Acute Vogt-Koyanagi-Harada Disease in Enhanced Spectral-Domain Optical Coherence Tomography
Acute Vogt-Koyanagi-Harada Disease in Enhanced Spectral-Domain Optical Coherence Tomography
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DOI：
10.1016/j.ophtha.2009.04.002
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发表时间：
2009-09-01
期刊：
影响因子：
13.7
通讯作者：
Yoshimura, Nagahisa
中科院分区：
文献类型：
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作者：
Ishihara, Kenji;Hangai, Masanori;Yoshimura, Nagahisa
目的：探讨急性Vogt-Koyanagi-Harada （VKH）病眼增强光谱域光学相干断层扫描（SD-OCT）的独特膜结构。设计：回顾性观察性病例系列。参与者：连续10例诊断为急性VKH病的患者的20只眼睛。方法：我们回顾了眼底照片、常规OCT图像、荧光素血管造影（FA）和增强SD-OCT图像，包括首次就诊时和类固醇治疗后获得的通过黄斑的连续切片，直到浆液性视网膜脱离完全消退。主要观察指标：VKH病眼SD-OCT增强和FA的表现。结果：20只眼均出现后眼底多灶浆液性视网膜脱离，晚期FA表现为多小叶染色池。20只眼中有17只（85%）在增强的SD-OCT图像上有染料池的部分区域对应于囊样腔，20只眼中有14只（70%）在中央凹有染料池和囊样腔。囊腔底为均匀厚度的膜状结构（14只眼中央凹平均厚度62.5 +/- 3.3 μ m）。在SD-OCT上，膜状结构似乎包括一条高反射线，这条线与代表视网膜附着区域的光感受器内外段（IS/OS）连接线连续。在20只眼睛中，有9只（45%）在涉及中央凹的囊状间隙附近的异常IS/OS线上可见视网膜内分裂。在类固醇治疗过程中，膜状结构转变为颗粒状结构。结论：在急性VKH疾病的眼睛中可见的膜状结构似乎代表了外节层的一部分，该部分已被囊样间隙与内节层分开。我们假设外节段的膜状结构与炎症产物（如纤维蛋白）的作用相结合，并且当类固醇治疗“溶解”将外节段固定在一起的纤维蛋白时，这种膜状结构转变为颗粒状结构。财务披露：作者在本文中讨论的任何材料中没有专有或商业利益。这篇文章。眼科2009;116:1799-1807 (C) 2009由美国眼科学会批准。
Objective: To demonstrate unique membranous structures seen on enhanced spectral domain optical coherence tomography (SD-OCT) images of eyes with acute Vogt-Koyanagi-Harada (VKH) disease.Design: Retrospective, observational case series.Participants: Twenty eyes of 10 consecutive patients diagnosed with acute VKH disease.Methods: We reviewed fundus photographs, conventional OCT images, fluorescein angiograms (FA), and enhanced SD-OCT images, including serial sections through the macula, obtained at the initial visit and periodically after steroid treatment until complete resolution of serous retinal detachment.Main Outcome Measures: Findings on enhanced SD-OCT imaging and FA in eyes with VKH disease.Results: All 20 eyes had multifocal serous retinal detachment in the posterior fundus that appeared as multilobular dye pooling on late-phase FA. In 17 of the 20 eyes (85%), some areas of dye pooling corresponded to cystoid spaces on enhanced SD-OCT images and in 14 of the 20 (70%) eyes, there were areas of dye pooling and cystoid spaces in the fovea. The floors of the cystoid spaces consisted of a membranous structure of uniform thickness (mean thickness in the fovea of 14 eyes, 62.5 +/- 3.3 mu m). The membranous structure, on SD-OCT, seemed to include a highly reflective line, which was continuous with the line representing the junction of the photoreceptor inner and outer segments (IS/OS) in attached areas of the retina. Intraretinal split was seen to overlie the abnormal IS/OS line in the vicinity of cystoid spaces involving the fovea in 9 of the 20 eyes (45%). During the course of steroid therapy, the membranous structure changed to a granular structure.Conclusions: The membranous structure that can be seen in eyes with acute VKH disease seems to represent a portion of the outer segment layer that has become separated from the inner segment layer by cystoid spaces. We hypothesize that the membranous form of the outer segment is bound with the action of inflammatory products, such as fibrin, and this membranous structure changes to a granular structure as steroid therapy "dissolves" the fibrin holding the outer segments together.Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in. this article. Ophthalmology 2009;116:1799-1807 (C) 2009 by the American Academy of Ophthalmology.