急性期Vogt-小柳-原田病的眼底表现及SD—OCT所见

The fundus manifestations and SD-OCT findings of patients with acute Vogt-Koyanagi-Harada disease

目的探讨急性期Vogt-小柳-原田病（VKH）患者眼底表现与频域光学相干层析成像（SD—OCT）的特点。方法回顾性系列病例研究。对2012年1月至2014年12月在北京协和医院眼科诊断为急性期VKH的17例患者（34只眼）临床资料进行分析，包括患者视力、前节裂隙灯显微镜检查、眼底散瞳检查，彩色眼底照像、FFA及SD．OCT检查。结果17例患者中男性9例，女性8例，年龄26．0～62．0岁，平均（40．5±11．6）岁。34只眼初诊视力0．01—0．09者14只眼（41．2％．），0．1—0．3者17只眼（50％），0．4～0．7者3只眼（8．8％），根据眼底表现的不同可分为3种类型，分别为视盘水肿型：14只眼（41．2％）；脉络膜炎型：10只眼（29．4％）；混合型：10只眼（29．4％）。SD—OCT显示34只眼（100％）均存在不同程度的渗出性视网膜脱离，且脱离区域内可见大量密集的点状高反射影。此外还有RPE皱褶19只眼（55．9％）、视网膜下膜样结构16只眼（47．1％）及视网膜内界膜（ILM）波浪样改变8只眼（23．5％），且SD—OCT检查所见神经上皮脱离范围与FFA晚期多湖样荧光积存有对应关系。结论急性期VKH眼底表现为视盘水肿型、脉络膜炎型及混合型3种类型；黄斑部SD．OCT常见特点为视网膜神经上皮层脱离、RPE皱褶、神经上皮下膜样结构及ILM波浪样改变等。

Objective To conclude the characteristics of fundus appearance and spectral domain optical coherence tomography（SD-OCT） findings of patients with acute Vogt-Koyanagi-Harada （VKH） disease. Methods The clinical data of 17 patients （34 eyes） diagnosed of acute VKH in Peking Union Medical College Hospital from Jan. 2012 to Dec. 2014 were studied retrospectively.Examinations included visual acuity, slit lamp, fundus, color fundus pictures, FFA and SD-OCT. Results Eight men and 9 women were enrolled with mean age of （40.5± 11.6） years old ranging from 26.0 to 62.0 years old. Vision acuity of their first consultations were as follows： 14 eyes （41.2%） were below 0.01-0.09, 17 eyes（50%） were among 0.1-0.3, 3 eyes （8.8%） were among 0.4-0.7. All patients were divided into 3 groups according to their fundus appearance： 14 eyes （41.2%） were optic disc swelling-type, 10 eyes （29.4%） were retinal detachment type and 10 eyes（29.4%）were mixed type. Subretinal fluid and serous retinal detachment appears in SD-OCT of all 34 eyes, with highly reflective signals in detached area. Other common characters were also noticeable, suh as RPE folds（19 eyes, 55.9%）, subretinal septa （16 eyes, 47.1%） and internal limiting membrane（ILM） fluctuation （8 eyes, 23.5%）. In addition, SD-OCT features were in accordance with multilobular dye pooling at late period of FFA. Conclusion SD-OCT of acute VKH presents some typical features： subretinal fluid and serous retinal detachment, RPE folds, ILM fluctuation, and subretinal septa.