急性视网膜色素上皮炎眼底荧光血管造影与频域光相干断层扫描特征观察

目的　观察急性视网膜色素上皮炎（ａｃｕｔｅｒｅｔｉｎａｌｐｉｇｍｅｎｔｅｐｉｔｈｅｌｉｉｔｉｓ，ＡＲＰＥ）的眼底荧光血管造影（ｆｌｕｏｒｅｓｃｅｉｎｆｕｎｄｕｓａｎｇｉｏｇｒａｐｈｙ，ＦＦＡ）与频域光相干断层扫描（ｓｐｅｃｔｒａｌ-ｄｏｍａｉｎｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ，ＳＤ-ＯＣＴ）的图像特征。方法　回顾分析１３例临床确诊的ＡＲＰＥ患者的临床资料，均行视力、眼底彩色照相、ＦＦＡ以及ＳＤ-ＯＣＴ检查。分析ＡＲＰＥ患者ＦＦＡ与ＯＣＴ特征，依据ＳＤ-ＯＣＴ检查结果提出ＡＲＰＥ的三种分型。结果　１３例均单眼发病，眼底可见黄斑区灰白色斑点灶，周围环绕黄白色脱色素晕环。ＦＦＡ特征:早期可见黄斑区斑点状透见荧光灶，呈“葡萄簇”样；晚期２眼黄斑中心凹旁环形弱荧光灶，周围环形荧光素染色，呈“中黑外亮”特征。ＳＤ-ＯＣＴ特征:８眼表现为光感受器细胞内外节连接（ｉｎ-ｎｅｒ／ｏｕｔｅｒｓｅｇｍｅｎｔｏｆｐｈｏｔｏｒｅｃｅｐｔｏｒ，ＩＳ／ＯＳ）与视网膜色素上皮（ｒｅｔｉｎａｌｐｉｇｍｅｎｔｅｐｉｔｈｅｌｉｕｍ，ＲＰＥ）层间帽状高反射，ＩＳ／ＯＳ层连续；３眼表现为ＩＳ／ＯＳ层与ＲＰＥ层间帽状高反射，伴ＲＰＥ内层与ＩＳ／ＯＳ层连续性中断；２眼表现为ＲＰＥ内层不均匀渗出，伴ＲＰＥ内层与ＩＳ／ＯＳ层连续性中断。连续观察８周后１０眼ＳＤ-ＯＣＴ示ＲＰＥ内层帽状高反射消退，中断的ＲＰＥ内层与ＩＳ／ＯＳ层反射带恢复，３眼中断的ＲＰＥ内层未恢复，但ＩＳ／ＯＳ层反射带恢复，受损的视力也得到恢复。结论　ＳＤ-ＯＣＴ能特征性显示ＡＲＰＥ患者的ＲＰＥ内层损害与ＩＳ／ＯＳ层损害，对应ＦＦＡ则为环形透见荧光环，ＦＦＡ黄斑中央弱荧光则为ＯＣＴ显示的ＲＰＥ内层与ＩＳ／ＯＳ层渗出形成的帽状高反射。ＡＲＰＥ急性期视力下降与暂时性ＩＳ／ＯＳ层与ＲＰＥ内层反射带连续性中断相关。

Characteristics of fluorescein fundus angiograph and spectral-domain optical coherence tomography in acute retinal pigment epithelitis

Objective To observe the characteristics of fluorescein fundus angiograph (FFA) and spectral-domain optical coherence tomography ( SD-OCT) in acute retinal pigment epithelitis ( ARPE ) . Methods The clinical data of 13 ARPE patients ( 13 eyes ) were retrospectively analyzed. The visual acuity , fundus photographs , FFA and SD-OCT were exanuned. The characteristics of FFA and SD-OCT were analyzed, and the types of ARPE were preferred in basis of SD-OCT results. ReSHlts ARPE in all 13 cases were monocular diseases. Macular pigment motting with surrounding yellow hypopigmented areas at the level of the retinal pigment epithelium was seen. FFA showed that , the early stage of FFA revealed transnussion hyperfluorescence , and 2 eyes in later stage had hypofluorescein around macular fovea. SD-OCT showed that: The dome-shaped highly reflection was seen between rnner segment and outer segment (IS/OS) and retinal pigment epithelial ( RPE ) layer , IS/OS layer was continued ; IS/OS and RPE layer in 3 eyes showed dome-shaped highly reflection , photoreceptor band was disrupted;The inner band of RPE in 2 eyes was deposited , IS/OS and RPE layer was disrupted. After 8 weeks , SD-OCT showed that IS/OS and RPE band in 10 patients eyes lesion were restored.the RPE inner band in 3 eyes were not restored. FFA also showed hyperfluorescein around macular fovea was disappeared. Conclusion SD-OCT can show the damage in the inner band of RPE and IS/OS , which in FFA is the ring transmission fluorescein, and the hyperfluorescern around macular fovea is the dome-shaped highly reflection between IS/OS and RPE layer. The visual acuity in acute stage is decreased,which associated with transmission of FFA in macular area and disruption of IS/OS and PRE inner layer.