急性视网膜色素上皮炎的临床特征分析

Clinical features of acute retinal pigment epitheltis

目的：观察急性视网膜色素上皮炎（acute retinal pigment epitheltis,ARPE）的临床特征。方法：回顾性分析我院2008-01/2014-01以来临床确诊为ARPE的36例40眼的临床资料。其中男21例（58.3%）,男女比例为1∶0.71。发病年龄17-60（平均40.92±7.13）岁。其中32例为单眼发病。BCVA 0.3-1.0,平均0.50±0.26。所有患者均行BCVA（矫正视力）、眼底彩照、FFA（荧光素眼底血管造影）、OCT（相干光断层扫描）检查。FFA表现为3种类型：Ⅰ型为多个＂中黑外亮＂或＂葡萄簇样＂的荧光斑;Ⅱ型为Ⅰ型病灶可见荧光渗漏;Ⅲ型病灶伴CNV形成。OCT主要表现为以下三种形态：Ⅰ型多个RPE（色素上皮）层反射断续、增殖病灶。Ⅱ型色素上皮脱离伴局限性神经上皮脱离。Ⅲ型前2型伴发脉络膜新生血管（CNV）。结果：眼底彩照表现为：所有40只患眼黄斑区或其附近均可见多个不连续的、暗灰色斑点伴周围淡晕环。FFA表现为Ⅰ型21眼;Ⅱ型17眼;Ⅲ型2眼,Ⅱ型、Ⅲ型与Ⅰ型间比较BCVA平均值下降,比较有统计学差异（P〈0.05）。而同型间不同形态的病例及Ⅱ、Ⅲ型间BCVA平均值比较,无统计学差异（P〉0.05）。OCT主要表现为Ⅰ型21眼,Ⅱ型17眼,Ⅲ型2眼。Ⅰ与Ⅱ、Ⅲ型病例间BCVA平均值比较有统计学差异（P〈0.05）,而Ⅱ、Ⅲ型病例间BCVA平均值比较无统计学差异（P〉0.05）。结论：ARPE眼底主要表现为后极部多个不连续暗灰色病灶,视力损害程度与有无色素上皮屏障功能受破坏及病灶位置有关。FFA及OCT可表现为3种类型,典型的FFA表现为＂中黑外亮＂或＂葡萄簇样＂的荧光斑,是诊断的依据。OCT能清晰的显示病变各层的组织形态,对ARPE的诊断和鉴别诊断起到愈来愈重要的作用。

AIM： To analyze of the clinical features of acute retinal pigment epitheltis（ ARPE）.METHODS： The clinical data of 36 ARPE patients（ 40eyes） attending this center from January 2008 to January2014 were reviewed retrospectively. Of them,21 patients（ 58.3%） were male（ male∶ female =1∶ 0.71）. The mean age was 40. 92 ± 7. 13 years old（ range： 17 - 60y）. The mean best- corrected visual acuity（ BCVA） was 0. 50 ± 0.26 with a range of 0. 3 - 1. 0. Thirty- two patients were unilateral cases. All the patients were examined for BCVA, funds photography, fluorescein fundus angiography（ FFA）, optical coherence tomography（ OCT）. FFA was shown as three types： type Ⅰ to multiple ＂ black light＂ or ＂ grape variety＂ fluorescent spot;Type Ⅱ for I lesions visible fluorescence leakage; Type Ⅲlesions with choroid neovascularization（ CNV）. OCT was the following three forms： multiple RPE lesions layer reflection intermittent,proliferation（ type Ⅰ）; pigment epithelial detachment with limitations neural epithelium（ type Ⅱ）; types I and II with CNV（ type Ⅲ）.RESULTS： Ocular fundus showed that the lesions were multiple dark- gray spots with a dark circumscribed area at the macular or nearby in all 40 eyes. FFA showed： 21 eyes were type Ⅰ,17 eyes were type Ⅱ and 2 eyes were type Ⅲ, BCVA between type Ⅰ and type Ⅱ was statistically significant（ P 〈 0. 05）,the same was between type Ⅲ. BCVA between different cases in the same type and between type Ⅱ,Ⅲ,was no statistical difference（ P〉 0. 05）. OCT showed 21 eyes wwere type Ⅰ,17 eyes were type Ⅱ and type Ⅲ 2 eyes. BCVA average between type Ⅰ and Ⅱ was statistically significant（ P 〈 0. 05）. The mean BCVA was no statistically significant difference between type Ⅱ and Ⅲ patients（ P 〉 0. 05）.CONCLUSION： ARPE fundus demonstrated the multiple dark gray discrete lesions, the degree of visual impairment related with the presence of pigment epithelial barrier and lesion location. OCT and FFA characterized three types. FFA is shown as ＂ black light ＂ or ＂ grape variety＂ fluorescent spot,and is the basis of diagnosis.OCT can display the lesions organization form of each layer clearly. It plays a more and more important role in the diagnosis and differential diagnosis of ARPE.