不同病变阶段急性梅毒性后极部鳞样脉络膜视网膜炎患眼多模式影像特征观察  

Multimodal imaging of acute syphilitic posterior placoid chorioretinitis

作　　者：张娟[1] 黎铧[1] 肖丽波[1] 李娟娟[1] Zhang Juan;Li Hua;Xiao Libo;Li Juanjuan(Department of Ophthalmology,Yunnan Second People's Hospital,Key Laboratory of Eye Disease Research of Yunnan Province,Yunnan Eye Hospital,Kunming 650021,China)

机构地区：[1]云南省第二人民医院眼科,云南省眼科疾病研究重点实验室,云南省眼科医院,昆明650021

出　　处：《中华眼底病杂志》2020年第9期697-701,共5页Chinese Journal of Ocular Fundus Diseases

基　　金：云南省医疗卫生单位内设研究机构科研项目(2017NS131);云南省卫生和计划生育委员会医学后备人才培养计划(H-201636)。

摘　　要：目的观察不同病变阶段急性梅毒性后极部鳞样脉络膜视网膜炎(ASPPC)患眼的多模式影像特征。方法回顾性病例研究。2016年7月至2019年3月于云南省第二人民医院眼科检查确诊的ASPPC患者8例11只眼纳入研究。其中,男性7例10只眼,女性1例1只眼;平均年龄(48.7±8.9)岁;平均病程(13.24±11.30)个月。患者均行眼底彩色照相、红外照相(IR)、FAF、FFA、OCT、OCT血管成像(OCTA)检查。根据病变阶段及特征将患眼分为急性期、吸收期,分别为7、4只眼。观察不同病变阶段ASPPC的眼底彩色照相、IR、FAF、FFA、OCT、OCTA的影像特征。结果急性期,眼底彩色照相可见后极部视网膜下黄白色鳞状病变、神经上皮脱离、黄白色渗出物;IR可见病灶区域内可见不均匀红外反光;FAF可见后极部类圆形或鳞片状强自身荧光,范围较眼底彩色照相更广泛;FFA动静脉期病灶呈模糊弱荧光,随时间延长荧光逐渐增强,晚期呈类圆形强荧光,其周围环绕弱荧光环,渗出浓厚区域呈荧光遮蔽;OCT可见病变区域神经上皮脱离,其内可见均匀强反射信号。吸收期,眼底彩色照相可见后极部视网膜下黄白色鳞状病变吸收,色素轻度脱失;IR可见病变区域内斑驳状红外反光较急性期明显减少;FAF可见后极部斑点状强自身荧光,其中"豹斑样"改变3只眼;FFA可见病灶内斑驳状荧光染色,未见荧光素渗漏和积存;OCT可见RPE层针尖样突起,外界膜、椭圆体带均显示不清;OCTA可见脉络膜毛细血管血流信号减弱,部分区域内信号缺失。结论ASPPC急性期,患眼后极部视网膜下黄白色鳞状病变、神经上皮脱离、黄白色渗出物,FFA可见病灶区晚期荧光素渗漏;吸收期,眼底可见黄白色病灶已吸收,FFA呈现荧光素着染,无渗漏。OCT提示RPE、外界膜及椭圆体带均有不同程度破坏,OCTA提示病变区脉络膜有血流信号减弱。Objective To observe the multimodal imaging features of the eyes with acute syphilitic post-polar squamous chorioretinitis(ASPPC)at different stages of disease.Methods A retrospective case study.From July 2016 to March 2019,8 patients(11 eyes)of ASPPC patients diagnosed in the ophthalmological examination of Yunnan Second People's Hospital were included in the study.Among them,there were 7 males(10 eyes)and 1 female(1 eye);the average age was 48.7±8.9 years;the average course of disease was 13.24±11.30 months.All patients underwent fundus color photography,infrared photography(IR),FAF,FFA,OCT,OCT angiography(OCTA).According to the stage and characteristics of the disease,the affected eyes were divided into acute phase and absorption phase,with 7 and 4 eyes respectively.We observed the color fundus images of ASPPC,IR,FAF,FFA,OCT,OCTA image characteristics of different disease stages.Results In the acute phase,the posterior pole subretinal yellow-white squamous lesions,neuroepithelial detachment,and yellow-white exudates were observed in fundus color photography;uneven infrared reflections can be seen in the lesion area by IR;the posterior pole was round or scaly with strong autofluorescence in FAF,the range was larger than the fundus color photography;FFA arteriovenous stage lesions showed fuzzy weak fluorescence,the fluorescence gradually increased with time,the late stage showed a round-shaped strong fluorescence,surrounded by a weak fluorescence ring,and the area with thick exudation was covered by fluorescence;the neuroepithelium of the diseased area was detached,the uniform strong reflection signal can be seen in it by OCT.In the absorption phase,fundus color photography showed the yellow-white scaly lesions under the posterior retina absorption,and the pigment was slightly depleted;IR showed the mottled infrared reflection in the lesion area was significantly reduced compared with the acute phase;FAF showed the posterior spot-like strong autofluorescence,including"leopard spot-like changes"3 eyes;FFA showe

关 键 词：脉络膜视网膜炎 梅毒 眼感染 细菌性 荧光素血管造影术 体层摄影术 光学相干 

分 类 号：R759.1[医药卫生—皮肤病学与性病学] R774.11[医药卫生—临床医学]