PPD与结核感染T细胞斑点试验阳性的匐行样脉络膜炎眼底影像学特征研究

Fundus imaging features of purified protein derivative and T-spot positive tubercular serpiginous-like choroiditis

目的探讨结核菌素(PPD)与结核感染T细胞斑点试验阳性的匐行样脉络膜炎(PTP-SLC)患者临床及眼底影像学特征及其与普通匐行性脉络膜炎(SC)的鉴别。方法回顾性系列病例研究。收集2015年11月至2017年11月在首都医科大学附属北京同仁医院就诊的PTP-SLC患者13例(21只眼),其中男性8例(14只眼),女性5例(7只眼);年龄(45±12)岁。对患者进行病史、全身及眼科检查结果资料的采集,分析患者眼底自发荧光照相、相干光层析成像术(OCT)、荧光素眼底血管造影(FFA)及吲哚青绿脉络膜血管造影(ICGA)等眼底影像学资料并进行总结。结果13例PTP-SLC患者中男女比例8∶5。其中双眼发病者8例,其双眼发病时间的间隔为(8.4±7.9)年。患者平均视力0.3,其中4例患者有明确的结核病接触史。PTP-SLC患者眼底活跃期病灶主要表现为,质地均匀边界不清的淡黄色病灶。自发荧光为弥漫边界不清的高自发荧光。OCT可见活动病灶区域脉络膜基质间点状高反射,视网膜外层结构破坏,伴层间水肿。玻璃体腔内还可见点状高反射。FFA早期示活跃期病灶呈弱荧光,晚期病变呈弥漫高荧光伴有渗漏。ICGA表现为持续的弱荧光灶。结论PTP-SLC眼底病变主要表现为质地均匀边界不清的淡黄色高自发荧光病灶,OCT可见脉络膜及视网膜外层结构受累,FFA可以发现更多视网膜血管炎性改变。仅根据临床特征和流行病学特征很难区分PTP-SLC与SC,结核病原学检查结果仍是鉴别诊断的关键。

Objective To summarize the clinical and fundus imaging features of purified protein derivative and T-spot positive tubercular serpiginous-like choroiditis(PTP-SLC)patients.Methods This retrospective study consecutively enrolled 13 PTP-SLC patients(21 eyes)in Beijing Tongren Hospital from November 2015 to November 2017.There were 8 males and 5 females with an average age of(45.2±12.1)years.Medical history and results of systemic and ophthalmological examinations,such us fundus autofluorescence photography,optical coherence tomography(OCT),fluorescein fundus angiography(FFA)and indocyanine green angiography,were evaluated.Results Eight patients had binocular disease with an average interval time of(8.4±7.9)years.The average visual acuity of all patients was 0.3,and 4 patients had a clear history of exposure to tuberculosis.The active lesions in the PTP-SLC patients were homogeneous and creamish-yellow with unclear boundaries.Fundus autofluorescence showed an ill-defined,diffuse hyperautofluorescent zone.OCT showed punctate hyperreflexes between the choroidal stroma,destruction of the outer retinal structure with intraretinal edema and discrete vitreal hyper-reflective spots.FFA showed hypofluorescence in the active lesion at early stage and diffuse hyperfluorescence with leakage.Indocyanine green angiography showed persistent hypofluorescence.Conclusions PTP-SLC fundus lesions are mainly manifested as homogeneous creamish-yellow lesions with unclear boundaries and high in autofluorescence.The involvement of the choroid and the outer layer of the retina can be observed on OCT.FFA can find more retinal vascular inflammatory changes.It is difficult to distinguish PTP-SLC from serpiginous choroiditis simply based on clinical and epidemiological characteristics.The pathogenic examination of tuberculosis is still the key to differential diagnosis.