【摘要】：目的探討急性區(qū)域性隱匿性外層視網(wǎng)膜病變(AZOOR)的臨床表現(xiàn)、診斷和鑒別診斷特點。方法經(jīng)我院臨床檢查確診為AZOOR的病例15例(15只眼)納入研究。所有患者均接受了最佳矯正視力(BCVA)、裂隙燈顯微鏡、檢眼鏡、眼底彩色照相、視野、視網(wǎng)膜電圖(ERG)、眼底自發(fā)熒光照相(FAF)、眼底熒光血管造影(FFA)、吲哚青綠血管造影(ICGA)及光學相干斷層掃描(OCT)檢查,觀察他們的臨床特征。隨訪3個月~2年,觀察他們的預(yù)后及轉(zhuǎn)歸。收集患者的所有資料,進行總結(jié)分析。結(jié)果 15例均為單眼發(fā)病。所有患者均為近視眼。就診時主訴視物模糊12例,其中伴閃光幻覺5例、伴視物變色3例;眼前暗點或黑影遮擋3例。眼底無明顯改變者10只眼(占66.67%),黃斑區(qū)有小片狀陳舊性脈絡(luò)膜視網(wǎng)膜萎縮灶分布者2只眼(占13.33%),黃斑區(qū)色素紊亂者3只眼(占20%)。11只眼表現(xiàn)為中心暗點或旁中心暗點,占73.33%;4只眼表現(xiàn)為生理盲點明顯擴大累及中心凹旁,占26.67%。視網(wǎng)膜電圖(ERG)檢查均表現(xiàn)為所有患眼均表現(xiàn)為桿體反應(yīng)、最大反應(yīng)、椎體反應(yīng)、閃爍反應(yīng)中a、b波幅值不同程度下降。5只眼行P-VEP檢查顯示P100波峰幅值不同程度下降。FD-OCT檢查所有患眼的眼底后極部光感受器內(nèi)外節(jié)連接(IS/OS)反光帶紊亂,變薄或局部缺失,這些異常改變與視野缺損區(qū)相對應(yīng);在FAF、FFA、ICGA檢查中無明顯異常改變。隨訪3月~2年,15只眼的BCVA及視野缺損均得到不同程度的改善,OCT檢查也顯示IS/OS層反光帶逐漸恢復(fù),其中有8只眼(占53.33%)的BCVA恢復(fù)到發(fā)病前水平,5只眼的視野及OCT檢查完全恢復(fù)正常(占33.33%)。結(jié)論 AZOOR以青年女性、近視眼發(fā)病為多見;早期眼底無明顯改變。視野、電生理及OCT檢查均有異常改變,對診斷有臨床意義。但是AZOOR的診斷需要綜合其臨床特點、視野、電生理及OCT檢查,逐一排除其他疾病才能確診。OCT檢查由于能夠動態(tài)監(jiān)測IS/OS層的改變狀況,而且方便、經(jīng)濟、直觀、無創(chuàng),還非常適合于隨訪。FAF、FFA、ICGA對其診斷無明顯幫助,但在鑒別診斷中也有重要價值。
[Abstract]:Objective to investigate the clinical features, diagnosis and differential diagnosis of acute regional occult outer retinopathy (AZOOR). Methods Fifteen cases (15 eyes) with AZOOR confirmed by clinical examination in our hospital were included in the study. All patients received best corrected visual acuity (BCVA),) slit lamp microscope, ophthalmoscope, fundus color photography, visual field, (ERG), fundus autofluorescence radiography (FAF), fundus fluorescence angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were used to observe their clinical features. They were followed up for 3 months to 2 years to observe their prognosis and prognosis. Collect all the data of the patients and summarize and analyze them. Results all 15 cases were monocular. All patients were myopia. There were 12 cases of blurred vision, including 5 cases with flash hallucination, 3 cases with discoloration of vision, 3 cases with anterior dark spot or dark shadow occlusion. 10 eyes (66.67%) had no obvious change in fundus, 2 eyes (13.33%) had small old choroidal and retinal atrophy foci in macular area, 3 eyes (20%) had pigment disorder in macular area, 11 eyes showed central dark spot or paracentric dark spot. In 73.33 eyes, the physiological blind spots were obviously enlarged and involved the paraventric fossa, accounting for 26.67%. Electroretinogram (ERG) showed that all the affected eyes showed rod body reaction, maximum reaction and vertebral body reaction. In the flicker reaction, the amplitude of aqb wave decreased in varying degrees. P-VEP examination showed that the peak amplitude of P100 wave decreased in different degrees in 5 eyes. All eyes were examined by FD-OCT. The reflex band of the posterior pole photoreceptor (IS/OS) of all the affected eyes was disordered, thinned or partially absent. These abnormal changes corresponded to the area of visual field defect, and there were no obvious abnormal changes in FAF,FFA,ICGA. From 3 months to 2 years follow-up, BCVA and visual field defect of 15 eyes were improved to some extent, and OCT examination also showed that the reflective zone of IS/OS layer gradually recovered. Among them, 8 eyes (53.33%) had recovered to the level before onset of BCVA, 5 eyes (33.33%) had normal visual field and OCT examination. Conclusion AZOOR is more common in young women and myopia, but there is no obvious change in the fundus in early stage. There were abnormal changes in visual field, electrophysiology and OCT examination, which had clinical significance for diagnosis. However, the diagnosis of AZOOR needs to synthesize its clinical characteristics, visual field, electrophysiology and OCT examination, one by one to exclude other diseases. OCT examination can dynamically monitor the changes of IS/OS layer, and it is convenient, economical, intuitive and non-invasive. FAF,FFA,ICGA is not helpful in diagnosis, but it has important value in differential diagnosis.
【作者單位】： 河北省眼科醫(yī)院;
【分類號】：R774.1

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