Vogt-小柳原田综合征全身免疫抑制治疗后患眼视网膜结构变化  

Changes of retinal structure after systemic immunosuppressive treatment in eyes with Vogt-Koyanagi-Harada disease

作　　者：曹绪胜 张永鹏 纪海霞 焦璇 王红 Cao Xusheng;Zhang Yongpeng;Ji Haixia;Jiao Xuan;Wang Hong(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Ophthalmology and Visual Science Key Laboratory,Beijing 100730,China)

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眼科学与视觉科学北京市重点实验室,北京100730

出　　处：《中华医学杂志》2020年第22期1725-1729,共5页National Medical Journal of China

基　　金：北京市自然科学基金(7122042)。

摘　　要：目的探讨Vogt-小柳原田综合征(VKH)患者接受全身免疫抑制治疗后患眼黄斑区视网膜频域光学相干断层成像(OCT)的特征变化。方法对2015年12月至2019年12月间在北京同仁医院眼科门诊诊治的17例VKH患者(34只眼)的临床资料进行回顾性分析。17例患者均为急性或亚急性起病,在我院眼科门诊接受糖皮质激素和(或)联合免疫抑制剂治疗,随访时间≥6个月。末次复诊时,患眼炎症控制稳定,停用糖皮质激素(醋酸泼尼松)或≤10 mg/d。分别对入选VKH患眼治疗前和治疗后1周、1个月、3个月及末次随访时的黄斑区频域OCT特征进行观察。结果本研究共纳入17例(34只眼)VKH患者,男6例,女11例,年龄(42.2±10.6)岁,随访时间(9.4±3.3)个月。治疗后1周,发生黄斑区视网膜神经上皮广泛或多发、局灶脱离,视网膜层间囊腔,视网膜层间渗出膜,视网膜色素上皮波浪状改变的患眼比例减少(5.9%比100%、2.9%比47.1%、5.9%比70.6%、11.8%比58.8%,均P<0.001);抗炎治疗前、治疗后3个月及末次随访时,患眼黄斑区椭圆体带和外界膜结构发生损害的比例差异有统计学意义(100%比35.3%、64.7%比52.9%、41.2%比26.5%,均P<0.001);末次随访时,黄斑区椭圆体带完整组(20眼)和受损组(14眼)、黄斑区外界膜完整组(25眼)和受损组(9眼)最佳矫正视力(BCVA)差异均有统计学意义[0(0,0.05)比0.10(0.03,0.33)(log MAR),P=0.004;0(0,0.07)比0.22(0.05,0.40)(log MAR),P=0.005]。结论VKH患者全身免疫抑制治疗后1周,脉络膜视网膜水肿明显消退;抗炎治疗前、治疗后3个月和末次随访时,黄斑区椭圆体带和外界膜的受损程度和恢复能力存在差异;至随访结束时,部分患者黄斑区视网膜外层结构未能完全恢复,且与视力相关。Objective To assess structural changes in retina after systemic immunosuppressive treatment in Vogt-Koyanagi-Harada(VKH)disease using spectral-domain optical coherence tomography(SD-OCT).Methods The clinical data of 17 VKH cases(34 eyes)who consecutively attended the Beijing Tongren Hospital between December 2015 and December 2019 were retrospectively reviewed.All the patients had acute or subacute onset,and underwent high-dose systemic corticosteroid and/or immunosuppressive treatment,with a followed-up time of at least 6 months.At the end of follow-up,the intraocular inflammation was controlled,and oral prednisone was withdrawn or being adjusted to less than 10 mg/day.The SD-OCT features of the included eyes were analyzed before treatment,1 week,1 month and 3 months after treatment,and at the last visit.Results A total of 17 cases(34 eyes;6 males and 11 females)were included,with an age of(42.2±10.6)years,and were followed up for(9.4±3.3)months.At 1 week after initiating treatment,the percentage of the eyes with extensive/multiple or multifocal retinal detachment in the macular region,membranous structures and intraretinal cysts,and undulations and bumps of retinal pigment epithelium(RPE)decreased(5.9%vs 100%,2.9%vs 47.1%,5.9%vs 70.6%,11.8%vs 58.8%,respectively,all P<0.001).There was statistical significant difference of the percentage of ellipsoid zone and external limiting membrane(ELM)disruptions before treatment,at 3 months and the last visit(100%vs 35.3%,64.7%vs 52.9%,41.2%vs 26.5%,respectively,all P<0.001).At the last visit,there were statistical significant differences of the best corrected vision acuity(BCVA)between the intact ellipsoid zone group(20 eyes)and the discontinuous group(14 eyes),as well as between the intact ELM group(25 eyes)and the discontinuous group(9 eyes),respectively[0(0,0.05)vs 0.10(0.03,0.33)(log MAR),P=0.004;0(0,0.07)vs 0.22(0.05,0.40)(log MAR),P=0.005].Conclusions The edema of choroid and retina subsided obviously at 1 week after initiating treatment.The extent of damage and re

关 键 词：葡萄膜脑膜脑炎综合征 体层摄影术 光学相干 糖皮质激素类 

分 类 号：R773.9[医药卫生—眼科]