梅毒性后葡萄膜炎的眼底自发荧光与眼底血管荧光造影特征

摘要

背景 眼底自发荧光(FAF)能反映视网膜色素上皮(RPE)细胞的功能状态,作为一种无创的检查手段,广泛应用于视网膜疾病的诊断,而其在梅毒性后葡萄膜炎中的应用国内外尚未见相关报道. 目的 观察和对比首诊于眼科的梅毒性后葡萄膜炎的FAF及荧光素眼底血管造影(FFA)和吲哚青绿血管造影(ICGA)的特征.方法 回顾性分析2010年5月至2012年10月在上海交通大学附属第一人民医眼科诊断为梅毒性后葡萄膜炎的患者18例27眼的临床资料,所有患者均经血清学检查确诊为梅毒,根据眼部的临床表现分为急性期(病程2个月内)组和慢性迁延期(病程2个月以上)组,均进行FFA、ICGA及FAF检查,对各期患者的FAF表现与FFA、ICGA特征进行对比和分析. 结果 梅毒性后葡萄膜炎患者的FFA像主要表现为后极部视网膜血管渗漏改变及视网膜的斑驳状透见荧光改变,部分患者伴有视盘着染或荧光素渗漏,急性期患者可见黄斑区渗出的低荧光,慢性迁延期患者可出现囊样水肿的高荧光.患者的ICGA显示,视网膜后极部出现弥漫性点片状低荧光,造影晚期更明显.患者的FAF像主要表现为后极部弥漫性荧光增强,尤以急性期患者更为明显,可见斑驳状荧光,局部有点片状FAF减弱；慢性迁延期患者FAF缺失更明显；伴有视盘水肿及黄斑水肿的患者表现为相应区域的低荧光. 结论 梅毒性后葡萄膜炎以眼底后极部视网膜血管炎表现为主,ICGA显示出广泛的RPE及脉络膜受累,而FAF表现提示急性期患者有RPE代谢的障碍,慢性迁延期患者为RPE萎缩或缺失.FAF是反映RPE形态变化的辅助诊断指标.%Background The fundus autofluorescence (FAF)can reflect the function of retinal pigment epithelium(RPE) cell.As an invasive examination,it has been extensive used in retina disease,but there has not any report in syphilitic posterior uveitis.Objective This study was to characterize and contrast the FAF and fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA) findings in patients with syphilitic posterior uveitis.Methods A retrospective series of cases observational study was designed.The clinical data of 27 eyes from 18 patients with syphilitic posterior uveitis were included in Shanghai First People's Hospital from 2010 May to 2012 October,and all the patients were diagnosed by serologic and ophthalmic tests.The patients were assigned to acute stage group(with the course ＜2 months)and chronic stage group(with the course ≥ 2 months).FFA,ICGA and FAF were performed respectively on all the patients,and the examination results were compared and analyzed.Results In the affected eyes with syphilitic posterior uveitis,the FFA image showed a retinal vasculitis sign and mottle-like fluorescence appearance in posterior pole and equator zone,and some affected eyes exhibited edema of optic disc and macula.Hypoautofluorescence zone was seen in the acute stage group and cystoid macular edema was found in the chronic stage group.ICGA presented with a wider damage of RPE,especially in the later phase of ICGA.A confluent of hyperautofluorescence with hypoautofluorescence in the posterior fundus,punctiform hyperautofluorescence as well as hypoautofluorescence in papillitis and macular edema were found on the FAF image.Conclusions The pathological basis of syphilitic posterior uveitis is retinal vasculitis and papillitis.ICGA indicates the damage of choroid membranes and RPE,and FAF reflects a metabolism disorder of RPE in the acute stage and atrophy and loss of RPE in the chronic stage.FAF is helpful for the diagnosis of syphilitic posterior uveitis as an assistant index.