Optical coherence tomography angiography for the diagnosis of granulomatosis with polyangiitis with serous retinal detachment: A case report.
Optical coherence tomography angiography for the diagnosis of granulomatosis with polyangiitis with serous retinal detachment: A case report.
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DOI：
10.1097/md.0000000000024789
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发表时间：
2021-02-19
期刊：
影响因子：
1.6
通讯作者：
Kaneko H
中科院分区：
文献类型：
--
作者：
Takashi N;Nakamura A;Kataoka K;Usui Y;Ito Y;Kaneko H
摘要肉芽肿病合并多血管炎（GPA）是一种罕见的系统性自身免疫性疾病，病因不明。GPA影响多个眼部组织，最常见的是眼眶、结膜、角膜和巩膜。视网膜和脉络膜的表现是罕见的GPA，但他们往往包括脉络膜新生血管（CNV）。一名36岁男子被诊断为GPA。他已经口服类固醇治疗8年了。他经历了疾病复发，在类固醇脉冲治疗后口服强的松龙的剂量增加。眼底检查显示小视网膜色素上皮脱离和浆液性视网膜脱离（SRD）。光学相干断层扫描（OCT）显示SRD内有一个突出的病变。荧光素血管造影（FA）显示SRD有小的点状荧光素渗漏，吲哚菁绿荧光素眼底血管造影显示脉络膜血管高通透性，与FA所见的高荧光一致。我们必须确定SRD内的突出病变是继发于GPA炎症的CNV，还是由大剂量类固醇治疗引起的中枢性浆液性脉络膜视网膜病变（CSC）样疾病。我们确认SRD是由于CSC而不是CNV，因为b扫描OCT血管造影（OCTA）检查的突出病变显示没有血流。我们决定减少类固醇的剂量。由于类固醇的减少，SRD的突出病变没有恶化的迹象。因此，我们提出了OCTA的这一先进功能在检查血流信号图像以检测CNV方面的有效性。
Granulomatosis with polyangiitis (GPA) is a rare systemic autoimmune disease of unknown etiology. GPA affects multiple ocular tissues, most commonly the orbit, conjunctiva, cornea, and sclera. Retinal and choroidal manifestations are rare in GPA, but they often include choroidal neovascularization (CNV). A 36-year-old man was diagnosed with GPA. He had been taking oral steroid treatment for 8 years. He experienced disease recurrence and the dose of oral prednisolone was increased after steroid pulse therapy. Fundus examination showed small retinal pigment epithelial detachment and serous retinal detachment (SRD). Optical coherence tomography (OCT) revealed a protruded lesion inside the SRD. Fluorescein angiography (FA) showed a small, dot-shaped fluorescein leakage in the SRD, and indocyanine green fluorescein fundus angiography showed choroidal vascular hyperpermeability that was consistent with the hyperfluorescence seen with FA. We had to determine whether the protruded lesion inside the SRD was CNV secondary to the inflammation due to GPA or whether it was central serous chorioretinopathy (CSC)-like condition caused by high-dose steroid treatment. We confirmed that the SRD was due to CSC but not CNV because the protruded lesion examined by B-scan OCT angiography (OCTA) showed no blood flow. We decided to reduce the dose of steroid. Since the reduction of steroids, no sign of worsening in the protruded lesions with SRD has been observed. We therefore propose the effectiveness of this advanced function of OCTA for the examination of blood flow signal images to detect CNV.