Zhao Chan, Zhang Mei-Fen, Dong Fang-Tian, Wang Xu-Qian, Wen Xin, Dai Rong-Ping, Yu Wei-Hong, Zhang Zhi-Qiao, Yang Zhi-Kun, Gao Fei
Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Chin Med Sci J. 2012 Mar;27(1):29-34. doi: 10.1016/s1001-9294(12)60019-4.
To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease.
Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients.
Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient.
Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.
提供葡萄膜大脑炎（VKH）病的新型光谱域光学相干断层扫描（SD OCT）检查结果，并对该疾病的发病机制提供新的见解。
回顾了2007年12月至2009年4月期间连续就诊的18例VKH患者（11例女性和7例男性）的详细SD OCT和荧光素血管造影（FA）检查结果，这些患者就诊时处于急性葡萄膜炎阶段。所有患者均进行了至少6个月的随访，其中10例患者进行了SD OCT复查。
视网膜内囊肿位于外视网膜的不同层次。除了光感受器层外，还可在外丛状层与外核层之间或跨越外界膜发现囊肿。在FA上，视网膜内囊肿可为低荧光、等荧光或高荧光。一些视网膜内囊肿具有特征性的FA表现，即一个小的圆形低荧光区被一圈高荧光环绕（甜甜圈状染料池）。在两名重症VKH患者的急性葡萄膜炎阶段出现了视网膜下纤维蛋白样沉积物，似乎由视网膜下渗出物发展而来，并演变为典型的视网膜下纤维化。在一名患者中观察到视网膜下纤维蛋白样沉积物/视网膜下纤维化的逐渐变形/迁移以及进行性增殖/色素沉着。
视网膜内囊肿可在外视网膜的不同层次形成，可能是脉络膜炎症扩展所致。VKH患者的视网膜下纤维化可能由视网膜下渗出物发展而来，并可能导致严重的视力损害。
