初发期Vogt-小柳原田病的眼部表现及其荧光素眼底血管造影和频域光学相干断层扫描影像特征分析

Ocular manifestations in onset of Vogt-Koyanagi-Harada disease and analysis of characteristic image with fluorescence angiography and fourier-domain optical coherence tomography

目的探讨初发期Vogt-小柳原田病(VKH)的眼部表现及其影像特征。方法收集山西省临汾市尧都区眼科医院2010年1月至2013年4月就诊的17例(34只眼)初发期Vogt-小柳原田病患者的临床资料,对所有患者进行常规眼底检查和荧光素眼底血管造影(FFA),其中8例(8只眼)同时行频域光学相干断层扫描(OCT),结合患者病史进行综合回顾性分析。结果眼底检查和FFA检查显示所有患者均为双眼发病。FFA显示17例(33只眼)视乳头周围及后极部多发针尖样荧光素渗漏,晚期荧光素渗漏增强呈多湖状荧光素积存。其中视乳头周围毛细血管扩张、荧光素渗漏及视乳头边界不清者7例(14只眼);视乳头边界清及晚期荧光素着色者10例(20只眼)。1例(1只眼)仅表现为视乳头周围毛细血管扩张、荧光素渗漏及视乳头边界不清,但视网膜和脉络膜无荧光素渗漏。1例(1只眼)可见视乳头向周边部发散的放射状及条纹状低荧光。对8例(8只眼)分别进行视乳头周围及黄斑区、中周部频域OCT,显示视乳头周围视网膜神经上皮脱离,黄斑区和中周部视网膜神经上皮呈多发浅脱离及神经上皮内囊腔。结论眼底检查发现视乳头充血、视网膜水肿皱褶及视网膜浅脱离的患者,荧光素眼底血管造影检查多可见视乳头周围及后极部、中周部呈多发强荧光斑点,晚期荧光素渗漏增强且扩散融合呈多湖状荧光素积存;OCT检查可见视乳头周围视网膜神经上皮脱离、后极部及中周部视网膜神经上皮多发浅脱离及神经上皮内囊腔。

Objective To explore the clinical feature and characteristic image of Vogt-Koyanagi-Harada disease(VKH) in incipient stage.Methods Clinical data,about onest of Vogt-Koyanagi-Harada disease patients 17 cases ( 34 eyes ) , were collected in Yaodu eye Hospital from January 2010 to April 2013.All patients were examined by routine examination of fundus and fundus fluorescein angiography , 8 cases (8 eyes) have been done frequency domain optical coherence tomography.It has been done a comprehensive retrospective analysis combined with the patient history . Results Telangiectasis and fluorescein leakage around papilla were found in 7 cases ( 14 eyes ) with unclear papilla boundary; In 10 cases (20 eyes) of optic papilla boundary is clear and fluorescein staining appear in the later phase;One case (one eye) showed peripapillary telangiectasia,fluorescein leakage,blurring of the disk margins;Conclusions OCT examination showed detachment of retinal neurepithelium around the optic disc . Multiple shallow detachment of retinal neurepithelium and cystoid intervals between retinal layers could be found in macular and mid-peripheral retinal.