多发性一过性白点综合征光相干断层扫描图像特征及脉络膜厚度观察

Characteristic of optical coherence tomography image and choroidal thickness in patients with multiple evanescent white dot syndrome

目的观察多发性一过性白点综合征（MEWDS）患者光相干断层扫描（OCT）图像特征及中心凹下脉络膜厚度（SFCT）。方法临床检查确诊的MEWDS患者10例10只眼（病例组）纳入研究，选取年龄、性别、屈光状态相匹配的10名正常人作为正常对照组。患者中女性9例9只眼，男性1例1只眼；平均年龄（27±8）岁。出现症状至就诊时间为5～14d。以发病后2周内为急性期；发病8周后为恢复期。所有患者均行矫正视力、裂隙灯显微镜、直接和（或）间接检眼镜、眼底彩色照相、荧光素眼底血管造影、吲哚青绿血管造影、OCT检查。采用Spectralis—OCT仪增强深部成像技术测量病例组患眼和对侧跟黄斑区中心凹下脉络膜厚度（SFCT）。平均随访时间5个月。观察病变急性期和恢复期患眼OCT图像特征，以及患眼和对侧眼SFCT的变化。结果病例组患眼病变急性期后极部光感受器内外节连接（IS／OS）光带均明显紊乱，变薄、缺失、不连续及反光减弱；恢复期IS／OS光带连续性及厚度恢复。患眼病变急性期、恢复期平均SFCT分别为（239．0±140．7）、（189．9±115．6）μm；恢复期SFCT较急性期明显变薄，差异有统计学意义（t=5．287，P〈0．05）。病变急性期、恢复期对侧眼平均SFCT分别为（214．6±127．2）、（186．5±108．6）μm；恢复期SFCT较急性期明显变薄，差异有统计学意义（t=3．553，P〈0．05）。正常对照组受检眼SFCT为（155．5±83．5）μm。病例组患眼急性期SFCT较正常对照组明显增厚，差异有统计学意义（z=-2．117，P〈0．05）。结论MEWDS患眼病变急性期IS／OS光带明显紊乱，变薄、缺失，外核层间见点状强反射信号；双眼病变急性期SFCT均较恢复期增厚，患眼急性期SFCT较正常人增厚。

Objective To observe the characteristic of optical coherence tomography （OCT） and subfoveal choroidal thickness（SFCT） in patients with multiple evanescent white dot syndrome （MEWDS）. Methods The clinical data of 10 patients （10 eyes）with MEWDS were included in the study. 10 normal subjects with matched age, gender and ocular refractive status was selected as control. The patients including 9 females （9 eyes） and 1 male （1 eye）, with the average age of （27±8） years. The onset time ranged from 5 to 14 days. The patients were in acute phase if it was in 2 weeks after onset, or convalescent phase if onset was 8 weeks ago. The corrected vision, slit lamp biomicroscopy, ophthalmoscope, fundus photography, fundus fluorescein angiography, indocyanine green angiography and optical coherence tomography （OCT） were performed alone or combined in all patients. The SFCT between the acute and convalescent phases were measured using enhanced depth imaging OCT. The average follow up was 5 months. The OCT characteristics of affected eyes between acute and convalescent phase were compared. The SFCT of the affected eyes and fellow eye were compared. Results The foveal inner segment-outer segment （IS/OS） was disrupted, thin, irregular in the acute phase, and restored in the convalescent phase. The SFCT of patients in the acute phase was （239 ± 140.7） μm, in the convalescent phase was （189.9 ± 115.6） μm. The SFCT in the acute phase was more thicker than the convalescent phase （t = 5. 287, P〈 0.05）. The SFCT of fellow eyes in the acute phase was （214.6±127.2） μm, in the convalescent phase was （186.5±108.6） μm, the difference was significant（t= 3. 553,P〈0.05）. The SFCT in the control subject was （155.5±83.5） μm. The SFCT in the acute phase was thicker than the control（Z=-2. 117, P〈 0.05）. Conclusions In the acute phase of MEWDS, the foveal IS/OS was disrupted, thin and irregular inOCT scan. The choroid is thicker in the acute phase than in the convalescent phase in hoth eyes, and thicker than controls.