Egawa Mariko, Mitamura Yoshinori, Akaiwa Kei, Semba Kentaro, Kinoshita Takamasa, Uchino Eisuke, Sonoda Shozo, Sakamoto Taiji
Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Br J Ophthalmol. 2016 Dec;100(12):1646-1650. doi: 10.1136/bjophthalmol-2015-307734. Epub 2016 Feb 23.
To report the changes of the choroidal structure in the enhanced depth imaging optical coherence tomographic (EDI-OCT) images after high-dose corticosteroid treatment for acute Vogt-Koyanagi-Harada (VKH) disease.
Retrospective, observational case series. Thirty-four eyes of 17 patients with acute VKH disease were examined by EDI-OCT before, and 1, 4 and 52 weeks after the treatment. The EDI-OCT images were binarised by ImageJ, a publicly accessible software. The luminal, stromal and total choroidal areas and ratio of luminal/stromal area (L/S ratio) were measured in the subfoveal choroid of 1500 µm width. The area of the peripapillary atrophy (PPA) was measured in the fundus photographs at 1 and 52 weeks. For statistical analyses, a generalised estimating equation method was used to eliminate the effect of within-subject intereye correlations.
Before treatment, the EDI-OCT images could not be binarised because of poor image quality in most of the cases. After treatment, the luminal, stromal and total choroidal areas were significantly decreased during the follow-up period (all p<0.05). The L/S ratio significantly fluctuated over time (p=0.0201), and was significantly lower at 4 weeks than at 1 week (p=0.0158). The L/S ratio at 1 week was significantly correlated with increase in the PPA area, subsequent chronic recurrences and total dose of corticosteroid (p<0.0001, p=0.0006, p=0.0037, respectively).
The L/S ratio measured by binarisation of EDI-OCT images was predictive factor for the progression of PPA, subsequent chronic recurrences and total dose of corticosteroid, and may serve as a marker for degree of choroidal inflammation in the VKH disease.
报告高剂量皮质类固醇治疗急性Vogt-小柳-原田（VKH）病后增强深度成像光学相干断层扫描（EDI-OCT）图像中脉络膜结构的变化。
回顾性观察病例系列。对17例急性VKH病患者的34只眼在治疗前、治疗后1周、4周和52周进行EDI-OCT检查。使用ImageJ（一款可公开获取的软件）对EDI-OCT图像进行二值化处理。在宽度为1500µm的黄斑中心凹下脉络膜测量管腔、基质和脉络膜总面积以及管腔/基质面积比（L/S比）。在眼底照片上测量1周和52周时视盘周围萎缩（PPA）的面积。为进行统计分析，采用广义估计方程法消除受试者内双眼相关性的影响。
治疗前，大多数病例因图像质量差，EDI-OCT图像无法进行二值化处理。治疗后，随访期间管腔、基质和脉络膜总面积显著减少（均p<0.05）。L/S比随时间显著波动（p=0.0201），4周时显著低于1周时（p=0.0158）。1周时的L/S比与PPA面积增加、随后的慢性复发以及皮质类固醇总剂量显著相关（分别为p<0.0001、p=0.0006、p=0.0037）。
通过EDI-OCT图像二值化测量的L/S比是PPA进展、随后慢性复发以及皮质类固醇总剂量的预测因素，可作为VKH病脉络膜炎症程度的标志物。
