Coats病光学相干断层扫描成像特征及其与黄斑纤维化的相关性

Optical coherence tomography imaging features of Coats disease and their correlation with macular fibrosis

目的分析Coats病患者光学相干断层扫描(OCT)成像特征及其在黄斑纤维化预测中的价值。方法采用巢式病例对照研究方法,收集2008年1月至2021年10月于空军军医大学西京医院经彩色眼底照相、眼部B型超声、荧光素眼底血管造影及频域OCT检查确诊的Coats病患者43例43眼。其中,男40例,女3例;年龄2~60岁,中位年龄13岁。以黄斑纤维化为不良预后指标,根据随访结束时是否出现黄斑纤维化将患者分为2个组,比较各组间OCT特征的差异,并采用Logistic回归分析这一不良预后指标发生的危险因素。结果43例Coats病患者的OCT临床特征包括视网膜内硬性渗出43眼(占100%)、视网膜下液21眼(占48.8%)、黄斑囊肿17眼(占27.9%)、视网膜下渗出9眼(占20.9%)、视网膜前高反射点7眼(占16.3%)、视网膜前膜21眼(占48.8%)以及视网膜内液22眼(占51.2%)。彩色眼底照相可见硬性渗出分布于后极部38眼(占93.0%)以及中周部27眼(占65.9%);OCT检查可见硬性渗出分布于内核层35眼(占81.4%)以及外核层33眼(占76.7%)。OCT检出渗出性视网膜脱离的21眼中,彩色眼底照相检出9眼(占42.9%),眼部B型超声检出18眼(占85.7%)。黄斑纤维化组视网膜下液以及视网膜下渗出眼数比例均高于无黄斑纤维化组,差异均有统计学意义(χ^(2)=20.755,P<0.001;χ^(2)=6.133,P=0.013)。Logistic回归分析结果显示,出现视网膜下液是发生黄斑纤维化的危险因素(比值比=48.345,95%置信区间:4.272~547.066,P=0.002)。结论OCT检查能够直观检测到Coats病患者的视网膜下液、视网膜下渗出、黄斑囊肿、黄斑渗出及视网膜高反射点等特征,其中视网膜下液是发生黄斑纤维化的危险因素。

Objective To analyze the optical coherence tomography(OCT)imaging characteristics in patients with Coats disease and their value in predicting macular fibrosis.Methods A nested case-control study was performed.A total of 43 patients(43 eyes)diagnosed with Coats disease through color fundus photography,ocular B-scan ultrasonography,fundus fluorescein angiography,and spectral-domain OCT examination were enrolled from January 2008 to October 2021 at the Xijing Hospital.Among them,there were 40 males and 3 females,aged from 2 to 60 years old,with a median age of 13 years.Macular fibrosis was used as an indicator of poor prognosis,and patients were divided into two groups based on whether macular fibrosis occurred at the end of follow-up.The differences in OCT characteristics between two groups were compared and logistic regression analysis was used to identify the risk factors for macular fibrosis.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Xijing Hospital of Fourth Military Medical University(No.KY20202009-C-1).Results The OCT clinical features of 43 cases of Coats disease included intraretinal hard exudates in 43 eyes(100%),subretinal fluid in 21 eyes(48.8%),macular cysts in 17 eyes(27.9%),subretinal exudates in 9 eyes(20.9%),anterior retinal hyperreflective dots in 7 eyes(16.3%),epiretinal membrane in 21 eyes(48.8%),and intraretinal fluid in 22 eyes(51.2%).In color fundus photos of 41 eyes,38 eyes(93.0%)had hard exudates distributed in the posterior pole and 27 eyes(65.9%)had the mid-peripheral region.OCT examination showed that hard exudates were distributed in the inner nuclear layer in 35 eyes(81.4%)and the outer nuclear layer in 33 eyes(76.7%).Among 21 eyes with exudative retinal detachment detected by OCT,9 eyes(42.9%)were detected by fundus photography and 18 eyes(85.7%)were detected by B-scan ultrasonography.The proportions of eyes with subretinal fluid and subretinal exudates were higher in the macular fibrosis group than in the non-macular fibrosis group,and the differences were statistically significant(χ^(2)=20.755,P<0.001;χ^(2)=6.133,P=0.013).Logistic regression analysis showed that the presence of subretinal fluid was a risk factor for macular fibrosis(odds ratio=48.345,95%confidence interval:4.272-547.066,P=0.002).Conclusions OCT examination can detect subretinal fluid,subretinal exudates,macular cysts,macular exudates,and hyperreflective spots in the retina of patients with Coats disease.Subretinal fluid is a risk factor for macular fibrosis.