急性期交感性眼炎的临床及多模影像学特征分析
Clinical and multimodal imaging features of sympathetic ophthalmia in acute stage
杨文慧 1刘媛媛 1杨丽坤 1陈松1
作者信息
- 1. 天津医科大学总医院眼科,天津 300052
- 折叠
摘要
目的 观察交感性眼炎(SO)急性期的临床表现及多模影像学特征.方法 回顾性病例系列研究.纳入天津医科大学总医院 2020 年 6 月至 2024 年 3 月首诊的 3 例SO急性期患者作为研究对象,其中男性 2 例,女性 1 例;平均年龄 65.7 岁,分析其临床特征和多模影像学资料,包括彩色眼底照相、荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)、B 超和光学相干断层扫描(OCT).随访 3 至 12 个月,观察治疗后效果及影像学特征变化.结果 三例患者首诊时均表现为后交感性眼炎(PSO).多模影像学的共同特征:B超示脉络膜弥漫性增厚;OCT示脉络膜增厚,脉络膜内管腔样结构模糊或消失;ICGA示不同程度的持续性、多灶性、低荧光斑点;FFA示视盘高荧光.多模影像学的其它表现:病例 2 的B超还显示渗出性视网膜和脉络膜脱离.病例 1 和 2 的OCT示增厚的脉络膜呈波浪样起伏;伴视网膜不同程度损害,椭圆体带不连续,其中病例 2 还伴有浆液性视网膜脱离、视杆体(锥体)层分离.病例 3 的视网膜色素上皮层下类圆形高反射病灶.病例 1 的FFA示早期散在低荧光斑点,晚期轻度荧光渗漏;病例 2 复发期示斑驳样透见荧光,病例 3 示散在斑点样透见荧光.三例患者经甲泼尼松龙联合硫唑嘌呤治疗后,B超显示视网膜及脉络膜脱离快速消退,脉络膜厚度逐渐降至正常;OCT示浆液性视网膜脱离快速消退,脉络膜厚度及管腔样结构逐渐恢复;椭圆体带恢复较慢,最终病例 2 遗留部分不可逆性椭圆体带损害,病例 3 的视网膜色素上皮下类圆形高反射病灶逐渐缩小.末次随访时 3 例患者眼内炎症均完全缓解,交感眼视力由首诊时的 0.15,手动/眼前和1.0 分别恢复至0.6,0.12 和1.0.结论 三例急性期SO患者临床表现均为PSO,多模影像呈现脉络膜弥漫性炎症性增厚及视网膜不同程度损害,经过及时治疗预后良好.
Abstract
Objective To observe the clinical manifestations and multimodal imaging features of sympathetic ophthalmia(SO)in acute stage.Methods This was a retrospective case series study.The clinical and imaging data of 3 cases with acute phase of SO who were first diagnosed in Tianjin Medical University General Hospital from Jun.2020 to Feb.2024 were collected.There were 2 males and 1 female,with an average age of 65.7 years.The clinical manifestations,multimodal imaging features combined with application of fundus photography,optical coherence tomography(OCT),B-mode ultrasound,fluoresein fundus angiography(FFA),indocyanine angiography(ICGA)in the 3 cases of acute phase of SO were analyzed.The follow-up period was 3 to 12 months,and the effect and changes of imaging characteristics were observed after treatment.Results All 3 patients presented with posterior sympathetic ophthalmia(PSO)at first presentation.Common features of multimodal imaging included diffuse choroidal thickening on B-mode ultrasound,thickening of the choroid and blurred or absent luminal structures of the physiologic vascular pattern in the choroid on OCT,and various degrees of persistent scattered spots with hypofluorescence at early,mid-and late phases on ICGA.The optic disc showed hyperfluorescence on FFA.Other features of multimodal imaging included exudative retinal and choroidal detachment on B-mode ultrasound in case 2.OCT in cases 1 and 2 showed undulating thickened choroid,varying degrees of retinal damage,such as serous retinal detachment and bacillary layer detachment,disruption of ellipsoidal zone in cases 1 and 2,and dome-shaped hyperreflective lesions below the retinal pigment epithelial in case 3.Early posterior multifocal hypoflurosencence spots and mild fluorescence leakage in late stage were observed on FFA in case 1,mottled fluorescence in the recurrent phase of case 2,and scattered translucent fluorescence spots in case 3.After treatment with methylprednisolone in combination with azathioprine,B-mode ultrasound showed rapid absorption of retinal and choroidal detachment,with gradual reduction of choroidal thickness to normal;OCT indicated rapid absorption of serous retinal detachment,gradual recovery of choroidal thickness and luminal structures,slow recovery of the ellipsoidal zone,residual irreversible ellipsoid zone damage in case 2,and gradual reduction of hyperreflective lesions below the retinal pigment epithelial in case 3.At the last follow-up,intraocular inflammation completely resolved in all three patients,and the visual acuity of the sympathetic eyes recovered from 0.15,hand motions and 1.0 at the first diagnosis to 0.6,0.12 and 1.0,respectively.Conclusion All 3 cases of acute phase of SO clinically present as PSO,with multimodal imaging showing diffuse choroidal inflammatory thickening and varying degrees of retinal damage.With timely treatment,the prognosis is good.
关键词
眼炎,交感性/荧光素血管造影术/体层摄影术,光学相干/多模式影像Key words
Ophthalmia,sympathetic/Fluorescein angiography/Tomography,optical coherence/Multimodal imaging引用本文复制引用
出版年
2024
NETL
NSTL
万方数据