不同阶段非特异性后巩膜炎扫频相干光断层扫描影像特征观察

Observation of imaging features in different stages of idiopathic posterior scleritis using swept-source optical coherence tomography

目的观察非特异性后巩膜炎患者不同疾病分期扫频相干光断层扫描(SS-OCT)的图像特征。设计回顾性病例系列。研究对象2018年9月至2021年2月北京同仁医院非特异性后巩膜炎患者27例,双眼发病14例,单眼发病13例。选取患眼共41眼作为研究组,单眼发病者对侧健眼共13眼作为对照组。方法根据入组患者的临床表现进行疾病分期,自患者出现不适症状开始,持续至稳定期之前为活动期;患者不适主诉已消失,且已停药或使用最小维持剂量糖皮质激素(口服醋酸泼尼松5~10 mg/日)和/或免疫抑制剂(口服甲氨蝶呤每周7.5mg或更低剂量)为稳定期;稳定期后,症状重新出现和/或重新确诊活动期后巩膜炎为复发期。所有患者首诊、治疗后1、2周,1、3、6、12个月随诊,行SS-OCT检查,比较不同分期时后极部SS-OCT图像中视网膜及脉络膜异常特征及黄斑区视网膜、脉络膜厚度的差异。主要指标视网膜及脉络膜异常征象及消退时间,视网膜及脉络膜厚度。结果活动期患眼(n=41)SS-0CT检查异常征象表现为视网膜皱褶者23眼(56.10%)、视网膜下液11眼(26.83%)、视网膜和/或脉络膜层间点状高反射35眼(85.37%)、视网膜色素上皮(RPE)波浪样改变11眼(26.83%)、视盘和/或黄斑水肿25眼(60.98%)、脉络膜结构异常12眼(29.27%);上述异常征象可同时出现在同一患者眼底的不同或相同部位。稳定期患眼(n=41)黄斑中心凹脉络膜厚度(245.923±6.829)μm,明显低于活动期(n=41)的(405.640±40.629)μm(P=0.001)。对比稳定期(n=41),复发期(n=12)患眼脉络膜厚度再次增加到(354.917±62.034)μm(P=0.001)。结论非特异性后巩膜炎活动期SS-0CT可见视网膜和/或脉络膜层间点状高反射、脉络膜厚度增加等异常影像,稳定期脉络膜厚度明显下降,复发期再次增加。

Objective To observe the image features of swept-source optical coherence tomography(SS-OCT)in patients with id-iopathic posterior scleritis at different disease stages.Design Retrospective case series.Participants A total of 27 patients with idio-pathic posterior scleritis diagnosed at Beijing Tongren Hospital from September 2018 to February 2021 were included in the study.A-mong them,14 patients were bilateral involved and other 13 patients were unilateral involved.A total of 41 affected eyes were selected as the study group,and other 13 eyes were selected as the control group.Methods Disease staging was conducted based on the clinical manifestations of the enrolled patients.The active stage was defined as the period from the onset of symptoms to the stabilization stage.The stabilization stage was defined as the disappearance of patient discomfort complaints,discontinuation of medication,or use of the minimum maintenance dose of oral glucocorticoids(5-10 mg/day)and/or immunosuppressants(oral methotrexate 7.5 mg per week or low-er doses).The recurrence stage was defined as the reappearance of symptoms and/or re-diagnosis of active posterior scleritis after the stabilization stage.All patients underwent SS-OCT examination at the initial visit,1 and 2 weeks,and at 1,3,6,and 12 months after treatment.The abnormal features of the retina and choroid,as well as the thickness of the retinal and choroidal layers in the posterior pole of SS-OCT images,were compared among different stages.Main Outcome Measures The abnormal signs of retina and choroid showed by SS-OCT and their resolving time,thickness of retinal and choroid.Results Abnormal signs observed using SS-OCT in the active stage(n=41)included retinal folds in 23 eyes(56.10%),subretinal fluid in 11 eyes(26.83%),punctate hyperreflectivity in the retina and/or choroid in 35 eyes(85.37%),RPE wave-like change in 11 eyes(26.83%),optic disc and/or macular edema in 25 eyes(60.98%).and choroidal structural abnormalities in 12 eyes(29.27%).These abnormal signs could occur simultaneously in different or the same regions of the fundus in the same patient.The choroidal thickness in the macular fovea of the eyes in the stabilization stage(n=41)was(245.923±6.829)μm,which was significantly lower than that in the active stage(n=41)(405.640±40.629)μm(P=0.001).Compared with the stabilization stage,the choroidal thickness in the eyes in the recurrence stage(n=12)(354.917±62.034μm)increased again(P=O.001).Conclusion Abnormal imaging signs including punctuate hyperreflectivity in retina and/or choroid,increased choroidal thickness could be seen in active idiopathic posterior scleritis,while the choroidal thickness decreased significantly during stabilization stage and re-increased during recurrence stage.