images showed disorganization and/or loss of the ellipsoid zone in the macular area in 4 patients,and other six patients had only central foveal ellipsoid zone preserved.Eight patients had moderately or severely reduced ffERG,and 2 patients demonstrated electro-negative ERG.Five patients revealed peripheral visual defect.AF images were from normal to low or high AF patches in the posterior pole and mid-peripheral retina.Conclusions The clinical manifestations of CAR are varied as common characteristics of progressive visual decrease with or without night blindness,visual field defect and abnormal ffERG recording.

关 键 词：癌症相关性视网膜病变 免疫性视网膜病变 临床特征 

分 类 号：R730.5[医药卫生—肿瘤] R774.1[医药卫生—临床医学]