获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎不同时期患者的眼底特征分析  

Fundus characteristics in patients with acquired immune deficiency syndrome complicated with cytomegalovirus retinitis at different periods

作　　者：叶红莉 焦康为 晏平静 张启航 赵洁[1] 冯萧萧 刘俊 肖丽波 Ye Hongli;Jiao Kangwei;Yan Pingjing;Zhang Qihang;Zhao Jie;Feng Xiaoxiao;Liu Jun;Xiao Libo(Department of Ophthalmology,Yunnan University Affiliated Hospital,Kunming 650000,China;Department of Infectious Disease,Kunming Third People’s Hospital,Kunming 650000,China)

机构地区：[1]云南大学附属医院眼科,昆明650000 [2]昆明市第三人民医院感染一科,650000

出　　处：《眼科》2023年第4期326-331,共6页Ophthalmology in China

基　　金：云南省眼部临床医学中心开放课题(YJZX-05);云南省科技计划项目(202001AU070037)。

摘　　要：目的 观察获得性免疫缺陷综合征(AIDS)合并巨细胞病毒性视网膜炎(CMVR)患者不同时期的超广角眼底照相及相干光断层扫描(OCT)图像特征。设计回顾性病例系列。研究对象2019年1月至2022年6月在云南大学附属医院及昆明市第三人民医院AIDS合并CMVR的患者14例(22眼)。方法回顾患者的病历资料。分析CMVR不同时期眼底像及OCT图像特征,及相应时期的CD4+T淋巴细胞(CD4)、血CMV-DNA水平。随访6~30个月。主要指标眼底像及OCT影像学特点、CD4值。结果初诊时所有患者均在CMVR急性期,其中CMVR初发期2例(3眼),活动期12例(19眼)。初诊时急性期平均CD4值为(32.26±25.7)个/μL,CMVR初发期表现为<1视盘直径(DD)的黄白色颗粒样病灶,OCT示视网膜无增厚但伴全层破坏;活动期眼底见大片黄白色奶酪样渗出伴出血,OCT示视网膜各层次显著增厚呈高反射,12例(19眼)中视网膜层间点状强反射9例(15眼),外层点状强反射4例(6眼),病灶累及黄斑区12例(15眼),伴黄斑水肿3例(3眼),视网膜前膜12例(18眼),玻璃体炎性细胞11例(16眼)。随访中的缓解期平均CD4值(380.4±85.2)个/μL,13例(20眼)眼底形成灰白色瘢痕,OCT见病变区视网膜萎缩、变薄,视网膜脱离1例(2眼)。结论AIDS合并CMVR患者不同时期眼底有不同表现,可见黄白色颗粒样、番茄奶酪样、灰白色瘢痕样病损,OCT呈视网膜显著高反射增厚或变薄、萎缩。(眼科,2023,32:326-331)Objective To observe ultra-wide angle fundus photography and optical coherence tomography(OCT)characteristics in patients with acquired immune deficiency syndrome(AIDS)complicated with cytomegalovirus retinitis(CMVR)at different periods.Design Retrospective case series.Participants 14 patients(22 eyes)diagnosed with AIDS complicated with CMVR from the Affiliated Hospital of Yunnan University and the Third People's Hospital of Kunming from January 2019 to June 2022.Methods The patient's medical records were reviewed.The characteristics of fundus and OCT images at different stages of CMVR,as well as the CD4+T lymphocytes(CD4)and blood CMV-DNA levels at corresponding stages were analyzed.Follow up was for 6~30 months.Main Outcome Measures CD4 value,fundus photography and OCT image features.Results All patients were in the acute stage of CMVR at the time of initial diagnosis,including 2 cases(3 eyes)in the initial stage of CMVR and 12 cases(19 eyes)in the active stage.The mean CD4 value in acute stage was(32.26±25.7)/μL at first diagnosis,and the manifestations of CMVR in initial stage were<1 DD yellow-white granular lesions.OCT showed no thickening of retina but full layer destruction.During the active stage,the fundus showed large yellow and white cheesy exudation accompanied by bleeding,and OCT showed significant thickening of retina at all levels and high reflexes.In 12 cases(19 eyes),there were 9 cases(15 eyes)of interlayer punctuated strong reflexes,4 cases(6 eyes)of outer layer punctuated strong reflexes,12 cases(15 eyes)of lesions involved the macular region,and 3 cases(3 eyes)of macular edema.Epiretinal membrane in 12 cases(18 eyes),vitreous inflammatory cells in 11 cases(16 eyes).During follow-up,the mean CD4 in remission period was(380.4±85.2)/μL.Grey and white scars of fundus were in 13 cases(20 eyes).Retinal atrophy and thinning in the lesion area were observed on OCT,and retinal detachment was observed in 1 case(2 eyes).Conclusion The fundus of AIDS patients with CMVR showed different manifestations

关 键 词：巨细胞病毒性视网膜炎 获得性免疫缺陷综合征 相干光断层扫描 眼底照相 

分 类 号：R774.11[医药卫生—眼科]