急性区域性隐匿性外层视网膜病变的临床表现和诊断特点

发布时间：2018-10-20 18:43

【摘要】：目的探讨急性区域性隐匿性外层视网膜病变(AZOOR)的临床表现、诊断和鉴别诊断特点。方法经我院临床检查确诊为AZOOR的病例15例(15只眼)纳入研究。所有患者均接受了最佳矫正视力(BCVA)、裂隙灯显微镜、检眼镜、眼底彩色照相、视野、视网膜电图(ERG)、眼底自发荧光照相(FAF)、眼底荧光血管造影(FFA)、吲哚青绿血管造影(ICGA)及光学相干断层扫描(OCT)检查,观察他们的临床特征。随访3个月~2年,观察他们的预后及转归。收集患者的所有资料,进行总结分析。结果 15例均为单眼发病。所有患者均为近视眼。就诊时主诉视物模糊12例,其中伴闪光幻觉5例、伴视物变色3例;眼前暗点或黑影遮挡3例。眼底无明显改变者10只眼(占66.67%),黄斑区有小片状陈旧性脉络膜视网膜萎缩灶分布者2只眼(占13.33%),黄斑区色素紊乱者3只眼(占20%)。11只眼表现为中心暗点或旁中心暗点,占73.33%;4只眼表现为生理盲点明显扩大累及中心凹旁,占26.67%。视网膜电图(ERG)检查均表现为所有患眼均表现为杆体反应、最大反应、椎体反应、闪烁反应中a、b波幅值不同程度下降。5只眼行P-VEP检查显示P100波峰幅值不同程度下降。FD-OCT检查所有患眼的眼底后极部光感受器内外节连接(IS/OS)反光带紊乱,变薄或局部缺失,这些异常改变与视野缺损区相对应;在FAF、FFA、ICGA检查中无明显异常改变。随访3月~2年,15只眼的BCVA及视野缺损均得到不同程度的改善,OCT检查也显示IS/OS层反光带逐渐恢复,其中有8只眼(占53.33%)的BCVA恢复到发病前水平,5只眼的视野及OCT检查完全恢复正常(占33.33%)。结论 AZOOR以青年女性、近视眼发病为多见;早期眼底无明显改变。视野、电生理及OCT检查均有异常改变,对诊断有临床意义。但是AZOOR的诊断需要综合其临床特点、视野、电生理及OCT检查,逐一排除其他疾病才能确诊。OCT检查由于能够动态监测IS/OS层的改变状况,而且方便、经济、直观、无创,还非常适合于随访。FAF、FFA、ICGA对其诊断无明显帮助,但在鉴别诊断中也有重要价值。
[Abstract]:Objective to investigate the clinical features, diagnosis and differential diagnosis of acute regional occult outer retinopathy (AZOOR). Methods Fifteen cases (15 eyes) with AZOOR confirmed by clinical examination in our hospital were included in the study. All patients received best corrected visual acuity (BCVA),) slit lamp microscope, ophthalmoscope, fundus color photography, visual field, (ERG), fundus autofluorescence radiography (FAF), fundus fluorescence angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were used to observe their clinical features. They were followed up for 3 months to 2 years to observe their prognosis and prognosis. Collect all the data of the patients and summarize and analyze them. Results all 15 cases were monocular. All patients were myopia. There were 12 cases of blurred vision, including 5 cases with flash hallucination, 3 cases with discoloration of vision, 3 cases with anterior dark spot or dark shadow occlusion. 10 eyes (66.67%) had no obvious change in fundus, 2 eyes (13.33%) had small old choroidal and retinal atrophy foci in macular area, 3 eyes (20%) had pigment disorder in macular area, 11 eyes showed central dark spot or paracentric dark spot. In 73.33 eyes, the physiological blind spots were obviously enlarged and involved the paraventric fossa, accounting for 26.67%. Electroretinogram (ERG) showed that all the affected eyes showed rod body reaction, maximum reaction and vertebral body reaction. In the flicker reaction, the amplitude of aqb wave decreased in varying degrees. P-VEP examination showed that the peak amplitude of P100 wave decreased in different degrees in 5 eyes. All eyes were examined by FD-OCT. The reflex band of the posterior pole photoreceptor (IS/OS) of all the affected eyes was disordered, thinned or partially absent. These abnormal changes corresponded to the area of visual field defect, and there were no obvious abnormal changes in FAF,FFA,ICGA. From 3 months to 2 years follow-up, BCVA and visual field defect of 15 eyes were improved to some extent, and OCT examination also showed that the reflective zone of IS/OS layer gradually recovered. Among them, 8 eyes (53.33%) had recovered to the level before onset of BCVA, 5 eyes (33.33%) had normal visual field and OCT examination. Conclusion AZOOR is more common in young women and myopia, but there is no obvious change in the fundus in early stage. There were abnormal changes in visual field, electrophysiology and OCT examination, which had clinical significance for diagnosis. However, the diagnosis of AZOOR needs to synthesize its clinical characteristics, visual field, electrophysiology and OCT examination, one by one to exclude other diseases. OCT examination can dynamically monitor the changes of IS/OS layer, and it is convenient, economical, intuitive and non-invasive. FAF,FFA,ICGA is not helpful in diagnosis, but it has important value in differential diagnosis.
【作者单位】：河北省眼科医院;
【分类号】：R774.1

【相似文献】