伴视盘出血的埋藏性视盘玻璃疣患者的临床特点和眼底影像特征

Clinical and fundus imaging features of patients with buried optic disc drusen and optic disc hemorrhage

目的分析伴视盘出血的埋藏性视盘玻璃疣患者的临床特点和眼底影像特征。方法回顾分析2014年5月至2019年11月青岛眼科医院伴视盘出血的埋藏性视盘玻璃疣18例(18只眼)患者的眼科及头颅神经影像学资料。所有患者随访5个月以上。结果18例患者中男性4例(22.22%),女性14例(77.78%),年龄11~36岁(中位数15岁)。均为近视、小视盘,18只眼视盘表面及其鼻侧视网膜下出血,11只眼伴玻璃体出血。所有患眼频域相干光层析成像术(SD-OCT)扫描见视盘鼻侧神经上皮层浅脱离,神经纤维层与视网膜色素上皮(RPE)层之间见中高反射光团;B型超声检查示视盘前强回声光斑。荧光素眼底血管造影(FFA)检查显示早期视盘表面遮蔽荧光,晚期呈高荧光。5例患者视野表现为生理盲点扩大。发病时患眼矫正远视力0.8~1.0,最后随访时视盘出血均完全吸收,病情无复发。结论埋藏性视盘玻璃疣可并发多种类型视盘出血,OCT、眼部B型超声等检查有特征性表现。

Objective To analyze the clinical and fundus imaging features of patients with buried optic disc drusen(ODD)and optic disc hemorrhage.Methods The ophthalmic and cranial neuroimaging data of 18 patients(18 eyes)with buried ODD and optic disc hemorrhage at the Qingdao Eye Hospital from May 2014 to November 2019 were retrospectively analyzed.All patients were followed up for at least five months.Results Among the 18 patients,there were four males(22.22%)and 14 females(77.78%)with a median age of 15 years(range:11~36 years).All of them had myopia,small optic disc,as well as subretinal hemorrhage on the surface and nasal side of the optic disc,and 11 eyes had vitreous hemorrhage.The SD-OCT scan showed superficial detachment of the neuroepithelial layer on the nasal side of optic disc in all eyes,and a medium-high reflection mass between the retinal nerve fiber layer and the retinal pigment epithelium was detected.The B-scan ultrasonography found hyper-reflective spikes in front of the optic disc,even at low gain in each optic disc.On the fundus fluorescein angiography(FFA),the surface of the optic disc showed blocked fluorescence in the early stage and hyper-fluorescence in the late stage.The visual field of the five patients showed enlargement of physiological blind spot,while the visual field of the contralateral eye was normal.The best corrected visual acuity(BCVA)ranged from 0.8~1.0 at disease onset for the patients.The optic disc hemorrhage was completely absorbed without recurrence in the subsequent five months to five years.Conclusions Buried ODD can be complicated with various types of optic disc hemorrhage.The combination of OCT and B-scan ultrasonography can improve the diagnosis of buried ODD.