点状内层脉络膜炎光相干断层扫描图像特征分析

Image features of punctate inner choroiditis on optical coherence tomography

目的：观察分析不同时期点状内层脉络膜炎（ PIC ）光相干断层扫描图像特征。 方法：回顾性分析点状内层脉络膜炎患者24例33眼,其中女19例（79.2%）、双眼发病9例（37.5%）、年龄中位数29（16～47）岁、近视19例（79.2%）。所有患者均行眼底荧光素钠血管造影（ FFA ）和光相干断层扫描（ OCT ）检查,观察不同时期点状内层脉络膜炎OCT检查中OPL（外丛状层）和ONL （外核层）形态、IS/OS （视细胞内外节连接）层完整性、RPE（视网膜色素上皮）层反光带完整性和形态、脉络膜和巩膜反光的强度。 结果：点状内层脉络膜炎活动期和萎缩期可以表现为外丛状层和外核层向脉络膜方向凹陷、IS/OS层反光带减弱或局部消失、RPE反光带中断或模糊、RPE反光带向外核层小丘样隆起或外核层下的中等偏高反射团、病灶下局部脉络膜或巩膜反光增强。其中活动期出现上述表现的比率分别是9.1%,100%,100%,86.4%,77.3%,恢复期分别是81.8%,90.1%,81.8%,45.5%,90.1%。外核层下隆起的中等偏高的反射团在活动期更常见（P 〈0.05）,外丛状层和外核层向脉络膜方向凹陷在萎缩期更常见（P〈0.05）。 结论：点状内层脉络膜炎活动期和萎缩期OCT表现有共同点但也有不同之处,提示了活动期和萎缩期外层神经上皮、视网膜色素上皮以及内层脉络膜炎症损伤再修复的病理过程。

AIM： To observe the image features of punctate inner choroiditis （PIC） at different stages by optical coherence tomography （ OCT） . METHODS： A retrospective analysis was performed on 24 PIC patients （33 eyes） with the median age of 29 years old （ range： 16 - 47 ） , where 19 cases were female （ 79.2%） . Among the 24 cases, 9 cases were bilateral onset （37. 5%） and 19 cases were with myopia （79. 2%）. All of the patients were given fundus fluorescein angiography （ FFA ） and optical coherence tomography （ OCT ） . Through OCT, patients with PIC at different stages were observed for morphology of outer plexiform layer （OPL） and outer nuclear layer （ONL）, integrity of inside and outside connections of visual cells （ IS/OS ） , integrity and morphology of reflective tape on retinal pigment epithelium （ RPE ） , and light reflection intensity of choroid and sclera. RESULTS： The results showed that during active stage and atrophic stage of PIC, there were excavation of ONL and OPL towards thechoroid, weakened or partially disappeared reflective tape of IS/OS, interrupted or fuzzy reflective tape of RPE, hillock- like protrusion of RPE towards the ONL or ONL with medium to high reflection, and strengthened reflection of choroid and sclera under the lesion partly. The rates of the above performances in active stage were 9. 1%, 100%, 100%, 86. 4% and 77. 3%, respectively, and in recovery stage, the corresponding rates were 81. 8%, 90. 1%, 81. 8%, 45. 5%, and 90. 1%. Medium to high reflection of the protrusion under ONL was more commonly seen in active stage, with P〈0. 05;while depression towards OPL and ONL was more commonly seen in atrophic stage, with P〈0. 05. CONCLUSION： There are both common points and differences of OCT features in PIC at active stage and atrophic stage, suggesting the injury and repair pathological process of outer neural epithelium, retinal pigment epithelium and innerchoroid inflammatory.