非急性期伏格特-小柳-原田综合征的眼底荧光造影特征分析  

Fundus fluorescence angiography of the non-acute Vogt-Koyanagi-Harada

作　　者：张娟[1] 马银燕 黎铧[1] 李娟娟[1] ZHANG Juan;MA Yinyan;LI Hua;LI Juanjuan(Department of Ophthalmology,Second People’s Hospital of Yunnan Province,Kunming 650021,China)

机构地区：[1]云南省第二人民医院眼科,昆明650021

出　　处：《眼科学报》2020年第5期319-326,共8页Eye Science

基　　金：云南省医疗卫生单位内设研究机构科研项目(2018NS0011)。

摘　　要：目的:观察非急性期伏格特-小柳-原田综合征(Vogt-Koyanagi-Harada syndrome,VKH)的眼底荧光血管造影(fundus fluorescein angiography,FFA)特征。方法:本研究为回顾性病例研究。收集2016年1月至2019年8月诊断为非急性期VKH的40例(80眼)患者纳入研究,总结分析其眼底影像特征。结果:40例患者中12例(24眼)出现不同程度的色素上皮损伤改变;10例(20眼)出现不同程度的脉络膜毛细血管损伤;18例(36眼)患者眼底彩色照片可见已视盘为中心视网膜脉络膜皱褶形成的放射状条纹样改变。24例(48眼)非急性期VKH患者眼底荧光造影呈现不典型的荧光素渗漏。其中10例(20眼)FFA表现为早期后极部可见部分高荧光点,至造影晚期均未见高荧光点的扩大、渗漏及荧光积存现象;14例(28眼)可见后极部大量强荧光点,观察至晚期均强荧光点轻度扩大渗漏,呈弥漫的点状高荧光区。6例(12眼)造影均无明显脉络膜视网膜荧光素渗漏,但光相干断层扫描(optical coherence tomography,OCT)提示仍有不同程度神经上皮层脱离,伴视网膜色素上皮(retinal pigment epithelium,RPE)层波浪状改变。4例(8眼)病程较长患者其眼底表现为后极部灰白色视网膜下条状、片状纤维瘢痕。40例患者中有37例视盘于FFA晚期呈不同程度荧光素着染强荧光,3例伴少许荧光素渗漏。结论:非急性期VKH眼底改变可以是多种表现,而眼底影像表现提示病变不同恢复程度及进展情况,有助于更为深入、细致、动态地了解该病的组织病理改变、发展转归,从而指导临床诊断和治疗。Objective:To observe the fundus fluorescein angiography(FFA)features of non-acute Vogt-Koyanagi-Harada syndrome(VKH).Methods:In this retrospective case study,40 patients(80 eyes)who were diagnosed with non-acute VKH admitted to our hospital from January 2016 to August 2019 were enrolled,and their fundus imaging features were summarized.Results:Twelve of 40 patients(24 eyes)developed varying degrees of pigment epithelial damage.Ten patients(20 eyes)presented with varying degrees of choroidal capillary damage.Color fundus images of 18 patients(36 eyes)showed a radial streak-like change in the retinal choroid folds.FFA showed atypical fluorescein leakage in 24 patients(48 eyes)with chronic VKH.Among them,FFA showed high fluorescence in the early posterior pole,and no enlargement,leakage and fluorescence accumulation in the late angiography of 10 cases(20 eyes);14 cases(28 eyes)showed a large quantity of high fluorescence in the posterior pole.In the late stage,high fluorescence was slightly enlarged with leakage,showing a diffuse point-like high fluorescence area.No evident choroidal fluorescein leakage was observed in 6 cases(12 eyes),but optical coherence tomography(OCT)detected different degrees of neuroepithelial detachment with undulating changes in the retinal pigment epithelium(RPE)layer.In 4 cases(8 eyes),fundus images showed a gray-white subretinal strip and a flaky fibrous scar in the posterior pole.Thirty-seven cases showed strong fluorescence in optic disk to different degrees in the late FFA,3 cases with slight leakage of fluorescein.Conclusion:The fundus changes are diverse in non-acute VKH.Fundus image shows different degrees of progression and recovery of the disease,which enables us to deepen the understanding of the histopathological changes,development and prognosis,and eventually provides guidance to clinical diagnosis and treatment of non-acute VKH.

关 键 词：眼底荧光造影检查 光相干断层扫描 视网膜色素上皮 伏格特-小柳-原田综合征 葡萄膜炎 

分 类 号：R773.9[医药卫生—眼科]