中华眼底病杂志

中华眼底病杂志

伴不同程度视盘水肿的急性葡萄膜炎期Vogt-Koyanagi-Harada综合征患眼视盘参数及环视盘神经纤维层厚度观察

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目的 观察伴不同程度视盘水肿的急性葡萄膜炎期Vogt-Koyanagi-Harada综合征(VKH)患眼视盘参数及环视盘神经纤维层(CP-RNFL)厚度的变化。 方法 回顾性临床病例分析。临床确诊为急性葡萄膜炎期VKH患者23例40只眼纳入研究。根据荧光素眼底血管造影检查结果,将视盘边界较清楚,晚期视盘持续强荧光定义为轻度视盘水肿;视盘边界不清楚,视盘表面及视盘周围毛细血管扩张渗漏定义为严重视盘水肿。23例40只眼中,轻度视盘水肿13例25只眼(A组),严重视盘水肿10例15只眼(B组)。A、B组患者性别、发病时间(t=−1.67)及矫正视力(t=−0.76)比较,差异无统计学意义(P>0.05);B组患者年龄较A组更大,差异有统计学意义(t=−2.17,P<0.05)。选择同期分别与A、B组患者年龄、性别、眼别相匹配的26名50只眼(C组)及20名30只眼(D组)作为其对照组。所有受检者均行视盘三维光相干断层扫描检查。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、CP-RNFL平均厚度及鼻侧、上方、颞侧、下方各象限的CP-RNFL厚度。对比分析A、B组及其与各自对照组的视盘参数及CP-RNFL厚度差异。 结果 与C组比较,A组患眼视盘面积、视杯面积、盘沿面积增大,CP-RNFL平均厚度及鼻侧、颞侧CP-RNFL厚度增厚,差异均有统计学意义(P<0.05)。与D组比较,B组患眼视盘面积、盘沿面积增大,CP-RNFL平均厚度及鼻侧、上方、颞侧、下方CP-RNFL厚度增厚,C/D面积比、C/D水平直径比、C/D垂直直径比较小,差异有统计学意义(P<0.05)。与A组比较,B组患眼视盘面积增大,视杯面积、C/D面积比、C/D水平直径比、C/D垂直直径比较小,CP-RNFL平均厚度及鼻侧、上方、下方CP-RNFL厚度增厚,差异有统计学意义(P<0.05)。 结论 伴轻度视盘水肿的急性葡萄膜炎期VKH患眼鼻侧、颞侧CP-RNFL增厚,伴严重视盘水肿患眼进一步累及上方、下方CP-RNFL,C/D面积比、直径比变小。

Objective To compare the differences of optic disc parameters and the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) in acute uveitis Vogt-Koyanagi-Harada (VKH) syndrome with different degrees of optic disc edema. Methods This is a retrospective study including 40 eyes of 23 VKH patients. The eyes were divided into 2 groups according to the results of fluorescein fundus angiography (FFA). The discs with hyperfluorescence but no leakage were in mild optic disc edema group (group A, 13 patients and 25 eyes), and the discs with hyperfluorescence and leakage were in severe optic disc edema group (group B, 10 patients and 15 eyes). The patients were significantly older in group B than in group A (t=−2.17, P<0.05). The differences of gender, diseased time (t=−1.67) and corrected visual acuity (t=−0.76) between 2 groups were not significant (P>0.05). Eighty eyes of 46 normal healthy subjects, matching group A and group B with age and gender, were divided into group C (26 subjects and 50 eyes) and group D (20 subjects and 30 eyes) respectively. All subjects underwent three dimensional optical coherence tomography examinations. 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. Results The disc area, disc cup area and rim area were bigger, the thickness of mean CP-RNFL and the nasal and temporal quadrants of CP-RNFL were thicker in group A than those in group C (P<0.05). The disc area and rim area were bigger, the thickness of mean CP-RNFL and the nasal, superior, temporal and inferior quadrant of CP-RNFL were thicker, C/D area ratio and C/D diameter ratio were smaller in group B than those in group D (P<0.05). The disc area was bigger, disc cup area, C/D area ratio and C/D diameter ratio were smaller, the thickness of mean CP-RNFL and the nasal , superior and inferior quadrants of CP-RNFL were thicker in group B than those in group A (P<0.05). Conclusions Acute VKH uveitis with mild optic disc edema has thicker CP-RNFL in the nasal and temporal quadrants; with severe optic disc edema has thicker CP-RNFL in all 4 quadrants. Acute VKH uveitis also has smaller C/D area ratio and C/D diameter ratio.

关键词: 葡萄膜脑膜脑炎综合征/并发症; 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 disk/physiopathology; Nerve fibers/pathology; Retina/physiopathology; Tomography, optical coherence

引用本文: 庞燕华, 袁雪晖, 王秀琴, 谭志, 吕秋荣, 刘华琼, 赵桂玲. 伴不同程度视盘水肿的急性葡萄膜炎期Vogt-Koyanagi-Harada综合征患眼视盘参数及环视盘神经纤维层厚度观察. 中华眼底病杂志, 2017, 33(5): 481-484. doi: 10.3760/cma.j.issn.1005-1015.2017.05.010 复制

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