急性视网膜色素上皮炎眼底荧光血管造影与频域光相干断层扫描特征观察

Characteristics of fluorescein fundus angiograph and spectral-domain optical coherence tomography in acute retinal pigment epithelitis

目的观察急性视网膜色素上皮炎(acute retinal pigment epitheliitis,ARPE)的眼底荧光血管造影(fluorescein fundus angiography,FFA)与频域光相干断层扫描(spectral-domain optical coherence tomography,SD-OCT)的图像特征。方法回顾分析13例临床确诊的ARPE患者的临床资料,均行视力、眼底彩色照相、FFA以及SD-OCT检查。分析ARPE患者FFA与OCT特征,依据SD-OCT检查结果提出ARPE的三种分型。结果13例均单眼发病,眼底可见黄斑区灰白色斑点灶,周围环绕黄白色脱色素晕环。FFA特征:早期可见黄斑区斑点状透见荧光灶,呈"葡萄簇"样;晚期2眼黄斑中心凹旁环形弱荧光灶,周围环形荧光素染色,呈"中黑外亮"特征。SD-OCT特征:8眼表现为光感受器细胞内外节连接(inner/outer segment of photoreceptor,IS/OS)与视网膜色素上皮(retinal pigment epithelium,RPE)层间帽状高反射,IS/OS层连续;3眼表现为IS/OS层与RPE层间帽状高反射,伴RPE内层与IS/OS层连续性中断;2眼表现为RPE内层不均匀渗出,伴RPE内层与IS/OS层连续性中断。连续观察8周后10眼SD-OCT示RPE内层帽状高反射消退,中断的RPE内层与IS/OS层反射带恢复,3眼中断的RPE内层未恢复,但IS/OS层反射带恢复,受损的视力也得到恢复。结论 SDOCT能特征性显示ARPE患者的RPE内层损害与IS/OS层损害,对应FFA则为环形透见荧光环,FFA黄斑中央弱荧光则为OCT显示的RPE内层与IS/OS层渗出形成的帽状高反射。ARPE急性期视力下降与暂时性IS/OS层与RPE内层反射带连续性中断相关。

Objective To observe the characteristics of fluorescein fundus angiograph （FFA） and spectral-domain optical coherence tomography （SD-OCT） in acute retinal pigment epithelitis （ARPE）. Methods The clinical data of 13 ARPE patients （13 eyes） were retrospectively analyzed. The visual acuity, fundus photographs, FFA and SD-OCT were examined. The characteristics of FFA and SD-OCT were analyzed, and the types of ARPE were preferred in basis of SD-OCT results. Results ARPE in all 13 cases were monocular diseases. Macular pigment motting with surrounding yellow hypopigmented areas at the level of the retinal pigment epithelium was seen. FFA showed that, the early stage of FFA revealed transmission hyperfluorescence, and 2 eyes in later stage had hypofluorescein around macular fovea. SD-OCT showed that： The dome-shaped highly reflection was seen between inner segment and outer segment （ IS/ OS） and retinal pigment epithelial （RPE） layer, IS/OS layer was continued; IS/OS and RPE layer in 3 eyes showed dome-shaped highly reflection, photoreceptor band was disrupted;The inner band of RPE in 2 eyes was deposited,IS/OS and RPE layer was disrupted. After 8 weeks, SD-OCT showed that IS/OS and RPE band in 10 patients eyes lesion were restored, the RPE inner band in 3 eyes were not restored. FFA also showed hyperfluorescein around macular fovea was disappeared. Conclusion SD-OCT can show the damage in the inner band of RPE and IS/OS,which in FFA is the ring transmission fluorescein, and the hyperfluorescein around macular fovea is the dome-shaped highly reflection between IS/OS and RPE layer. The visual acuity in acute stage is decreased,which associated with transmission of FFA in macular area and disruption of IS/OS and PRE inner layer.