本文選題：超廣角眼底熒光血管造影(UWFFA) + 光學相干斷層掃描(OCT)　； 參考：《河北醫(yī)科大學》2016年碩士論文

【摘要】：目的:對Vogt-小柳-原田綜合征(Vogt-Koyanagi-Harada syndrome,VKH)患者進行超廣角眼底熒光素血管造影(ultra wide-field fundus fluorescein angiography,UWFFA)檢查,觀察VKH患眼周邊眼底影像特征,測量UWFFA圖像7-9min的患眼周邊血管滲漏面積,分析其與最佳矯正視力(best correct visual acuity,BCVA),眼壓(intra ocular pressure,IOP),復發(fā)性,活動期,前節(jié)反應,后極部滲漏面積,周邊血管滲漏圈至中心凹的距離(圈凹距),周邊血管滲漏圈至視盤的距離(圈盤距),盤周萎縮弧(peripapillary atrophy,PPA),中心凹視網(wǎng)膜厚度(central retinal thickness,CRT)之間的關系和差異性,評價VKH患眼周邊血管滲漏在VKH疾病診斷、進展、治療和預后中的意義,以期對臨床工作有所指導。方法:1收集2014.2-2016.2于河北醫(yī)科大學第二醫(yī)院眼科門診確診為VKH的患者。符合條件的總計13例26只眼納入研究。分別進行人口統(tǒng)計學數(shù)據(jù)收集和臨床檢查,包括年齡、性別、發(fā)病時間、全身常規(guī)檢查、BCVA、IOP、裂隙燈、眼前節(jié)照相、眼底照相、UWFFA及光學相干斷層掃描(optical coherence tomography,OCT)等,隨訪期均為8個月,對首診治療前、治療后3個月、治療后6-8個月時的上述檢查結(jié)果進行觀察和數(shù)據(jù)統(tǒng)計分析。2在以上13例患者中,根據(jù)首診治療前UWFFA圖像周邊血管滲漏的有無分為兩組。2.1有周邊血管滲漏組(M組:14只眼):UWFFA圖像有周邊血管滲漏,表現(xiàn)為造影過程中染料滲漏,血管壁著染,周邊眼底斑片狀強熒光。2.2無周邊血管滲漏組(N組:12只眼):UWFFA圖像無周邊血管滲漏。所有患眼均直接給予玻璃體腔內(nèi)注射曲安奈德(triamcinolone acetonide,TA)4mg,治療后復發(fā)者,給予全身糖皮質(zhì)激素治療:注射用甲潑尼龍琥珀酸鈉500mg/日,3日。隨后根據(jù)療效逐漸減量為口服強的松片(1mg/kg·d),直至減為隔日晨服一片后根據(jù)病情停藥,治療時間至少維持6個月。結(jié)果:13例患者中出現(xiàn)周邊血管滲漏的7例(53.85%),平均周邊血管滲漏面積10957.00±27199.75pixels。VKH急性初發(fā),首診治療前UWFFA圖像即有周邊血管滲漏的患眼在治療過程中更易復發(fā),治療難度更大;更易出現(xiàn)較長的活動期,若以30天為界,則更易大于30天;更易發(fā)生持續(xù)的前節(jié)反應;在6-8個月時UWFFA圖像更易有周邊血管滲漏且滲漏面積大于首診治療前的滲漏面積;在6-8個月時眼底照相更易有PPA,預后較差,以上特征均具有統(tǒng)計學意義(P㩳0.05);首診治療前UWFFA圖像周邊血管滲漏對比首診治療前CRT和后極部滲漏面積,6-8個月時BCVA和IOP無顯著差異;周邊血管滲漏面積和后極部滲漏面積無顯著關系,以上均不具有統(tǒng)計學意義(P"g0.05)。首診治療前CRT和后極部滲漏面積有關,且隨著后極部滲漏面積增大,CRT相應增高,此特征具有統(tǒng)計學意義(P㩳0.05);CRT和周邊血管滲漏面積無顯著關系,不具有統(tǒng)計學意義(P"g0.05)。同期圈盤距大于圈凹距,且兩者之間具有顯著關系,隨著圈凹距增大,圈盤距相應增大,此特征具有統(tǒng)計學意義(P㩳0.05);首診治療前和6-8個月時的圈凹距無顯著差異,不具有統(tǒng)計學意義(P"g0.05)�；顒悠邺e30天較"f30天的患眼更易出現(xiàn)前節(jié)反應,此特征具有統(tǒng)計學意義(P㩳0.05);同期有無周邊血管滲漏的患眼并沒有表現(xiàn)出前節(jié)反應的顯著差異,不具有統(tǒng)計學意義(P"g0.05)。結(jié)論:1 UWFFA較傳統(tǒng)FFA觀察眼底范圍更大,有利于發(fā)現(xiàn)傳統(tǒng)FFA不能觀察到的VKH周邊眼底病變。2 VKH急性初發(fā)時的周邊血管滲漏對復發(fā)性、治療難度、活動期、前節(jié)反應、隨訪期間周邊血管滲漏持續(xù)存在、PPA和預后等臨床特征有影響,對CRT、后極部滲漏面積、BCVA和IOP無影響。3 VKH急性初發(fā)時的后極部滲漏面積越大,CRT越高,周邊血管滲漏面積對CRT無影響。4同期圈盤距大于圈凹距,且圈凹距越大,圈盤距越大。5活動期㧐30天較"f30天的患眼更易出現(xiàn)前節(jié)反應。
[Abstract]:Objective: to examine the Vogt- wide-field fundus fluorescein angiography (UWFFA) angiography (ultra wide-field fundus fluorescein angiography, UWFFA) for patients with Vogt-Koyanagi-Harada syndrome (VKH), to observe the imaging features of the periophthalmic fundus surrounding the VKH eye, and to measure the area of the peripheral vascular leakage of the affected eyes. Corrected visual acuity (best correct visual acuity, BCVA), intraocular pressure (intra ocular pressure, IOP), recurrent, active, anterior segment reaction, posterior pole leakage area, distance from peripheral vascular leaking to recess (circle concave distance), circumference of percolation circle to disc distance (circle disc distance), circumference atrophy arc (peripapillary atrophy, PPA), central concave network The relationship and difference between central retinal thickness (CRT) and the significance of VKH peripheral vascular leakage in the diagnosis, progression, treatment and prognosis of VKH disease in order to guide the clinical work. Method: 1 collect 2014.2-2016.2 at the ophthalmology outpatient department of the second hospital of Hebei Medical University. A total of 13 cases of 26 eyes were included in the study. Demographic data collection and clinical examination were carried out, including age, sex, onset time, general routine examination, BCVA, IOP, slit lamp, anterior segment photography, fundus photography, UWFFA and optical coherence tomography (optical coherence tomography, OCT) and so on. The follow-up period was 8 months, before the first treatment, 3 months after treatment, the results of the above examination at 6-8 months after treatment were observed and statistical analysis of.2 in the above 13 patients, according to whether there were two groups of peripheral vascular leakage group (group M: 14 eyes) in the peripheral vascular leakage group (group M: 14 eyes) in the peripheral vascular leakage of the peripheral blood vessels before the first diagnosis. The UWFFA map resembles peripheral vascular leakage, showing the dyestuff infiltration during the contrast process. Leakage, vascular wall staining, peripheral fundus plaque like strong fluorescein.2.2 without peripheral vascular leakage group (group N: 12 eyes): no peripheral vascular leakage in UWFFA image. All eyes were given Cu Ann Ned (triamcinolone acetonide, TA) 4mg in all eyes directly. After treatment, the patients were treated with systemic glucocorticoid treatment: injection of methylprednisolone Amber Sodium acid 500mg/ day, 3 days. Then according to the curative effect gradually reduced to oral prednisone tablets (1mg/kg d), until after the day morning after the morning clothes to stop medicine, treatment time for at least 6 months. Results: 13 cases of peripheral vascular leakage of 7 cases (53.85%), the average peripheral vascular leakage area of 10957 + 27199.75pixels.VKH acute initial hair Before the first diagnosis, the UWFFA image, that is, the percolation of peripheral blood vessels, is more prone to relapse in the treatment process. The treatment is more difficult to treat; it is easier to have a longer period of activity. If it is 30 days as the boundary, it is more likely to be more than 30 days; it is easier to have a continuous anterior segment reaction; in the 6-8 month, the UWFFA image is more likely to have peripheral vascular leakage and the leakage area is greater than the first diagnosis and treatment. The preoperative leakage area; the fundus photography was more likely to have PPA at 6-8 months. The prognosis was poor and the above features were statistically significant (P? 0.05). The leakage of peripheral blood vessels around UWFFA images before first diagnosis was compared with the leakage area of CRT and the posterior pole before the first diagnosis, and there was no significant difference between BCVA and IOP at 6-8 months; peripheral vascular leakage area and the leakage area of the posterior pole. There was no statistical significance (P "g0.05). The leakage area of CRT and the posterior pole was related before the first treatment, and with the increase of the leakage area of the posterior pole, the CRT increased correspondingly. This characteristic was statistically significant (P? 0.05); CRT had no significant relationship with the peripheral vascular leakage area, and did not have statistical significance (P" g0.05). The distance of the disc was large at the same time. There is a significant relationship between the circle concave distance and the difference between the two. With the increase of the pitch distance and the increase of the distance of the disc, this feature has statistical significance (P? 0.05); there is no significant difference between the recess distance of the first diagnosis and 6-8 months. There is no statistical significance (P "g0.05). The activity period is 30 days more than that of the F30 day. Study significance (P? 0.05); there was no significant difference in the anterior segment response without peripheral vascular leakage in the same period, and did not have statistical significance (P "g0.05). Conclusion: 1 UWFFA is larger than the traditional FFA observation, which is beneficial to the detection of peripheral vascular leakage of.2 VKH acute early onset of.2, which is not observed by the traditional FFA. Recurrence, treatment difficulty, activity period, anterior segment reaction, peripheral vascular leakage persisted during follow-up, PPA and prognosis and other clinical characteristics, CRT, the posterior pole leakage area, BCVA and IOP without affecting the.3 VKH acute early hair leakage area of the greater, the higher the CRT, the peripheral vascular leakage area of CRT does not affect the.4 synchronization disc distance greater than.4 greater than the CRT. The greater the pitch, the larger the pitch, the greater the.5 interval. The 30 day is more prone to the anterior segment reaction than the F30 eye.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R773.9

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1 宗巖;超廣角眼底熒光血管造影評估Vogt-小柳—原田綜合征患眼周邊血管滲漏的意義[D];河北醫(yī)科大學;2016年

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