大泡性视网膜脱离的临床表现及影像学特征观察

Analysis of clinical manifestations and imaging features of bullous retinal detachment

目的观察大泡性视网膜脱离患眼临床表现及影像学特征。方法回顾性临床病例观察性研究。2015年7月至2021年9月于北京大学人民医院眼科中心检查确诊的大泡性视网膜脱离患者11例11只眼纳人研究。其中,男性10例,女性1例;均为单眼发病;年龄(39.27±6.81)岁;病程3个月~14年。患眼均行最佳矫正视力(BCVA)、间接检眼镜、彩色眼底照相、光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)、B型超声检查。BCVA检查采用标准对数视力表进行,统计时换算为最小分辨角对数(logMAR)视力。回顾分析并总结患者临床资料和BCVA、OCT、FFA、ICGA影像特征。结果患眼logMARBCVA为0.91±0.45。对侧眼存在中心性浆液性脉络膜视网膜病变表现9例。发病前接受全身或局部糖皮质激素治疗6例。眼底彩色照相可见视网膜下黄白色物质6只眼;视网膜皱褶5只眼。OCT检查,所有患眼可见黄斑区浆液性视网膜脱离,伴视网膜下颗粒样或片状强反射信号,其中可见神经视网膜层少许颗粒样强反射物质6只眼;黄斑区神经视网膜囊样变性6只眼;脱离的神经视网膜局部与视网膜色素上皮(RPE)粘连6只眼;RPE撕裂6只眼;不同形态RPE脱离(PED)6只眼。FFA检查,存在多发性荧光素渗漏点10只眼,平均荧光素渗漏点(3.82±2.44)个;存在多发性弥漫性RPE病变区9只眼,平均弥漫性RPE病变区(2.45±1.04)个。ICGA检查,所有患眼均可见脉络膜血管扩张及多发性强荧光。B型超声检查,所有患眼均可见明确视网膜脱离。光动力疗法(PDT)治疗后平均(2.0±1.0)个月视网膜脱离复位,(2.36±0.81)个月黄斑区视网膜下液完全吸收,logMARBCVA提高至0.50±0.33,6个月随访无复发。结论大泡性视网膜脱离与糖皮质激素使用有关;视网膜下黄白色物质和OCT视网膜脱离区强反射物质多见;特征性合并黄斑区神经视网膜囊样变性、神经视网膜与RPE粘连、RPE撕裂及PED;伴多个荧光素渗漏点和弥漫性RPE病变区;PDT是治疗大泡性视网膜脱离的有效方法。

Objective To investigate and analyze the clinical manifestations and imaging features of the eyes with bullous retinal detachment.Methods Retrospective case series study.Eleven eyes of 1l patients with bullous retinal detachment diagnosed in Department of Ophthalmology,Peking University People's Hospital from July 2015 to September 2021 were enrolled.There were 10 males and 1 female,with the mean age of(39.27±6.81)years.All patients had monocular bullous retinal detachment,with mean duration ranged from 3 months to 14 years.The basic information and medical history of all patients were collected.All patients underwent best corrected visual acuity(BCVA),indirect ophthalmoscopy,color fundus photography,optical coherence tomography(OCT),fundus fluorescein angiography(FFA),indocyanine green angiography(ICGA)and B-scan ultrasonography.BCVA was performed using a standard logarithmic visual acuity chart,which was converted to logarithm of the minimum angle of resolution(logMAR)visual acuity.The clinical data and imaging features of BCVA,OCT,FFA and ICGA were retrospectively analyzed and summarized.Results:The mean logMAR BCVA of the 11 eyes was 0.91±0.45.Nine patients had bilateral disease,but bullous retinal detachment occurred in only 1 eye,and CSC manifestations were present in the contralateral eye.Six patients had received systemic or topical hormone therapy prior to onset.Yellowish-white material was observed in 6 eyes and retinal folds were observed in 5 eyes.OCT examination showed serous retinal detachment in the macular area with granular or patchy hyperreflective signals in the subretinal area in all eyes,and a few granular hyperreflective substances in the neuroretina in 6 eyes.Neuroretina cystoid degeneration was observed in 6 eyes,adhesion between the detached neuroretina and retinal pigment epithelial(RPE)was observed in 6 eyes,RPE tear was observed in 6 eyes,and different forms of retinal pigment epithelial detachment(PED)were observed in 6 eyes.FFA showed multiple fluorescence leakage spots in 10 eyes,and the average number of fluorescence leakage spots in all eyes was 3.82±2.44.There were multiple diffuse RPE lesions in 9 eyes.The results of ICGA examination showed that choroidal vessels were dilated and multiple hyperfluorescent leaks were observed in all eyes.B-scan ultrasonography examination of all affected eyes showed retinal detachment.Retinal reattachment can be achieved at(2.0±1.0)months after photodynamic therapy(PDT),while SRF can be completely absorbed at(2.36±0.81)months.The mean logMAR BCVA can be improved to 0.50±0.33,and no recurrence was found in the follow-up period up to 6 months.Conclusions Bullous retinal detachment is often associated with the use of hormones,while yellow-white material in the subretina and hyperreflective material in the OCT are common.It is characterized by neuroretina cystoid degeneration in the macular area,adhesion between the neuroretina and RPE,RPE tear and PED,with multiple fluorescence leakage spots and diffuse RPE lesions.PDT is an effective treatment for bullous retinal detachment.