拟诊为结核性多灶性脉络膜炎多模式影像学特征研究  

Multimodal imaging manifestations of presumed tuberculous multifocal Choriditis

作　　者：贾舒雅 朱婕 陈放 杨添意 甘春兰 Jia Shuya;Zhu Jie;Chen Fang;Yang Tianyi;Gan Chunlan(Department of Ophthalmology,Subei People’s Hospital Affiliated to Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学附属苏北人民医院眼科,扬州225001

出　　处：《临床眼科杂志》2023年第3期219-225,共7页Journal of Clinical Ophthalmology

基　　金：2020年扬州市社会发展计划项目(YZ2020112)。

摘　　要：目的分析并探讨临床拟诊为结核性多灶性脉络膜炎患者的眼部多模式影像学表现及相对特征,为临床诊治提供理论依据。方法回顾性系列病例研究。纳入2018年1月至2021年7月就诊于苏北人民医院的拟诊为结核性多灶性脉络膜炎且抗结核治疗有效的患者16例(24只眼)。患者年龄30~79岁;男性7例(43.8%),女性9例(56.2%)。收集患者眼科影像学检查资料,分析并总结,包括广角扫描激光眼底成像(SLO)、广角眼底荧光素血管造影(FAF)、吲哚青绿血管造影(ICGA)、相干光层析成像术(OCT)、超声生物显微镜(UBM)等,寻找结核性多灶性脉络膜炎多模式影像学的相对特征性表现。结果患者诊断性抗结核治疗前平均logMAR视力为0.69±0.62,抗结核治疗后为0.39±0.52,治疗后最佳矫正视力(BCVA)较治疗前明显提高。活动性多灶性脉络膜炎在眼底照上主要表现为多发性的边界不清的黄白色点片状病灶。眼底自发荧光(FAF)表现为弥漫性的高自发荧光,部分表现为边界不清的高自发荧光边缘包绕主体病灶。FFA表现为视网膜下多个大小不一的病灶,造影早期病灶为低荧光改变,随时间进展,病灶边缘出现荧光素渗漏包绕低荧光病灶,边界不清。ICGA表现为圆形或椭圆形的低荧光暗点(HDDs)及地图样低荧光改变,不可透见下方脉络膜血管。OCT表现为外层视网膜结构破坏、视网膜外层的疣状突起或视网膜色素上皮层(RPE)上下的高反射物质堆积,可伴脉络膜血管的扩张,治疗后OCT表现部分好转。结论结核性脉络膜炎在ICGA常见的表现为圆形或椭圆形的低荧光暗点及地图样低荧光改变。与FFA相比,ICGA可发现更多的脉络膜炎性病灶,有助于结核性脉络膜炎的诊断。OCT中表现为黄斑水肿、HF和视网膜外层高反射物质沉积,且OCT有利于疾病随访。Objective To analyze and explore the ocular multimodal imaging manifestations and relative characteristics of patients with presumed tuberculous multifocal choroiditis,so as to provide theoretical basis for clinical diagnosis and treatment.Methods Retrospective case series study.16 patients(24 eyes)with presumed tuberculous multifocal choroiditis and effective anti-tuberculous treatment who were treated in Northern Jiangsu People's Hospital from January 2018 to July 2021 were included.The patient's age was 30~79 years old;There were 7 males(43.8%)and 9 females(56.2%).The ophthalmic imaging examination data of patients were were statistical analysised,including scanning laser ophthalmoscope(SLO),fundus fluorescein angiography(FFA),indocyanine green angiography(ICGA),optical coherence tomography(OCT),ultrasonic biomicroscopy(UBM).Results The average logMar visual acuity of patients before the diagnostic antituberculosis treatment was 0.69±0.62,and after anti-tuberculosis treatment was 0.39±0.52.The best corrected visual acuity after the treatment was significantly higher than that before the treatment.Active multifocal choroiditis was mainly manifested as multiple yellow-white patchy lesions with unclear boundaries on fundus photography.FFA showed diffuse high auto-fluorescence,and some showed high auto-fluorescence with unclear boundaries surrounding the main focus.FFA showed subretinal multiple lesions of different sizes.In the early stage of angiography,the lesions showed low fluorescence changes.With time going on,fluorescein leakage appeared at the edge of the lesions,surrounding the low fluorescence lesions,and the boundary was unclear.ICGA showed round or oval hypofluorescent dark dots and geographic low fluorescence changes,and the underlying choroidal vessels are imperceptible.OCT showed destruction of the outer retina structure,verrucous protuberance in the outer retina,or accumulation of hyperreflective substances above and below the retinal pigment epithelium,which could be accompanied by choroidal va

关 键 词：结核性脉络膜炎 多模式影像 诊断 

分 类 号：R773.4[医药卫生—眼科]