Department of Ophthalmology, Saint-Roch University Hospital, Nice, France.
Retina. 2011 Jun;31(6):1156-63. doi: 10.1097/IAE.0b013e3181fbcea5.
To determine the specific location of the initial lesion in acute retinal pigment epitheliitis.
Four patients diagnosed with acute retinal pigment epitheliitis were studied. Fundus photographs, fluorescein angiography and indocyanine green angiography, and spectral-domain optical coherence tomography findings were reviewed.
Four healthy young patients presented with acute onset of unilateral decreased vision. Ophthalmoscopy showed macular pigment mottling with surrounding yellow hypopigmented areas at the level of the retinal pigment epithelium (RPE). Fluorescein angiography revealed transmission hyperfluorescence. Early-phase and midphase indocyanine green angiography images showed a patchy macular hyperfluorescence. At late phase of indocyanine green angiography, a hyperfluorescent halo with a cockadelike appearance of the macular area was observed. Spectral-domain optical coherence tomography showed a disruption of the photoreceptors' inner segment and outer segment interface associated with a wider disruption of the RPE inner band. These disrupted lines were replaced by a dome-shaped highly reflective lesion involving the RPE inner layer, the photoreceptors' inner segment and outer segment layers, and, in two cases, the outer nuclear layer. With time, indocyanine green angiography showed resolution of the observed lesions. Spectral-domain optical coherence tomography showed restored and continuous inner segment and outer segment layers and RPE inner band.
Spectral-domain optical coherence tomography findings suggest that the initial lesion in acute retinal pigment epitheliitis is located at the junction between the photoreceptor outer segments and the apical side of the RPE cells. Indocyanine green angiography and spectral-domain optical coherence tomography show that the RPE appears to be more widely involved than the neurosensory retina.
确定急性视网膜色素上皮炎初始病变的确切位置。
对 4 例诊断为急性视网膜色素上皮炎的患者进行研究。回顾眼底照相、荧光素血管造影、吲哚青绿血管造影和频域光相干断层扫描的结果。
4 名健康年轻患者均表现为单侧突发性视力下降。眼底镜检查显示黄斑色素斑点状，视网膜色素上皮（RPE）水平有周围黄白色色素脱失区。荧光素血管造影显示传递性强荧光。早期和中期吲哚青绿血管造影图像显示黄斑区斑片状强荧光。吲哚青绿血管造影晚期，观察到黄斑区呈卷曲状高荧光晕。频域光相干断层扫描显示光感受器的内节和外节界面中断，RPE 内层内带中断更广泛。这些中断线被一个穹顶状高反射病变取代，累及 RPE 内层、光感受器的内节和外节层，在 2 例中还累及外核层。随着时间的推移，吲哚青绿血管造影显示观察到的病变消退。频域光相干断层扫描显示内节和外节层以及 RPE 内层的恢复和连续带。
频域光相干断层扫描结果提示急性视网膜色素上皮炎的初始病变位于光感受器外节和 RPE 细胞顶侧的交界处。吲哚青绿血管造影和频域光相干断层扫描显示 RPE 的受累范围似乎比神经感觉视网膜更广。
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