EN FACE OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF MULTIPLE EVANESCENT WHITE DOT SYNDROME New Insights Into Pathogenesis
EN FACE OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF MULTIPLE EVANESCENT WHITE DOT SYNDROME New Insights Into Pathogenesis
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DOI：
10.1097/iae.0000000000001255
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发表时间：
2016-12-01
影响因子：
3.3
通讯作者：
Sarraf, David
中科院分区：
文献类型：
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作者：
Pichi, Francesco;Srvivastava, Sunil K.;Sarraf, David
目的：通过比较“面”光学相干断层扫描（OCT）和OCT血管造影与各种常规成像方式对多发性消失性白点综合征不同程度异常的定位。方法：在回顾性病例系列中，对36例多发性消失性白点综合征患者在9个视网膜中心进行多模态成像，包括广角眼底自身荧光（FAF）、荧光素血管造影（FA）和吲吲吲胺绿血管造影，以及b扫描和“en face”c扫描增强深度成像和光谱域oct，并在视网膜浅、深毛细血管丛和脉络膜水平进行光学相干断层血管造影。结果：FA和FAF对多发性消失性白点综合征病变的检出率更高，检出率更高。FAF、FA和吲哚菁绿血管造影发现了两种病变类型：较大的广泛分散的“斑点”（直径约200 μ）， FA高荧光，FAF高自荧光，吲哚菁绿血管造影低反射，主要代表视网膜色素上皮/光感受器交界处的异常；和点状“点”（直径小于100 m）， FA高荧光、FAF高自荧光或等自荧光，吲哚菁绿血管造影低荧光，定位于外核层。这些病变与“en face”oct共定位。较大的融合“斑点”低反射，共定位于椭球区水平，而较小的高反射“斑点”共定位于外核层。结构光谱域光学相干层析成像进一步证实了“点”在外核层的位置，在某些情况下，这些点聚集成从外限制膜延伸到外丛状层的超反射线。光学相干断层扫描血管造影分析的视网膜微血管和绒毛膜毛细血管和脉络膜完全不显著在我们的100%的患者。结论：结合多模态成像，作者提出多发性消失性白点综合征主要是由外部光感受器水平的炎症导致“光感受器炎”，导致内外节段的损失。其易逝性表明，在大多数情况下，光感受器细胞体保持完整，确保光感受器内外段完全恢复，与白斑和白点自发消退的临床过程相一致。
Purpose: To localize the various levels of abnormalities in multiple evanescent white dot syndrome by comparing "en face" optical coherence tomography (OCT) and OCT angiography with various conventional imaging modalities.Methods: In this retrospective case series, multimodal imaging was performed in 9 retinal centers on 36 patients with multiple evanescent white dot syndrome and included widefield fundus autofluorescence (FAF), fluorescein angiography (FA), and indocyanine green angiography, and B-scan and "en face" C-scan enhanced depth imaging and spectral domain OCT. Optical coherence tomography angiography was also performed at the level of the superficial and deep retinal capillary plexus and choroid.Results: Multiple evanescent white dot syndrome lesions were more numerous and more easily detectable with FA and FAF. Two types of lesions were identified with FAF, FA, and indocyanine green angiography: larger widely scattered "spots" (approximately 200 mu in diameter) that were hyperfluorescent with FA, hyperautofluorescent with FAF, and hyporeflective in indocyanine green angiography, representing abnormalities primarily at the retinal pigment epithelium/photoreceptor junction; and punctate "dots" (less than 100 m in diameter) that were hyperfluorescent with FA, hyperautofluorescent, or isoautofluorescent with FAF, and hypofluorescent with indocyanine green angiography and that localized to the outer nuclear layer. These lesions colocalized with "en face" OCT. The larger confluent "spots" were hyporeflective and colocalized to the level of the ellipsoid zone, whereas smaller hyperreflective "dots" colocalized to the outer nuclear layer. The location of the "dots" in the outer nuclear layer was further confirmed by structural spectral domain optical coherence tomography which showed coalescence of the dots into hyperreflective lines extending from the external limiting membrane to the outer plexiform layer in certain cases. Optical coherence tomography angiography analysis of the retinal microvasculature and choriocapillaris and choroid were entirely unremarkable in 100% of our patients.Conclusion: By combining multimodal imaging, the authors propose that multiple evanescent white dot syndrome is primarily the result of inflammation at the outer photoreceptor level leading to a "photoreceptoritis" and causing loss of the inner and outer segments. Its evanescent nature suggests that the photoreceptor cell bodies remain intact ensuring complete recovery of the photoreceptor inner and outer segments in most cases, compatible with the clinical course of spontaneous resolution of white spots and dots.