急性伏格特小柳原田综合征的频域光学相干断层扫描图像观察

摘要

Objective To observe retinal morphology in fundus and the pathognomonic internal structure of acute Vogt - Koy-anagi - Harada syndrome (VKH syndrome) by spectral domain optical coherence tomography ( SD - OCT) (Cirrus; Carl Zeiss Meditec, Inc. ) . Methods Data on 40 eyes of 20 cases of acute stage of VKH syndrome were collected from Beijing Tongren Hospital. All the patients underwent careful examination, including visual acuity, slit - lamp microscopy, indirect ophthalmoscopy, fundus fiuorescein angiography, with Cirrus OCT using 512 X 128 cube scan pattern and HD - 5 cube scan pattern. Main indexes were the qualitative description the specific changes in the internal structure of OCT retinal posterior pole. Results HD - OCT showed that 12 eyes (30% ) had edema of optic disc bulge, 34 eyes (85% ) had posterior pole retinal detachment, six of which (15% ) had simple retinal detachment. The other 28 eyes (70% ) showed split inside and outside the photoreceptor cell section (IS/OS) layer in the central fovea of macula, formation of cysts (cystoid space CS) , presence of granular reflected signal in CS, the photoreceptor cell layer of the outer segment ( OS) layer close to the retinal pigment epithelium ( RPE) , and a layer of uniformly thick film - like structure. Conclusions Acute Vogt - Koyanagi - Harada syndrome does not cause retinal detachment alone; retinal IS / OS splitting occurs only in the central fovea of macula.%目的 采用频域Cirrus HD-OCT进一步观察急性伏格特小柳原田综合征(Vogt-Koyanagi-Harada,VKH)眼底的形态及视网膜内部的特有结构.方法 收集北京同仁医院急性期VKH综合征确诊病例20例40只眼.对20例患者进行详细的病史采集,包括:最佳矫正视力、眼压、裂隙灯显微镜、间接检眼镜和荧光素眼底血管造影等检查.当天选用Cirrus HD-OCT机器,应用512×128及高清5线两种扫描模式测量20例(40只眼)后极部视网膜结构,此后每7 d 采用频域光学相干断层扫描(optical coherence tomography,OCT)复查,直至后极部视网膜完全复位,主要指标:定性描述OCT后极部视网膜内在结构的特异改变.结果 HD-OCT显示12只眼(30%)视乳头隆起水肿;34只眼(85%)可见后极部视网膜神经上皮层脱离,其中6只眼(15%)表现为单纯视网膜神经上皮层脱离,另28只眼(70%)在黄斑中心凹处出现光感受细胞层内外节(IS/OS)层的劈裂,形成囊腔(cystoid space CS),CS中呈现颗粒样反射信号,光感受细胞层外节(outer segment,OS)层紧贴在视网膜色素上皮层(retinal pigment epithelium,RPE),形成厚度均匀的一层膜样结构.结论 急性伏格特小柳原田综合征后极部并非单纯发生视网膜神经上皮脱离;视网膜IS/OS劈裂只发生在黄斑中心凹.OCT在急性伏格特小柳原田综合征早期诊断及疗效评价上有重要的辅助作用.