OCT在Vogt-小柳原田综合征临床诊疗中的作用

Application of OCT in clinical diagnosis and treatment of Vogt-Koyanagi-Harada syndrome

目的探讨频域相干光断层扫描（Optical Coherence Tomography，OCT）在Vogt-小柳原田综合征（VKH）临床诊疗过程中的作用。方法对14例28只眼VKH患者早期行OCT检查，并行荧光素眼底血管造影（FFA）。全部病例均应用甲强龙冲击3天后糖皮质激素口服治疗，在用药前、口服药前及口服强的松1周、1个后月均行OCT检查。结果14例28只眼VKH患者早期OCT检查表现为视网膜神经上皮层及色素上皮层渗出性脱离、隆起呈泡状或多囊状，神经上皮最大脱离高度4058μm，最小脱离高度156μm，平均（2869±138．65）μm，最大脱离直径超过6mm扫描范围，最小直径1348μm，色素上皮单发或多发脱离，应用甲强龙冲击3天后神经上皮脱离快速消退，神经上皮最大脱离高度2058μm，最小脱离高度49μm，平均（1345±115．85）μm，最大脱离直径2568μm，最小直径563μm，平均（1078±98．43）μm，与治疗前对比差异有统计学意义（P〈0．05）。用药7-1O天后神经上皮及色素上皮脱离均消退，视乳头水肿明显减轻，所有患者均恢复至发病前视力，1个月后黄斑区神经上皮及色素上皮恢复正常，合并视乳头水肿者水肿均消退，视力稳定无下降。结论OCT在VKH临床阜期诊断、诊疗妁果的评价以殛与赢者沟诵方而均且右雷萼临床膏叟．

Objective To study the application of clinical diagnosis and treatment with Optical Coherence Tomography （OCT） in Vogt-Koyanagi-Harada （VKH） Syndrome. Methods Fourteen pa- tients （28 eyes） of VKH on the early stage were examined by OCT and fundus fluorescein angiogra- phy （FFA） simultaneously. All patients had OCT examination pretreatment, 3 days after methylprednis- olone injection therapy, 1 week and 1 month after oral administration of glucocorticoid. Results Main clinical manifestation were retina nerve layer and pigment epithelium exudative desquamation, upheaval pattern appearing bubbly or polycystic shape by OCT examined for VKH patients in the early stage. Maximum nerve epithelium tissue desquamation ranged from 156gμm to 40581μm, mean er- ror of 2869±138.65 and desquamation diameter scanning was greater than 6mm, minimum was 13481μ m. Boundedness or multiple desquamation were found in nerve epithelium tissue. These patients were treated by methylprednisolone injection, the area of retinal detachment were decreased and re- lieved marketable by OCT examination that demonstrated on nerve epithelium tissue after three days. Nerve epithelium tissue desquamation ranged from 49μm to 2058μm at the highest degree, mean er- ror of 1345±115.85, maximum 2568μm and minimum 563μm, mean of 1078±98.43μm. There were statistically significant differences clinical effect before and after therapy （P 〈 0.05）. Nerve epitheli- um tissue and pigment epithelium exudative desquamation were decreased and relieved apparently by 7-10 days therapy. Papilledema were improved markedly and visual acuity recovered to as the sameas the before illness. Macular area nerve layer and pigment epithelium recuperated after 30 days ther- apy, papilledema vanished gradually. Conclusions OCT is an important tool in ophthalmologic clinic diagnosis, evaluate curative effect and as a good communication ideas between doctors and patients to Vogt-Koyanagi-Harada Syndrome.