中华眼底病杂志

中华眼底病杂志

单侧急性特发性黄斑病变患眼临床和影像特征

查看全文

目的 观察单侧急性特发性黄斑病变(UAIM)患眼临床表现和影像特征。 方法 回顾性病例分析。临床检查确诊的UAIM患者6例6只眼纳入研究。其中,男性4例4只眼,女性2例2只眼。所有患眼行最佳矫正视力(BCVA)、眼底彩色照相、频域光相干断层扫描(SD-OCT)、荧光素眼底血管造影(FFA)检查;行同步吲哚青绿血管造影(ICGA)检查3只眼。患者明确诊断后均未进行干预;平均随访时间6.3个月。随访时均行BCVA、眼底彩色照相、SD-OCT、FFA检查。 结果 患者眼部症状主要表现为单侧视力突然下降,伴视物变形或中心暗点;眼底彩色照相检查发现,黄斑区黄白色斑块状病灶,其中伴小片状不规则浅层出血3只眼。FFA检查发现,早期黄斑区不规则强荧光,晚期荧光素积存;ICGA检查的3只眼,黄斑区呈持续弱荧光,未见强荧光。SD-OCT检查发现,黄斑区视网膜神经上皮脱离,其下呈中等反射,椭圆体带中断,外界膜欠清晰。初诊后2周,黄白色斑块状病灶、出血基本吸收。视网膜神经上皮脱离逐渐消失,椭圆体带连续性部分修复;1个月后椭圆体带连续性完全修复。末次随访时,患眼BCVA 0.8、1.0者分别为4、2只眼;基本恢复正常。 结论 UAIM以单眼黄斑区急性一过性渗出病灶为主要特征;以视网膜外层局限受损为主,结构可自行恢复。

Objective To observe the clinical characteristics and fundus imaging features of unilateral acute idiopathic maculopathy (UAIM). Methods Retrospective cases series. Six eyes of 6 patients with UAIM were included in this study. There were 4 males and 2 females. All patients underwent best corrected visual acuity (BCVA), fundus color photography, spectral domain optical coherence tomography (SD-OCT) and fundus fluorescein angiography (FFA) examinations. 3 patients underwent indocyanine green angiography (ICGA) examination. No intervention was given in all patients after diagnosis. The mean follow-up was 6.3 months. BCVA, fundus color photography, SD-OCT and FFA were performed in follow-up. Results The ocular symptoms included unilateral sudden decreased vision, metamorphopsia and central scotoma. All patients had a yellow-white lesion involving the macular and irregular small bleeding was seen in 3 eyes. Irregular hyper-fluorescence in macular area was seen in all patients, some with the hemorrhages showed blocked fluorescence at the early stage of FFA and fluorescence storage at the late stage. ICGA showed that hypo-fluorescence in macular area continually. SD-OCT showed that subretinal fluid in the macular and lost the ellipsoid zone. During the follow-up period, the subretinal fluid was absorbed spontaneously in one month. The ellipsoid zone structure recovered gradually and the visual acuity were normal. At the time of the latest follow-up, the BCVA was 0.8 in 4 eyes, 1.0 in 2 eyes. Conclusions UAIM is featured with a unilateral, acute, transient and exudative lesion in the macular, which can be spontaneously resolved; It mainly affects outer retina.

关键词: 黄斑/损伤; 视网膜疾病/诊断; 疾病特征

Key words: Macula lutea/injuries; Retinal Diseases/diagnosis; Disease attributes

引用本文: 杨卫丹, 闵靖宇, 谢莉萍, 宫媛媛. 单侧急性特发性黄斑病变患眼临床和影像特征. 中华眼底病杂志, 2017, 33(6): 573-576. doi: 10.3760/cma.j.issn.1005-1015.2017.06.004 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Yannuzzi LA, Jampol LM, Rabb MF, et al. Unilateral acute idiopathic maculopathy[J]. Arch Ophthalmol, 1991, 109(10): 1411-1416. DOI:10.1001/archopht.1991.01080100091049.
2. 杜磊, 邢怡桥, 陈长征.急性特发性黄斑病变[J]. 中国实用眼科杂志, 2006, 24(5): 450-452. DOI:10.3760/cma.j.issn.1006-4443.2006.05.002.Du L, Xing YQ, Chen CZ. Acute idiopathic maculopathy[J]. Chin J Pract Ophthalmol, 2006, 24(5): 450-452. DOI: 10.3760/cma.j.issn.1006-4443.2006.05.002.
3. Hoang QV, Strauss DS, Pappas A, et al. Imaging in the diagnosis and management of acute idiopathic maculopathy[J]. Int Ophthalmol Clin, 2012, 52(4): 263-268. DOI:10.1097/IIO.0b013e31826861db
4. Ng SK, Ebneter A, Gilhotra JS.Atypical findings in delayed presentation of unilateral acute idiopathic maculopathy[J]. Int Ophthalmol, 2013, 33(4): 387-389. DOI:10.1007/s10792-013-9722-x.
5. Beck AP, Jampol LM, Glaser DA, et al. Is coxsackievirus the cause of unilateral acute idiopathic maculopathy?[J]. Arch Ophthalmol, 2004, 122(1): 121-123.DOI:10.1001/archopht.122.1.121.
6. Jung CS, Payne JF, Bergstrom CS, et al. Multimodality diagnostic imaging in unilateral acute idiopathic maculopathy[J]. Arch Ophthalmol, 2012, 130(1): 50-56. DOI: 10.1001/archophthalmol.2011.359.
7. Hashimoto Y, Saito W, Saito M, et al. Increased choroidal blood flow velocity with regression of unilateral acute idiopathic maculopathy[J]. Jpn J Ophthalmol, 2015, 59(4): 252-260. DOI: 10.1007/s10384-015-0380-6.
8. Landa G, Su E, Garcia PM, et al. Inner segment-outer segment junctional layer integrity and corresponding retinal sensitivity in dry and wet forms of age-related macular degeneration[J]. Retina, 2011, 3l(1): 364-370. DOI:10.1097/IAE.0b013e3181e91132.
9. de la Fuente MA, Cuadrado R.Unilateral acute idiopathic maculopathy: angiography, optical coherence tomography and microperimetry findings[J]. J Ophthalmic Inflamm Infect, 2011, 1(3): 125-127. DOI:10.1007/s12348-010-0014-6.
10. Aggio FB, Farah ME, Meirelles RL, et al. STRATUSOCT and multifocal ERG in unilateral acute idiopathic maculopathy[J]. Graefe’s Arch Clin Exp Ophthalmol, 2006, 244(4): 510-516.DOI: 10.1007/s00417-005-1172-3.
11. 杨卫丹, 俞素勤, 王泓, 等. 不同病程梅毒性后葡萄膜炎患眼眼底影像特征观察[J]. 中华眼底病杂志, 2017, 33(1): 31-34.DOI:10.3760/cma.j.issn.1005-1015.2017.01.009.Yang WD, Yu SQ, Wang H, et al. Multimodal fundus imaging in patients of syphilitic posterior uveitis at different stages[J]. Chin J Ocul Fundus Dis, 2017, 33(1): 31-34. DOI:10.3760/cma.j.issn.1005-1015.2017.01.009.
12. Schneider U, Inhoffen W, Gelisken F. Indocyanine green angiography in a case of unilateral recurrent posterior acute multifocal placoid pigment epitheliopathy[J]. Acta Ophthalmol Scand, 2003, 81(1): 72-75. DOI: 10.1034/j.1600-0420.2003.00026.x
13. Gaudric A, Mrejen S. Why the dots are black only in the late phase of the indocyanine green angiography in multiple evanescent white dot syndrome[J]. Retin Cases Brief Rep, 2017, 11 Suppl 1: S81-85. DOI: 10.1097/ICB.0000000000000422.
14. Iaccheri E, Fiore T, Androudi S, et al. Acute posterior multifocal placoid pigment epitheliopathy (APMPPE): final outcome and visual prognosis[J]. IOVS, 2004, 45: 2692-2697.
15. Singh AK, Sharma V. A rare case of unilateral acute idiopathic maculopathy in young male [J]. J Clin Diagn Res, 2017, 11(2): 3-4. DOI: 10.7860/JCDR/2017/24197.9443.