摘要
目的 探讨急性梅毒性后极部鳞样脉络膜视网膜炎（ASPPC）的临床表现及影像学特征.方法 回顾性系列病例研究.收集2011年至2016年就诊于北京同仁眼科中心的10例急性梅毒性后极部鳞样脉络膜视网膜炎的患者,其中男性6例（10只眼）,女性4例（8只眼）,年龄（43.4＆#177;11.6）岁,总结其临床表现及OCT、自发荧光、FFA、ICGA检查结果.结果 10例ASPPC患者最多因出现视力下降（8/10）而就诊,以双眼发病为主（8/10）.患眼初始视力介于指数到0.8,平均视力0.3（中位数）.眼压正常.仅1例患者出现轻度前房炎性反应.眼底病变均集中在以黄斑为中心的后极部,表现为：6只眼（6/18）为鳞样病灶型、4只眼（4/18）为弥漫黄白病灶型、7只眼（7/18）为混合型（二者均有）.OCT示病变主要累及外层视网膜,最显著特征是：椭圆体层部分或全部消失、结构紊乱或不清;RPE结节;玻璃体内细胞.此外,可见黄斑中心小凹下部分神经上皮脱离,脱离处细沙样高反射点状物.自发荧光、FFA、ICGA检查显示病变范围与形态均与眼底表现基本一致.自发造影表现为斑片状或弥漫高荧光区.自发荧光检查结果示病灶边界欠清;病变区静脉期后期开始轻度高荧光,随着时间荧光进行性增强,晚期渗漏;5只眼（5/12）病灶区的血管出现晚期管壁着染.ICGA示病变区中晚期低荧光,其内夹杂针尖状高及更低荧光点.结论 ASPPC患者表现为急性双眼显著视力下降,而眼底改变轻.ASPPC影像学特征为眼底像、FA、ICG、自发荧光检查基本一致的病变范围以及OCT所示的椭圆体层的破坏、RPE层结节、玻璃体内细胞.以上临床和影像学表现属于一种特征性的眼梅毒,对于其鉴别诊断十分重要.
Objective To investigate the clinical manifestations and imaging characteristics of acute syphilitic posterior placoid chorioretinitis （ASPPC）. Methods Retrospective study of 10 patients diagnosed ASPPC in the Department of Ophthalmology,Beijing Tongren Hospital from 2011 to 2016, including 6 males （10 eyes involved） and 4 females （8 eyes involved） with an age of （43.4 ＆#177; 11.6）years （range, 26-60 years）. Their clinical manifestations and imaging characteristics were summarized. Results All 10 ASPPC patients complained about the reduction of visual acuity, and the majority of them had both eyes involved. The initial visual acuity ranged from finger count to 0.8, with an average of 0.4 and a median visual acuity of 0.3. The intraocular pressure was in the normal range. The inflammation of anterior chamber occurred in only one patient （1/10）. The lesions were located at the posterior pole as shown on fundus photographs. There are six placoid lesions, four yellowish massive lesions and seven mixed lesions（placoid and yellowish massive lesions）. Partial or whole disappearance, abnormality and opacity of the ellipsoidlayer, retinal pigment epithelial （RPE） nodules, and cells in the vitreous body were observed by optical coherence tomography. There were partial detachment between the neuronal retina and RPE layer with fine-sand like hypereflective dots. The lesion size and morphology on autofluorescence （AF）, fundus fluorescence angiography （FFA） and indocyanine green angiography （ICG） were almost consistent with those on fundus photography. The lesions were hyperautofluorescent in a placoid or massive shape. The lesions on FFA showed slight hyperfluorescence with unclear edges from the venous phase, and the fluorescence increased with the time and leaked in the late phase. Vascular walls showed blood staining in the late phase. The lesions on ICG showed hypofluorescence with hyperfluorescence and hypofluorescence dots like fine needles in the middle and late phases. Conclusion ASPPC mainly occurs among the young adults without gender difference. The characteristic is the contradiction between sever clinical symptoms and slight signs on the fundus. The lesion area shown on fundus photography, FFA, ICG and AF is consistent, as well as injuries of the ellipsoid layer, RPE nodules and cells in the vitreous body. The above manifestations and imaging characteristics of ASPPC are significant for the diagnosis and differential diagnosis.
出处
《中华眼科杂志》
CSCD
北大核心
2017年第5期352-357,共6页
Chinese Journal of Ophthalmology
基金
北京市眼科研究所重点学科引领计划（201503）
