急性Vogt-小柳-原田综合征黄斑相干光断层扫描观察

摘要

目的 观察急性Vogt-小柳-原田综合征(VKH综合征)的相干光断层扫描(OCT)图像特征以及与临床的关联.探讨新型频域OCT在急性VKH综合征结构特征和定量分析中的临床价值.方法 回顾分析临床确诊的急性VKH综合征21例(42眼)的OCT检查资料.所有患者接受最佳矫正视力(BCVA)、直接或间接检眼镜、裂隙灯显微镜+前置镜检查和荧光素眼底血管造影(FFA)检查.5线扫描(5 line Raster)模式下通过中心凹的水平+垂直两条扫描线的分析,对黄斑区视网膜各层结构变化的细微结构进行观察,用软件自带cliaper功能模块手工测量黄斑中心小凹厚度(FT)、神经上皮脱离高度(SRD)、神经上皮厚度(SRT).在立方体(Cube)扫描模式下,采用软件自带的功能模块对黄斑中心厚度(CFT)、黄斑中心凹体积(V)、平均厚度(AT)进行测量.回顾分析时,重点分析黄斑区视网膜各层结构变化的细微结构,以及OCT图像特征与视力的相互关系.结果 所有急性VKH综合征患者均可见后极部浆液性视网膜脱离.FT(r =0.2,P=0.00),SRD(r=0.83,P=O.00),CFT(r =0.81,P=0.000),AT(r =0.59,P=O.0001)和V(r=0.58,P=O.0001)值与初始视力呈负相关.视网膜色素上皮(RPE)上存在膜结构的35眼,平均视力为0.86±0.40 log MAR,差于无膜结构的7眼(P =0.0074).结论 频域OCT可对急性VKH综合征特征性的黄斑改变进行定性及定量的观察,具有一定的诊断与鉴别诊断价值.VKH综合征的OCT图像特征性表现为:治疗前的渗出性视网膜脱离,“膜样”、“隔状”结构和RPE皱折,以及激素治疗后的“颗粒样”结构.存在“膜样”结构视力更差,FT和神经上皮脱离高度可能可反映脉络膜炎症的程度和疾病的严重程度.%Objective To explore the structural features of eyes with acute Vogt-Koyanagi-Harada ( VKH) syndrome using enhanced Spectral Domain Cirrus Optical Coherence Tomography (SD-OCT). Methods The records of 21 patients (42 eyes) diagnosed with acute VKH syndrome were reviewed retrospectively. OCT images were obtained using spectral-domain OCT. Central fovea thickness ( CFT) , cube volume ( V ) , cube average thickness ( AT) were collected from the OCT readings. The height of the serous retinal detachment (SRD) , sensory retinal thickness (SRT) , and foveal thickness (FT) were measured manually. The correlation between retinal morphology and visual acuity was evaluated. Results All eyes had serous macular detachment. The initial visual acuity was significantly worse in VKH syndrome patients with a higher FT(r =0. 2, P=0.00) , SRD (r=0.83, P=0.00), CFT(r =0. 81 ,P =0.000) ,AT(r = 0. 59,P = 0.0001) and a larger V( r =0. 58,P =0. 0001) , but the correlation between initial visual acuity and SRT was not significant. The average visual acuity in the 35 eyes with membranous layers on the retinal pigment epithelium ( RPE) was 0. 86 ± 0.40 log MAR units, which was worse than the 0.43 ± 0. 35 log MAR units in the 7 eyes without the layers. Conclusions SD-OCT imaging provided qualitative and quantitative observation of acute VKH syndrome, and had value in the diagnosis and differential diagnosis of the disease. Before treatment, the OCT features of acute VKH syndrome were serous retinal detachment, the septa and membranous structures and RPE undulation. After treatment, the OCT characteristic features were granular structures. The presence of membranous structures might predict a worse visual acuity and a higher FT and SRD might reflect the degree of choroid inflammation and severity of disease in VKH syndrome.