急性区域性隐匿性外层视网膜病变频域光学相干断层扫描图像的特征分析

Characteristics of spectral-domain optical coherence tomography scan in patients with acute zonal occult outer retinopathy

目的观察急性区域性隐匿性外层视网膜病变(acute zonal occult outer retinopathy,AZOOR)的频域光学相干断层扫描图像(optical coherence tomography,OCT)的特征。方法临床确诊为AZOOR患者5例(5眼)纳入研究,健眼为对照眼。所有患者均行最佳矫正视力检查,并行OCT检查患者的黄斑区,观察并分析患者的OCT图像特征,并和健眼比较分析黄斑区的厚度差异和结构改变。结果 OCT检查提示患者存在不同程度的视网膜外层损害,损害的位置和范围不同,其共同特征是外界膜层光带信号强度不均匀,局部显示模糊甚至局部缺损,局部区域向下凹陷。光感受器内节/外节光带出现强度减弱和部分区域断裂、消失的现象。而在几乎所有的患眼病变区域视锥细胞外节尖端层模糊或消氉失,视网膜色素上皮层则没有显著的结构改变。患眼中心凹处外界膜-视网膜色素上皮层厚度为(83.20±9.90)μm,健眼为(101.80±2.23)μm,差异有统计学意义(t=-4.09,P<0.05)。Pearson相关分析显示患眼与健眼外界膜-视网膜色素上皮层厚度的差值,与患眼BCVA呈负相关(r=-0.94,P<0.05)。结论 AZOOR患者的视网膜损害多位于外层,其中视锥细胞外节尖端层损害最为显著;患者均有不同程度的外界膜层至视网膜色素上皮层变薄的现象,可能是导致患者视力下降的主要原因。

Objective To observe the characteristics of spectral-domain optical coherence tomography （SD-OCT）in patients with acute zonal occult outer retinopathy （AZOOR）. Methods Five patients （5 eyes） with AZOOR were enrolled in this study, the heathy eyes served as control eyes. All patients were examined for corrected visual acuity. SD-OCT examined the macula area of the patients and compared with the con- trol eye for the differences in the thickness of macular area and changes in the struc- tnre. Results SD-OCT of the patients＇ macular area showed uneven apperance outer limited membrane （OLT）line with focal obscure and indentatiom, weaked, fade or even absent in the IS/OS line, almost disappeard in the affected area of the cone outer seg- ment tip line, mild changed in the retinal pigment epithelium （RPE） line. The average thickness of the ELM-RPE layer was （ 83.20 ±9.90） μm at the center of the fovea in the affected eyes,and （ 101.80 ±2.23 ） μm at the control eyes, there was statistical differ- ence （ t = -4.09 ,P 〈0.05 ）. Person analysis showed there was negative relationship be- tween the difference of ELM-RPE layer thickness between affected eyes and control eyes and BCVA of the affected eyes （ r = - 0.94, P 〈 0.05 ）. Conclusion SD-OCT show the outer retinal layer is the primary site of damage by the AZOOR,mainly the cone outer segment tip line. And the decrease of visual acuity may be caused by the thin change of the ELM-RPE line thickness.