南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (1): 135-140.doi: 10.12122/j.issn.1673-4254.2021.01.20

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自发荧光联合频域光学相干断层扫描在急性 Vogt-Koyanagi-Harada综合征诊断及预后随诊中的作用

田澍蔚，姚 静，王建明，张 洁，周爱意
  

  • 出版日期:2021-01-26 发布日期:2021-01-26

Autofluorescence combined with spectral domain optical coherence tomography for diagnosis and follow-up of acute Vogt-Koyanagi-Harada disease

  • Online:2021-01-26 Published:2021-01-26

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摘要：

目的 深入探讨眼底自发荧光联合频域光学相干断层扫描在急性Vogt-Koyanagi-Harada综合征（VKH）预后评估和随诊观察中的作用。方法 收集我院2018年5月~2019年11月间12例（23只眼）急性VKH病例，包括详细的病史、最佳矫正视力、裂隙灯、眼底照相、SD-OCT、眼底荧光造影和眼底自发荧光（FAF）等检查，并于治疗一段时间和/或出院后随诊再次行SD-OCT及FAF检查，与入院时进行对比分析。结果 11例患者为双眼发病（91.67%）。眼底检查见视盘水肿16只眼（69.57%）。同时SD-OCT示多处视网膜神经上皮脱离，积液明显（100%）。所有患眼FFA造影早期可见多发性细小点状荧光素渗漏，晚期视网膜下大量荧光渗漏，出现特征性的多囊状的荧光素积存。FAF见高自发荧光区域（100%），范围与FFA荧光积存范围一致。10眼见高自发荧光区域内有片状相对低荧光（43.48%）。4眼高自发荧光区域有“颗粒样”高荧光（17.39%）。VKH恢复期FAF检查见自发荧光分布恢复至正常状态（34.78%）, 或者高自发荧光的强度减低范围缩小（39.13%）（平均面积减小了55.2%，相对荧光强度减低了46.52%）。6只眼病变范围仅剩一些点状高自发荧光颗粒散在分布（26.09%）。SD-OCT视网膜下积液明显减少甚至消失（相对入院时积液量平均减少69.5%）。并且FAF荧光强度与SD-OCT中视网膜下积液呈正相关（r=0.626，P<0.05）。结论 眼底荧光造影、眼底自发荧光成像联合SD-OCT可以提高VKH诊断准确率。FAF、SD-OCT等非侵入性检查可以作为判断恢复及病情监测的检查手段。

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Abstract:

Objective To evaluate the value of fundus autofluorescence (FAF) imaging combined with spectral domain optical coherence tomography (SD-OCT) in diagnosis, prognostic assessment and follow-up observation of acute Vogt-Koyanagi-Harada (VKH) disease. Methods Clinical data were collected from 12 patients (23 eyes) with acute VKH disease treated in our hospital from May, 2018 to November, 2019, including detailed medical history, best corrected visual acuity (BCVA), and results of slit lamp biomicroscopy, fundus photography, SD-OCT, fundus fluorescein angiography (FFA) and FAF imaging. SD-OCT and FAF imaging were repeated after a course of treatment and in follow-up examination, and the results were compared with those at the time of admission. Results VKH disease involved both eyes in 11 patients (91.7% ). Fundus photography showed optic disc edema in 16 eyes (69.6%), and multiple retinal neuroepithelial detachment was detected by SD-OCT in all the involved eyes (100%). IN all the eyes, FFA revealed small and dense fluorescein leakage in the early stage and fluorescein accumulation in advanced stages of VHK disease to form multiple dye pooling in the areas of serous detachment. Hyperauto flfl uorescence was a common finding in FAF imaging (100% ), and the area involved was consistent with that of fluorescein accumulation shown by FAF imaging. Ten eyes (43.5% ) showed patches of relative hypoauto flfl uorescence in the hyperauto flfl uorescence areas, and granular hyperauto flfl uorescence was found in the lesions in 4 eyes (17.4% ). During the remission period of VKH disease, FAF imaging showed normal finding in 8 eyes (34.8%) and reduced areas (by 55.2%) and intensity (by 46.5% ) of hyperautoflfluorescence in 9 eyes (39.1% ). In 6 eyes (26.1% ), only a few hyperautoflfluorescent spots scattered in the macula were observed. SD-OCT demonstrated significantly reduced (by 69.5% on average) or even disappearance of subretinal fluid in the eyes. The fluorescence intensity in FAF imaging showed a significant positive correlation with the volume of subretinal fluid detected by SD-OCT (r=0.626, P<0.05). Conclusion The combination of fluorescein angiography, FAF imaging and SD-OCT can significantly improve the diagnostic accuracy of VKH disease. FAF imaging combined with SD-OCT provides an effective and noninvasive modality for evaluation of remission and monitoring the changes in VKH disease.

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