Chen Xuejing, Rahimy Ehsan, Sergott Robert C, Nunes Renata P, Souza Eduardo C, Choudhry Netan, Cutler Nathan E, Houston Samuel K S, Munk Marion R, Fawzi Amani A, Mehta Sonia, Hubschman Jean-Pierre, Ho Allen C, Sarraf David
Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, California; Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, California.
Wills Eye Hospital, Philadelphia, Pennsylvania.
Am J Ophthalmol. 2015 Jul;160(1):26-34.e1. doi: 10.1016/j.ajo.2015.04.004. Epub 2015 Apr 4.
To evaluate the spectrum of retinal diseases that can demonstrate paracentral acute middle maculopathy and isolated ischemia of the intermediate and deep capillary plexus.
Retrospective, multicenter, observational case series.
This is a retrospective case series review of 9 patients (10 eyes) from 5 centers with paracentral acute middle maculopathy lesions and previously unreported retinal vascular etiologies. Case presentations and multimodal imaging, including color photographs, near-infrared reflectance, fluorescein angiography, spectral-domain optical coherence tomography (SD OCT), and orbital color Doppler imaging, are described. Baseline and follow-up findings are correlated with clinical presentation, demographics, and systemic associations.
Five men and 4 women, aged 27-66 years, were included. Isolated band-like hyperreflective lesions in the middle retinal layers, otherwise known as paracentral acute middle maculopathy, were observed in all patients at baseline presentation. Follow-up SD OCT analysis of these paracentral acute middle maculopathy lesions demonstrated subsequent thinning of the inner nuclear layer. Novel retinal vascular associations leading to retinal vasculopathy and paracentral acute middle maculopathy include eye compression injury causing global ocular ischemia, sickle cell crisis, Purtscher's retinopathy, inflammatory occlusive retinal vasculitis, post-H1N1 vaccine, hypertensive retinopathy, migraine disorder, and post-upper respiratory infection.
Paracentral acute middle maculopathy lesions may develop in a wide spectrum of retinal vascular diseases. They are best identified with SD OCT analysis and may represent ischemia of the intermediate and deep capillary plexus. These lesions typically result in permanent thinning of the inner nuclear layer and are critical to identify in order to determine the cause of unexplained vision loss.
评估可表现为中心旁急性黄斑中层病变及中间和深层毛细血管丛孤立性缺血的视网膜疾病谱。
回顾性、多中心、观察性病例系列研究。
这是一项对来自5个中心的9例患者（10只眼）进行的回顾性病例系列研究，这些患者患有中心旁急性黄斑中层病变及此前未报告的视网膜血管病因。描述了病例介绍和多模态成像，包括彩色照片、近红外反射、荧光素血管造影、谱域光学相干断层扫描（SD OCT）和眼眶彩色多普勒成像。将基线和随访结果与临床表现、人口统计学和全身相关性进行关联分析。
纳入5名男性和4名女性，年龄在27至66岁之间。在所有患者的基线检查中均观察到视网膜中层孤立的带状高反射病变，即中心旁急性黄斑中层病变。对这些中心旁急性黄斑中层病变进行随访SD OCT分析显示，内核层随后变薄。导致视网膜血管病变和中心旁急性黄斑中层病变的新型视网膜血管关联包括引起全眼球缺血的眼部压迫伤、镰状细胞危象、普尔夏视网膜病变、炎症性闭塞性视网膜血管炎、甲型H1N1流感疫苗接种后、高血压性视网膜病变、偏头痛障碍和上呼吸道感染后。
中心旁急性黄斑中层病变可能在多种视网膜血管疾病中发生。通过SD OCT分析能最好地识别这些病变，它们可能代表中间和深层毛细血管丛的缺血。这些病变通常会导致内核层永久性变薄，对于确定不明原因视力丧失的病因至关重要，因此必须加以识别。
