SD-OCT联合FFA诊断Stargardt病分析

Diagnosis of Stargardt＇s disease by the combination of SD-OCT and FFA

目的 探讨频域光相干断层扫描（SD-OCT）联合眼底荧光血管造影（FFA）诊断Star-gardt病.方法 回顾性病例系列研究.对2008年1月至2013年12月在河北医大第二医院眼科就诊的21例（42只眼）Stargardt病的SD-OCT和FFA临床资料,分析总结其影像特征.结果 Stargardt病双眼病变对称,不同病变时期FFA和SD-OCT表现不同的特征.早期：眼底黄斑区污秽,色素紊乱,少量黄色斑点;FFA呈横椭圆形斑驳状透见荧光;SD-OCT黄斑区IS/OS层反射信号减弱或缺失,其余各层基本正常.中期：眼底黄斑区横椭圆形轻度萎缩灶,周围黄色斑点;FFA呈横椭圆形斑驳状透见荧光;SD-OCT黄斑区IS/OS层、外核层反射信号缺失,外丛状层塌陷,视网膜变薄;晚期：眼底黄斑区金箔样反光,横椭圆形萎缩灶,透见脉络膜大血管,周围大量黄色斑点;FFA呈“靶环”状透见荧光,周围斑点状透见荧光;SD-OCT黄斑区IS/OS层、外核层、外丛状层反射信号缺失,RPE层反射信号条带明显变薄,脉络膜反射信号明显增强,黄斑全层萎缩.结论 SD-OCT联合FFA可以明确诊断Star-gardt病,SD-OCT有助于评估病变的严重程度.

Objective To investigate the significance of combined SD-OCT and FFA in the diag nosis of Stargardt＇s disease.Methods Retrospective case series study.The SD-OCT and FFA images of 21 patients （42 eyes） with Stargardt＇s disease were collected and thereafter summarized the characteristics.Results The Stargardt＇s disease was known as bilateral ocular disorder with variable features at different stages.At the early stage,it presented as macula pigment disturbance and yellow flecks on biomicroscopy,mottled transmitted fluorescence on FFA,and the disruption and defect of IS/OS with normal choroidal appearance on SD-OCT.At the medium stage,Stargardt＇s disease was observed as mild oval-like atrophy lesion encircled by yellow dots by ophthalmoscope,mottled window defect at macula on FFA,and defect or absence of IS/OS,outer nuclear layer and outer plexiform layer signals on SD-OCT.While at the late stage,it was observed with golden reflection and oval atrophy lesion circled by yellow flecks by ophthalmoscope,target-like and dot-like window defect on FFA,and the disappearance of inner nuclear layer,outer plexiform layer and IS/OS layer,thinning of RPE layer and enhancement of choroid on SD-OCT,which indicated the atrophy of macular layers.Conclusions The combination of SD-OCT and FFA can diagnose Stargardt＇s disease precisely,and what＇s more,SD-OCT is of great importance in evaluating the severity of the disease.