交感性眼炎眼底多模式影像特征观察  

Multimodal imaging characteristics of fundus in patients with sympathetic ophthalmia

作　　者：程奕喆 张乘瑞 陈春丽 张智涵 侯思梦 彭晓燕[1] Cheng Yizhe;Zhang Chengrui;Chen Chunli;Zhang Zhihan;Hou Simeng;Peng Xiaoyan(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing ophthalmology&Visual Sciences Key Lab,Beijing 100730,China;Department of Ophthalmology,Beijing Nuclear Industry Hospital,Beijing 100045,China)

机构地区：[1]北京同仁眼科中心,眼科学与视觉科学北京市重点实验室,首都医科大学附属北京同仁医院,北京100730 [2]北京核工业医院眼科,北京100045

出　　处：《中华眼底病杂志》2022年第5期359-365,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：首都卫生发展科研专项(首发2018-2-1081);北京同仁医院重点医学专业发展计划(trzdyxzy 201801)。

摘　　要：目的观察并分析交感性眼炎(SO)患眼的多模式影像特征。方法回顾性临床研究。2012年10月至2021年12月于北京同仁医院眼科检查确诊的SO患者28例36只眼纳入研究。患者中,男性19例25只眼,女性9例11只眼;年龄(51.61±12.02)岁。诱发眼8只,交感眼28只。外伤或手术后发病时间(46.10±107.98)个月。所有患者均行视力、眼底彩色照相、光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)检查。行OCT血管成像(OCTA)检查3只眼;自身荧光(AF)检查8只眼。病程早期、晚期分别定义为发病时间≤2、>2个月。回顾分析患眼多模式影像特征。结果诱发眼8只眼中,大片状视网膜下纤维化伴多灶性视网膜萎缩及色素增生5只眼(62.50%,5/8);"晚霞状"眼底3只眼(37.50%,3/8)。交感眼28只眼中,病程早期表现为多灶性视网膜浅脱离伴视盘水肿9只眼(32.14%,9/28);病程晚期表现为视盘周围(盘周)及周边视网膜下黄白色病灶11只眼(39.29%,11/28),"晚霞状"眼底11只眼(39.29%,11/28)。Dalen-Fuchs结节10只眼(35.71%,10/28)。OCT检查,病程早期可见视网膜脱离和不规则脉络膜隆起;病程晚期可见盘周及黄斑大片隆起的视网膜下强反射物质及视网膜层间囊腔。FFA检查,早期"针尖样"强荧光,晚期伴"多湖状"荧光素积存及渗漏;病程早期盘周"地图状"弱荧光,周边视网膜各象限存在点状强荧光病灶,病程晚期荧光增强。ICGA检查,中晚期FFA强荧光病灶为弱荧光。AF检查,边界欠清晰的点片状强弱AF病灶。表现为"晚霞状"眼底的8只眼,其视力轻度下降,为0.5~1.0;盘周黄白色病灶的9只眼,其视力显著下降,为无光感~0.1。结论SO病程早期可表现为与Vogt-Koyanagi-Harad综合征急性期相似的多模式影像特征,病程晚期表现为盘周、黄斑及周边视网膜下持续存在的黄白色病灶。存在盘周黄白色病灶患眼视力显著下降;"晚霞状"眼底患眼视力轻度下Objective To observe and analyze the multimodal imaging characteristics of fundus in patients with sympathetic ophthalmia(SO).Methods A retrospective study.From October 2012 to December 2021,28 patients(36 eyes)diagnosed SO in the Department of Ophthalmology,Beijing Tongren Hospital were inclued in the study.There were 19 males(25 eyes)and 9 females(11 eyes),with the mean age of 51.61±12.02 years.There were 8 exciting eyes and 28 sympathizing eyes.The time to onset after trauma or surgery was 46.10±107.98 months.All patients underwent examinations including vision test,color fundus photograph,optical coherence tomography(OCT),fundus fluorescence angiography(FFA),indocyanine green angiography(ICGA).Angio-OCT(OCTA)was performed on 3 eyes and fundus autofluorescence(AF)was performed on 8 eyes.The early and late phase were defined respectively as≤2 months and>2 months.Their multimodal imaging characteristics were summarized.Results In 8 exciting eyes,subretinal fibrosis with mutifocal retinal atrophy and pigmentation was noted in 5 eyes(62.50%,5/8),the other 3 eyes showed sunset glow fundus(37.50%,3/8).In 28 sympathizing eyes,in the early phase,the fundus photograph showed shallow retinal detachment with optic disc edema in 9 eyes(32.14%,9/28);in the late phase,peripapillary yellowish-white subretinal lesions in 11 eyes(39.29%,11/28).In the late course of the disease,there were yellow-white lesions around the optic disc(peridisc)and peripheral subretinal area in 11 eyes(39.29%,11/28).Dalen-Fuchs nodules were found in 10 eyes(35.71%,10/28).On OCT,multiple serous retinal detachment and irregular choroidal folds were noted in the early phase;hill-like subretinal hyperreflective elevation was noted in peripapillary area and subfovea with presence of cystic spaces in the intraretina in the late phase.FFA examination showed"pinpoint-like"strong fluorescence in the early stage,and"multi-lake-like"fluorescein accumulation and leakage in the late stage;"map-like"weak fluorescence around the disc in the early stage of the

关 键 词：眼炎 交感性 荧光素血管造影术 体层摄影术 光学相干 多模式影像 

分 类 号：R771[医药卫生—眼科]