伴有外层视网膜或脉络膜视网膜萎缩的特发性多灶性脉络膜炎

Idiopathic multifocal choroiditis with outer retinal or chorioretinal atrophy.

作者信息

Jung Jesse J, Khan Samira, Mrejen Sarah, Gallego-Pinazo Roberto, Cunningham Emmett T, Freund K Bailey, Jampol Lee M, Yannuzzi Lawrence A

机构信息

*Department of Ophthalmology, New York University School of Medicine, New York, New York; †Vitreous Retina Macula Consultants of New York, New York, New York; ‡Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York; §Department of Ophthalmology, Feinberg School of Medicine of Northwestern University, Chicago, Illinois; ¶LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; **Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain; ††Department of Ophthalmology California Pacific Medical Center, San Francisco, California; ‡‡Department of Ophthalmology, Stanford University School of Medicine, Stanford, California; and §§West Coast Retina Medical Group, San Francisco, California.

出版信息

Retina. 2014 Jul;34(7):1439-50. doi: 10.1097/IAE.0000000000000079.

DOI:10.1097/IAE.0000000000000079

PMID:24378424

Abstract

PURPOSE

To report thirteen cases of idiopathic multifocal choroiditis with discrete chorioretinal lesions who were found to have zonal, multizonal, or diffuse outer retinal or chorioretinal atrophy.

METHODS

A retrospective observational case series using multimodal imaging including high-definition optical coherence tomography, fundus autofluorescence imaging, and fluorescein and indocyanine green angiography.

RESULTS

Twenty-one eyes in 13 patients with idiopathic multifocal choroiditis were found to have zonal, multizonal, or diffuse outer retinal or chorioretinal atrophy visualized using multimodal imaging. Thirteen eyes presented with diffuse disease, six eyes with multizonal, and two with zonal atrophy. Patterns of atrophy included zones surrounding the optic nerve, multiple geographic zones in the mid and far periphery, and a diffuse peripheral pattern with relative sparing of the central macula until later in the course of disease. Eleven of the 13 patients were treated with topical, periocular, or systemic corticosteroids, and 1 patient was also treated with systemic immunomodulatory treatment. The atrophic changes progressed over an average of 8 years of follow-up in 10 eyes despite therapy.

CONCLUSION

Idiopathic multifocal choroiditis can present with an uncommon pattern of zonal, multizonal, or diffuse outer retinal or chorioretinal atrophy as part of its clinical spectrum. The severity, extent, and progression of these atrophic changes are best appreciated using multimodal diagnostic imaging.

摘要

目的

报告13例特发性多灶性脉络膜炎伴离散性脉络膜视网膜病变患者，这些患者被发现存在带状、多带状或弥漫性外层视网膜或脉络膜视网膜萎缩。

方法

一项回顾性观察病例系列研究，采用包括高清光学相干断层扫描、眼底自发荧光成像以及荧光素和吲哚菁绿血管造影在内的多模态成像技术。

结果

13例特发性多灶性脉络膜炎患者的21只眼中，通过多模态成像发现存在带状、多带状或弥漫性外层视网膜或脉络膜视网膜萎缩。13只眼表现为弥漫性病变，6只眼为多带状，2只眼为带状萎缩。萎缩模式包括围绕视神经的区域、中周部和远周部的多个地图状区域，以及弥漫性周边模式，在疾病后期黄斑中心相对 spared。13例患者中有11例接受了局部、眼周或全身皮质类固醇治疗，1例患者还接受了全身免疫调节治疗。尽管进行了治疗，但10只眼在平均8年的随访中萎缩性改变仍有进展。