超广角眼底荧光血管造影评估Vogt-小柳—原田综合征患眼周边血管渗漏的意义

发布时间：2018-05-30 23:28

本文选题：超广角眼底荧光血管造影(UWFFA) + 光学相干断层扫描(OCT)　；参考：《河北医科大学》2016年硕士论文

【摘要】：目的:对Vogt-小柳-原田综合征(Vogt-Koyanagi-Harada syndrome,VKH)患者进行超广角眼底荧光素血管造影(ultra wide-field fundus fluorescein angiography,UWFFA)检查,观察VKH患眼周边眼底影像特征,测量UWFFA图像7-9min的患眼周边血管渗漏面积,分析其与最佳矫正视力(best correct visual acuity,BCVA),眼压(intra ocular pressure,IOP),复发性,活动期,前节反应,后极部渗漏面积,周边血管渗漏圈至中心凹的距离(圈凹距),周边血管渗漏圈至视盘的距离(圈盘距),盘周萎缩弧(peripapillary atrophy,PPA),中心凹视网膜厚度(central retinal thickness,CRT)之间的关系和差异性,评价VKH患眼周边血管渗漏在VKH疾病诊断、进展、治疗和预后中的意义,以期对临床工作有所指导。方法:1收集2014.2-2016.2于河北医科大学第二医院眼科门诊确诊为VKH的患者。符合条件的总计13例26只眼纳入研究。分别进行人口统计学数据收集和临床检查,包括年龄、性别、发病时间、全身常规检查、BCVA、IOP、裂隙灯、眼前节照相、眼底照相、UWFFA及光学相干断层扫描(optical coherence tomography,OCT)等,随访期均为8个月,对首诊治疗前、治疗后3个月、治疗后6-8个月时的上述检查结果进行观察和数据统计分析。2在以上13例患者中,根据首诊治疗前UWFFA图像周边血管渗漏的有无分为两组。2.1有周边血管渗漏组(M组:14只眼):UWFFA图像有周边血管渗漏,表现为造影过程中染料渗漏,血管壁着染,周边眼底斑片状强荧光。2.2无周边血管渗漏组(N组:12只眼):UWFFA图像无周边血管渗漏。所有患眼均直接给予玻璃体腔内注射曲安奈德(triamcinolone acetonide,TA)4mg,治疗后复发者,给予全身糖皮质激素治疗:注射用甲泼尼龙琥珀酸钠500mg/日,3日。随后根据疗效逐渐减量为口服强的松片(1mg/kg·d),直至减为隔日晨服一片后根据病情停药,治疗时间至少维持6个月。结果:13例患者中出现周边血管渗漏的7例(53.85%),平均周边血管渗漏面积10957.00±27199.75pixels。VKH急性初发,首诊治疗前UWFFA图像即有周边血管渗漏的患眼在治疗过程中更易复发,治疗难度更大;更易出现较长的活动期,若以30天为界,则更易大于30天;更易发生持续的前节反应;在6-8个月时UWFFA图像更易有周边血管渗漏且渗漏面积大于首诊治疗前的渗漏面积;在6-8个月时眼底照相更易有PPA,预后较差,以上特征均具有统计学意义(P㩳0.05);首诊治疗前UWFFA图像周边血管渗漏对比首诊治疗前CRT和后极部渗漏面积,6-8个月时BCVA和IOP无显著差异;周边血管渗漏面积和后极部渗漏面积无显著关系,以上均不具有统计学意义(P"g0.05)。首诊治疗前CRT和后极部渗漏面积有关,且随着后极部渗漏面积增大,CRT相应增高,此特征具有统计学意义(P㩳0.05);CRT和周边血管渗漏面积无显著关系,不具有统计学意义(P"g0.05)。同期圈盘距大于圈凹距,且两者之间具有显著关系,随着圈凹距增大,圈盘距相应增大,此特征具有统计学意义(P㩳0.05);首诊治疗前和6-8个月时的圈凹距无显著差异,不具有统计学意义(P"g0.05)。活动期㧐30天较"f30天的患眼更易出现前节反应,此特征具有统计学意义(P㩳0.05);同期有无周边血管渗漏的患眼并没有表现出前节反应的显著差异,不具有统计学意义(P"g0.05)。结论:1 UWFFA较传统FFA观察眼底范围更大,有利于发现传统FFA不能观察到的VKH周边眼底病变。2 VKH急性初发时的周边血管渗漏对复发性、治疗难度、活动期、前节反应、随访期间周边血管渗漏持续存在、PPA和预后等临床特征有影响,对CRT、后极部渗漏面积、BCVA和IOP无影响。3 VKH急性初发时的后极部渗漏面积越大,CRT越高,周边血管渗漏面积对CRT无影响。4同期圈盘距大于圈凹距,且圈凹距越大,圈盘距越大。5活动期㧐30天较"f30天的患眼更易出现前节反应。
[Abstract]:Objective: to examine the Vogt- wide-field fundus fluorescein angiography (UWFFA) angiography (ultra wide-field fundus fluorescein angiography, UWFFA) for patients with Vogt-Koyanagi-Harada syndrome (VKH), to observe the imaging features of the periophthalmic fundus surrounding the VKH eye, and to measure the area of the peripheral vascular leakage of the affected eyes. Corrected visual acuity (best correct visual acuity, BCVA), intraocular pressure (intra ocular pressure, IOP), recurrent, active, anterior segment reaction, posterior pole leakage area, distance from peripheral vascular leaking to recess (circle concave distance), circumference of percolation circle to disc distance (circle disc distance), circumference atrophy arc (peripapillary atrophy, PPA), central concave network The relationship and difference between central retinal thickness (CRT) and the significance of VKH peripheral vascular leakage in the diagnosis, progression, treatment and prognosis of VKH disease in order to guide the clinical work. Method: 1 collect 2014.2-2016.2 at the ophthalmology outpatient department of the second hospital of Hebei Medical University. A total of 13 cases of 26 eyes were included in the study. Demographic data collection and clinical examination were carried out, including age, sex, onset time, general routine examination, BCVA, IOP, slit lamp, anterior segment photography, fundus photography, UWFFA and optical coherence tomography (optical coherence tomography, OCT) and so on. The follow-up period was 8 months, before the first treatment, 3 months after treatment, the results of the above examination at 6-8 months after treatment were observed and statistical analysis of.2 in the above 13 patients, according to whether there were two groups of peripheral vascular leakage group (group M: 14 eyes) in the peripheral vascular leakage group (group M: 14 eyes) in the peripheral vascular leakage of the peripheral blood vessels before the first diagnosis. The UWFFA map resembles peripheral vascular leakage, showing the dyestuff infiltration during the contrast process. Leakage, vascular wall staining, peripheral fundus plaque like strong fluorescein.2.2 without peripheral vascular leakage group (group N: 12 eyes): no peripheral vascular leakage in UWFFA image. All eyes were given Cu Ann Ned (triamcinolone acetonide, TA) 4mg in all eyes directly. After treatment, the patients were treated with systemic glucocorticoid treatment: injection of methylprednisolone Amber Sodium acid 500mg/ day, 3 days. Then according to the curative effect gradually reduced to oral prednisone tablets (1mg/kg d), until after the day morning after the morning clothes to stop medicine, treatment time for at least 6 months. Results: 13 cases of peripheral vascular leakage of 7 cases (53.85%), the average peripheral vascular leakage area of 10957 + 27199.75pixels.VKH acute initial hair Before the first diagnosis, the UWFFA image, that is, the percolation of peripheral blood vessels, is more prone to relapse in the treatment process. The treatment is more difficult to treat; it is easier to have a longer period of activity. If it is 30 days as the boundary, it is more likely to be more than 30 days; it is easier to have a continuous anterior segment reaction; in the 6-8 month, the UWFFA image is more likely to have peripheral vascular leakage and the leakage area is greater than the first diagnosis and treatment. The preoperative leakage area; the fundus photography was more likely to have PPA at 6-8 months. The prognosis was poor and the above features were statistically significant (P? 0.05). The leakage of peripheral blood vessels around UWFFA images before first diagnosis was compared with the leakage area of CRT and the posterior pole before the first diagnosis, and there was no significant difference between BCVA and IOP at 6-8 months; peripheral vascular leakage area and the leakage area of the posterior pole. There was no statistical significance (P "g0.05). The leakage area of CRT and the posterior pole was related before the first treatment, and with the increase of the leakage area of the posterior pole, the CRT increased correspondingly. This characteristic was statistically significant (P? 0.05); CRT had no significant relationship with the peripheral vascular leakage area, and did not have statistical significance (P" g0.05). The distance of the disc was large at the same time. There is a significant relationship between the circle concave distance and the difference between the two. With the increase of the pitch distance and the increase of the distance of the disc, this feature has statistical significance (P? 0.05); there is no significant difference between the recess distance of the first diagnosis and 6-8 months. There is no statistical significance (P "g0.05). The activity period is 30 days more than that of the F30 day. Study significance (P? 0.05); there was no significant difference in the anterior segment response without peripheral vascular leakage in the same period, and did not have statistical significance (P "g0.05). Conclusion: 1 UWFFA is larger than the traditional FFA observation, which is beneficial to the detection of peripheral vascular leakage of.2 VKH acute early onset of.2, which is not observed by the traditional FFA. Recurrence, treatment difficulty, activity period, anterior segment reaction, peripheral vascular leakage persisted during follow-up, PPA and prognosis and other clinical characteristics, CRT, the posterior pole leakage area, BCVA and IOP without affecting the.3 VKH acute early hair leakage area of the greater, the higher the CRT, the peripheral vascular leakage area of CRT does not affect the.4 synchronization disc distance greater than.4 greater than the CRT. The greater the pitch, the larger the pitch, the greater the.5 interval. The 30 day is more prone to the anterior segment reaction than the F30 eye.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R773.9

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