双眼急性后极部多灶性鳞状色素上皮病变1例  

A case of bilateral acute posterior multifocal placoid pigment epitheliopathy

作　　者：彭睿 王鑫 王敏 PENG Rui;WANG Xin;WANG Min(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2025年第S1期44-48,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：女性33岁,因“双眼眼前黑影飘动伴左眼视力下降1周”就诊。体格检查如下。最佳矫正视力:右眼1.0,左眼0.3-1。双眼前节无殊,玻璃体未见细胞,视网膜后极部及中周部广泛黄白色点状病灶。自发荧光可见病灶强、弱自发荧光混合,边界清楚。光学相干层析成像(OCT)提示双眼病灶处椭圆体带中断,左眼累及黄斑中心凹。荧光素眼底血管造影(FFA)显示黄白色病灶早期弱荧光、晚期强荧光,吲哚菁绿血管造影(ICGA)显示病灶始终为弱荧光。OCT血管成像(OCTA)表现为病灶处脉络膜毛细血管层缺血无灌注。最终诊断为双眼急性后极部多灶性鳞状色素上皮病变(APMPPE),定期随访,17个月后,OCTA可见病灶处脉络膜毛细血管层无灌注区逐渐恢复再灌注。讨论体会:多模影像有助于白点综合征的诊断和鉴别诊断,OCTA在疾病的病因、诊断、鉴别诊断和随访中有独特的作用。A 33-year-old female presented with bilateral floating shadows with blurred vision in the left eye for one week.The best corrected visual acuity was 1.0 in the right eye(OD)and 0.3-1 in the left(OS).Slit lamp examination revealed normal anterior segments,no cells in the vitreous,and extensive yellowishwhite punctate foci on the posterior and mid-peripheral retina.Autofluorescence showed a mixed pattern of hypoautofluorescence and hyperautofluorescence with distinct boundaries.Optical coherence tomography(OCT)revealed disruption of the outer retina at the ellipsoid zone in both eyes,and the fovea was involved in OS.The lesions were hypofluorescent in the early phase of fundus fluorescein angiography(FFA)and hyperfluorescent in the late stage.The lesions appeared as hypofluorescent spots across all phases of indocyanine green angiography(ICGA).Optical coherence tomograph angiography(OCTA)showed non-perfusion of the choriocapillaris at the lesion sites.The final diagnosis was bilateral acute posterior multifocal placoid pigment epitheliopathy(APMPPE).OCTA demonstrated that the non-perfusion area of the choriocapillaris gradually recovered to normal during 17-months follow-up.Discussion and experience:Multimodal imaging helps in the diagnosis and differential diagnosis of white spot syndrome(WSS).OCTA plays a unique role in the etiology,diagnosis,differential diagnosis and follow-up of the disease.

关 键 词：急性后极部多灶性鳞状色素上皮病变 白点综合征 光学相干层析血管成像 多模影像 

分 类 号：R73[医药卫生—肿瘤]