中华眼底病杂志

中华眼底病杂志

Vogt-Koyanagi-Harada综合征与视神经炎患眼视盘水肿形态结构参数的三维光相干断层扫描观察

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目的 观察伴有视盘水肿的急性葡萄膜炎期Vogt-Koyanagi-Harada综合征(VKH)和视神经炎(ON)患眼视盘形态与结构的差异。 方法 回顾性临床病例分析。伴有视盘水肿的急性葡萄膜炎期VKH 患者21例35只眼(VKH组)以及伴视盘水肿的ON患者22例27只眼(ON组)纳入研究。所有患者均为首次发病。两组患者性别(χ2=0.20)、年龄(t=−1.11)比较,差异无统计学意义(P>0.05)。选取同期年龄、性别、眼别均与VKH组、ON组相匹配的健康体检者43名62只眼作为对照组。所有受检眼均行视盘三维光相干断层扫描(OCT)检查。运用系统自带软件自动计算视盘面积、视杯面积、盘沿面积、杯盘比(C/D)面积比和直径比、环视盘视网膜神经纤维层(CP-RNFL)平均厚度及鼻侧、上方、颞侧、下方各象限的CP-RNFL厚度;同时对OCT断层图视盘两端的视网膜色素上皮(RPE)终末端延长线的夹角(视盘RPE夹角)进行测量。对比观察VKH组、ON组患眼视盘形态差异以及3组受检眼视盘参数、CP-RNFL厚度及视盘RPE夹角等视盘结构差异。 结果 VKH组35只眼中,视盘旁视网膜脱离(RD)31只眼,占88.57%;视盘表面内界膜呈锯齿形3只眼,占8.57%。视盘旁RD眼中,RD区内点、线状或膜状强反射20只眼,占64.52%。ON组27只眼均无视盘旁RD及视盘表面内界膜锯齿形改变。与ON组比较,VKH组视杯面积、C/D面积比、C/D直径比较大,CP-RNFL平均厚度及上方、下方CP-RNFL厚度较薄,视盘RPE夹角较小,差异有统计学意义(P<0.05)。与对照组比较,VKH组患眼视盘面积、视杯面积、盘沿面积较大,C/D垂直直径比较小,CP-RNFL平均厚度及鼻侧、上方、颞侧、下方CP-RNFL厚度增厚,视盘RPE夹角较小;ON组患眼视盘面积较大,视杯面积、C/D面积比、C/D直径比均较小,CP-RNFL平均厚度及各象限CP-RNFL厚度增厚,视盘RPE夹角较大;差异均有统计学意义(P<0.05)。 结论 与ON患眼比较,VKH患眼视盘RPE夹角更小,易于出现视盘旁RD;C/D面积比及直径比更大,CP-RNFL平均厚度及上方、下方CP-RNFL厚度较薄。

Objective To compare the differences of optic disc morphology and optic nerve head parameters between Vogt-Koyanagi-Harada (VKH) syndrome and optic neuritis (ON) with optic disc edema. Methods This is a retrospective study including 21 first-onset VKH patients (35 eyes) as VKH group and 22 first-onset ON patients with optic disc edema (27 eyes) as ON group. The differences of age (t=−1.11) and gender (χ2=0.20) between two groups were not significant (P>0.05). Sixty-two eyes of 43 age and gender-matched healthy subjects were enrolled in this study as control group. All subjects underwent three dimensional optical coherence tomography (3D-OCT) examinations. The difference of optic disc morphology between two groups was observed. The parameters included average thickness of entire circumpapillary retinal nerve fiber layer (CP-RNFL), thickness of nasal, superior, temporal and inferior quadrant of CP-RNFL, disc area, disc cup area, rim area, cup/disc (C/D) area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio. The disc retinal pigment epithelium (RPE) angle was observed too. Results Among 35 eyes in VKH group, 31 eyes (88.57%) had retinal detachment next to the disc, 3 eyes (8.57%) had serrated inner limiting membranes of the disc. Twenty eyes (64.52%) had highly reflective points, lines, or membrane-like structures in the retinal detachment areas. No such signs appeared in ON patients. Compared with ON group, the optic cup area, C/D area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio were bigger, the thickness of mean CP-RNFL and the superior, inferior quadrants of CP-RNFL were thinner, disc RPE angles was smaller in VKH group (P<0.05). Compared with control group, the disc area, optic cup area, rim area were bigger, C/D vertical diameter ratio was smaller, the mean CP-RNFL and 4 quadrants CP-RNFL were thicker, disc RPE angles was smaller in VKH group (P<0.05); the disc area, optic cup area, C/D area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio were smaller, the mean CP-RNFL and 4 quadrants CP-RNFL were thicker, disc RPE angles was bigger in VKH group (P<0.05). Conclusions VKH patients have smaller disc RPE angles and more chance to develop retinal detachment next to disc than ON patients. The C/D area ratio, C/D horizontal diameter ratio and C/D vertical diameter ratio are bigger, the mean CP-RNFL and the superior, inferior quadrants of CP-RNFL are thinner in VKH eyes.

关键词: 葡萄膜脑膜脑炎综合征/并发症; 视神经炎/诊断; 视盘/病理生理学; 神经纤维/病理学; 视网膜/病理生理学; 体层摄影术,光学相干

Key words: Uveomeningoencephalitic syndrome/complications; Optic neuritis/diagnosis; Optic disk/physiopathology; Nerve fibers/pathology; Retina/physiopathology; Tomography, optical coherence

引用本文: 庞燕华, 谭志, 王秀琴, 梁德茂, 赵桂玲. Vogt-Koyanagi-Harada综合征与视神经炎患眼视盘水肿形态结构参数的三维光相干断层扫描观察. 中华眼底病杂志, 2017, 33(5): 476-480. doi: 10.3760/cma.j.issn.1005-1015.2017.05.009 复制

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