局限性脉络膜凹陷15例临床观察

doi:10.6040/j.issn.1673-3770.0.2019.154

摘要/Abstract

摘要： 目的观察局限性脉络膜凹陷的临床特点及频域相干光断层扫描(SD-OCT)特征。方法回顾性分析经SD-OCT确诊的局限性脉络膜凹陷15例(18眼)患者的临床资料,所有患者均行矫正视力、裂隙灯显微镜、检眼镜及SD-OCT扫描,部分患者行眼底彩色照像、眼底血管荧光造影、吲哚青绿血管造影检查。结果 15例患者中男9例,女6例,平均为(36.93±8.43)岁,平均屈光度(-1.54±1.83)D,患眼矫正视力0.78±0.23,双眼3例6眼,单眼12例12眼, 眼底表现为大致正常或不同程度脱色素。2例合并中心性浆液性脉络膜视网膜病变,1例合并特发性黄斑脉络膜新生血管。SD-OCT表现为黄斑中心凹或附近视网膜色素上皮层(RPE)反光带层、光感受器外节/RPE复合体、光感受器内外节连接层、外界膜向脉络膜层凹陷,凹陷处脉络膜变薄,伴有不同程度的RPE层、光感受器内外节连接层反射减弱。紧密型16眼,分离型2眼;12眼位于中心凹下,6眼位于中心凹旁。结论局限性脉络膜凹陷单眼发生及紧密型多见,多伴有轻中度近视,可以合并多种黄斑病变;SD-OCT可以清晰、完整地揭示局限性脉络膜凹陷的形态及组织层次变化,是诊断的金标准。

关键词: 相干光断层扫描, 脉络膜凹陷, 脉络膜疾病

Abstract: Objective To observe the clinical characteristics and spectral-domain optical coherence tomography(SD-OCT)findings of focal choroidal excavation(FCE). Methods A retrospective observation case series were examined. The medical records of 18 eyes from 15 patients with FCE who had undergone SD-OCT were reviewed. All patients had their best-corrected visual acuity(BCVA)reviewed, a slit-lamp biomicroscopy, direct ophthalmoscopy, and an SD-OCT. Additionally, color photography, a fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA)were performed in some cases. Results The 15 patients included 9 males and 6 females with an average age of 36.93±8.43 years old. Patients refraction ranged from(-1.54±1.83)D, with a BCVA of 0.78±0.23.3 pations(6 eyes)and bilateral involvement. Twelve pations in 12 eyes were affected unilaterally. Varying, average degrees of foveal pigmentary alterations were generally seen during clinical examinations and color photography. The SD-OCTs showed that the retinal pigment epithelium(RPE)layer, the outer photoreceptor segment, the pigment junction layer, the photoreceptor inner segment, and outer segment junction layer, as well as the external limiting membrane, were involved in the excavation. The photoreceptor inner and outer segment junction layer and the RPE layer were accompanied by differing degrees of reflection attenuation. Their position was under and beside the macular fovea. The FCE can be classified as compact in which there is no separation between the photoreceptors and the RPE in the depression or detached in which there is separation between the photoreceptors and the RPE in the depression. Sixteen cases were classified as compact, and 2 cases as detached. The SD-OCTs showed that the FCE was located in the subfoveal of 12 eyes. In the other 6 eyes the FCE was seen to be eccentric. The FCE was complicated with central serous chorioretinopathy in 2 cases and idiopathic choroidal neovascularization in 1 case. Conclusion The FCE was generally classified as conforming with mild and moderate myopia found in a single eye. The FCE was complicated with maculopathy. The SD-OCT reveals the morphological and histological changes of the FCE. From these results, focal choroidal excavation using SD-OCT can be widely recommended.

Key words: Optical coherence tomography, Focal choroidal excavation, Choroid diseases

中图分类号:

R773.4

赵娟,周历,司艳芳,毕晓达,张琳. 局限性脉络膜凹陷15例临床观察[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 85-88.

ZHAO Juan, ZHOU Li, SI Yanfang, BI Xiaoda, ZHANG Lin. Clinical characteristics and spectral-domain optical coherence tomography findings of 15 focal choroidal excavation cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 85-88.

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