急性旁中心中层黄斑病变的光学相干断层扫描血管成像的影像特征

Imaging features of optical coherence tomography angiography in paracentral acute middle maculopathy

目的:观察并总结急性旁中心中层黄斑病变(paracentral acute middle maculopathy,PAMM)的光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)的影像特征。方法:将临床上确诊为PAMM的25例患者(26只眼)纳入研究。其中男15例(16只眼),女10例(10只眼)。患眼均行最佳矫正视力(best corrected v isual acuity,BCVA)、眼底彩色照相、频域光学相干断层扫描(spectral-domain optical coherence tomography,SD-OCT)、眼底自发荧光(fundus auto fluorescence,FAF)、OCTA、视野及多焦视网膜电图(multifocal elect roretinograms,M-ERG)检查,其中10例患者行眼底荧光血管造影(fundus fluorescein angiography,FFA)及吲哚青绿血管造影(indoc yanine green angi ography,ICGA)检查。结果:OCTA检查结果示PAMM病灶区域的浅层毛细血管层(superficial capillary plexuses,SCP)及深层毛细血管层(deep capillary plexuses,DCP)毛细血管匮乏,血流密度明显降低。将分层线调整至中层毛细血管层(intermediate capillary plexuses,ICP),即内丛状层(inner plexiform layer,IPL)向上10μm至内丛状层向下30μm(IPL-10至IPL+30),可见结构En face显示为静脉周围典型的蕨状分布形态,B-scan显示内核层(inner nuclear layer,INL)和外丛状层(outer plexiform layer,OPL)之间呈不连续的高反射带。结论:PAMM病变部位主要位于视网膜中层毛细血管层,OCTA能够清晰显示出病变层次及形态,在结构En face及B-san上均有特征性的影像表现,相较于其他影像检查,可分层观察是OCTA在PAMM疾病中的最大优势。

Objective:To observe and summarize the imaging features of optical coherence tomography angiography(OCTA)in paracentral acute middle maculopathy(PAMM).Methods:A total of 25 patients(26 eyes)were diagnosed with PAMM in this retrospective study,including 15 male(16 eyes)and 10 female(10 eyes).All patients underwent the best corrected visual acuity(BCVA),fundus photography,spectral-domain optical coherence tomography(SD-OCT),fundus auto fluorescence(FAF),visual field examination,multifocal electroretinograms(M-ERG)and OCTA examinations.Ten patients underwent fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA)examination.Results:OCTA showed the vessel flow density in the superficial capillary plexuses(SCP)and deep capillary plexuses(DCP)were decreased significantly.By adjusting the stratification line to the intermediate capillary layer inner plexiform layer(IPL)-10 to IPL+30,En face image showed the fernlike hype-reflection distribution around the vein.B-scan showed the discontinuous hyper-reflection bands in the inner nuclear layer(INL)and outer plexiform layer(OPL).Conclusion:PAMM lesions are mainly located in the intermediate capillary plexuses(ICP),OCTA can show the form and structure of lesions clearly,which has the characteristic image in En face and B-scan model.Compared with the other traditional examinations,OCTA has the advantage of stratified observation of PAMM lesions.