Mesquida Marina, Llorenç Victor, Fontenla José Ramón, Navarro Manuel Javier, Adán Alfredo
Uveitis Unit, Department of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
Retina. 2014 Oct;34(10):2121-7. doi: 10.1097/IAE.0000000000000197.
Retinal vasculitis (RV) is an important component of Behçet disease. It may be difficult to detect either clinically or with conventional retinal imaging. The role of ultra-wide-field (UWF) retinal imaging was assessed in the diagnosis and management of RV associated with Behçet disease.
A total of 38 eyes of 20 patients with active RV associated to Behçet disease underwent UWF imaging with the Optos scanning laser ophthalmoscope, fundus autofluorescence, and/or fluorescein angiography. This study determined the UWF findings and percentage of patients in whom this imaging modality assisted in diagnosing the extent of vasculitis, planning treatment, and monitoring disease activity.
Optos UWF imaging assisted in diagnosing and quantifying the extent of RV in 16 patients (80%), planning medical treatment or laser photocoagulation in 13 of 20 patients (65%), and enhanced disease monitoring in 11 of 20 patients (55%). UWF fluorescein angiography revealed vasculitis not clinically evident in 28 of 33 eyes (84.8%). Predominant angiographic findings were diffuse vascular leakage (75.7%), peripheral retinal nonperfusion (66.7%), optic disk leakage (63.6%), macular leakage (30.3%), and macular edema (27.3%). Eighteen patients (34 eyes) underwent UWF fundus autofluorescence, showing multiple hyperfluorescent spots in retinal periphery in 28 eyes (82.3%).
Ultra-wide-field imaging is a valuable tool in the management of patients with RV associated to Behçet disease and can be used for the diagnosis, treatment, and follow-up. Additional studies, including longitudinal evaluations, are needed to elucidate whether these findings or the subsequent management alterations may improve patients' outcomes.
视网膜血管炎（RV）是白塞病的重要组成部分。无论是在临床上还是通过传统的视网膜成像检测，都可能存在困难。本研究评估了超广角（UWF）视网膜成像在与白塞病相关的RV诊断和管理中的作用。
20例活动性与白塞病相关的RV患者的38只眼接受了Optos扫描激光检眼镜的UWF成像、眼底自发荧光和/或荧光素血管造影。本研究确定了UWF的检查结果以及通过这种成像方式协助诊断血管炎程度、规划治疗和监测疾病活动的患者百分比。
Optos UWF成像协助诊断和量化了16例患者（80%）的RV程度，协助20例患者中的13例（65%）规划药物治疗或激光光凝，并协助20例患者中的11例（55%）加强疾病监测。UWF荧光素血管造影显示，33只眼中有28只（84.8%）存在临床上不明显的血管炎。血管造影的主要表现为弥漫性血管渗漏（75.7%）、周边视网膜无灌注（66.7%）、视盘渗漏（63.6%）、黄斑渗漏（30.3%）和黄斑水肿（27.3%）。18例患者（34只眼）接受了UWF眼底自发荧光检查，其中28只眼（82.3%）在视网膜周边出现多个高荧光点。
超广角成像在与白塞病相关的RV患者管理中是一种有价值的工具，可用于诊断、治疗和随访。需要进行包括纵向评估在内的更多研究，以阐明这些发现或随后的管理改变是否可以改善患者的预后。
