Ishihara Kenji, Hangai Masanori, Kita Mihori, Yoshimura Nagahisa
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin,Sakyo-ku, Kyoto, Japan.
Ophthalmology. 2009 Sep;116(9):1799-807. doi: 10.1016/j.ophtha.2009.04.002. Epub 2009 Jul 30.
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.
Retrospective, observational case series.
Twenty eyes of 10 consecutive patients diagnosed with acute VKH disease.
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.
Findings on enhanced SD-OCT imaging and FA in eyes with VKH disease.
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 microm). 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.
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.
在急性Vogt-小柳-原田（VKH）病患者的眼睛增强谱域光学相干断层扫描（SD-OCT）图像上展示独特的膜状结构。
回顾性观察病例系列。
连续10例诊断为急性VKH病患者的20只眼睛。
我们回顾了眼底照片、传统OCT图像、荧光素血管造影（FA）以及增强SD-OCT图像，包括通过黄斑的连续切片，这些图像在初次就诊时以及类固醇治疗后定期获取，直至浆液性视网膜脱离完全消退。
VKH病患者眼睛增强SD-OCT成像和FA的表现。
所有20只眼睛后极部均有多灶性浆液性视网膜脱离，在FA晚期表现为多叶状染料渗漏。20只眼睛中的17只（85%），部分染料渗漏区域在增强SD-OCT图像上对应囊样间隙，20只眼睛中的14只（70%），黄斑区存在染料渗漏区域和囊样间隙。囊样间隙底部由厚度均匀的膜状结构组成（14只眼睛黄斑区的平均厚度为62.5±3.3微米）。在SD-OCT上，膜状结构似乎包括一条高反射线，其与视网膜附着区域代表光感受器内、外节（IS/OS）交界处的线相连。在20只眼睛中的9只（45%），涉及黄斑的囊样间隙附近，视网膜内劈裂位于异常IS/OS线之上。在类固醇治疗过程中，膜状结构变为颗粒状结构。
在急性VKH病患者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离。我们推测外节的膜状形式与纤维蛋白等炎症产物的作用有关，并且随着类固醇治疗“溶解”将外节连接在一起的纤维蛋白，这种膜状结构会变为颗粒状结构。
作者对本文讨论的任何材料均无专利或商业利益。
