Department of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 64239, Israel.
Graefes Arch Clin Exp Ophthalmol. 2013 Aug;251(8):2037-45. doi: 10.1007/s00417-013-2334-3. Epub 2013 Apr 9.
The aim of our study was to investigate vitreal, retinal, and choroidal morphologic changes in active and scarred toxoplasmosis lesions using spectral-domain optical coherence tomography (SD-OCT).
In this prospective study, 19 eyes of 15 consecutive patients with ocular toxoplasmosis were included. Complete ophthalmologic examination and SD-OCT were done at the initial visit and during follow-up. Retina and choroid SD-OCT protocols directed to macular area and lesions observed on clinical examination were used.
Seventeen active lesions and 56 retinochoroidal scars were studied. In the acute phase, disruption, thickening, and hyper-reflectivity of the neurosensory retina with photoreceptor (PR) interruption and retinal pigment epithelial (RPE) elevation were found. The choroid became thickened and hyporeflective. During follow-up, neurosensory retinal layers thinning and disorganization, PR interruption, and RPE elevation and/or atrophy were demonstrated. The choroid returned to normal thickness and became more hyperreflective. Five active lesions presented with hyperreflective oval deposits within the vitreoretinal interface, adjacent to or far away from the lesions. During follow-up, the deposits became smaller, entered into the inner retina layers and faded with time until complete resolution. Multiple hyperreflective dots in the vitreous cavity, compatible with vitritis, and posterior hyaloid thickening were demonstrated in the acute phase, with complete resolution and detachment of the posterior hyaloid during follow-up. Four types of scars were specified according to outer retina-choroid interface changes; atrophic, elevated, deep, and combined (atrophic & elevated). Epiretinal membrane segments were found over active and scarred lesions.
SD-OCT imaging showed toxoplasmic retinochoroidal lesions and scars to be complex and characterized acutely by thickening and disorganization of both the retina and underlying choroid, and following scar formation by varying degrees of thinning, often in conjunction with irregularity of the outer retinal layers.
本研究旨在应用频域光学相干断层扫描（SD-OCT）观察活动期和瘢痕期弓形虫病的玻璃体、视网膜和脉络膜形态变化。
本前瞻性研究纳入了 15 例（19 只眼）眼弓形虫病患者。在初次就诊和随访期间进行了全面的眼科检查和 SD-OCT 检查。使用针对黄斑区和临床检查中观察到的病变的视网膜和脉络膜 SD-OCT 方案。
研究了 17 个活动病变和 56 个视网膜脉络膜瘢痕。在急性期，发现神经感觉层视网膜中断、光感受器（PR）中断和视网膜色素上皮（RPE）抬高，伴有神经感觉层增厚和高反射。脉络膜增厚且低反射。在随访期间，发现神经感觉层变薄和紊乱、PR 中断以及 RPE 抬高和/或萎缩。脉络膜恢复到正常厚度并变得更加高反射。5 个活动病变在与病变相邻或远离病变的玻璃体视网膜界面处出现高反射椭圆形沉积物。在随访过程中，沉积物逐渐变小，进入内视网膜层并随时间消失直至完全消退。在急性期，玻璃体内可见多个高反射点，符合玻璃体炎和后玻璃体增厚，在随访过程中，后玻璃体完全分离和脱离。根据外视网膜-脉络膜界面的变化，指定了 4 种类型的瘢痕；萎缩性、抬高性、深部和混合型（萎缩性和抬高性）。在活动病变和瘢痕病变上发现了视网膜内膜段。
SD-OCT 成像显示弓形虫病的视网膜脉络膜病变和瘢痕复杂，急性期表现为视网膜和其下脉络膜均增厚和结构紊乱，形成瘢痕后，视网膜各层厚度不同程度变薄，常伴有外视网膜层不规则。
