Hu F, Wang X N, Cao X S, Peng X Y
Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab., Beijing 100730, China.
Zhonghua Yan Ke Za Zhi. 2017 May 11;53(5):352-357. doi: 10.3760/cma.j.issn.0412-4081.2017.05.007.
To investigate the clinical manifestations and imaging characteristics of acute syphilitic posterior placoid chorioretinitis (ASPPC). Retrospective study of 10 patients diagnosed ASPPC in the Department of Ophthalmology, Beijing Tongren Hospital from 2011 to 2016, including 6 males (10 eyes involved) and 4 females (8 eyes involved) with an age of (43.4±11.6) years (range, 26-60 years). Their clinical manifestations and imaging characteristics were summarized. All 10 ASPPC patients complained about the reduction of visual acuity, and the majority of them had both eyes involved. The initial visual acuity ranged from finger count to 0.8, with an average of 0.4 and a median visual acuity of 0.3. The intraocular pressure was in the normal range. The inflammation of anterior chamber occurred in only one patient (1/10). The lesions were located at the posterior pole as shown on fundus photographs. There are six placoid lesions, four yellowish massive lesions and seven mixed lesions (placoid and yellowish massive lesions). Partial or whole disappearance, abnormality and opacity of the ellipsoid layer, retinal pigment epithelial (RPE) nodules, and cells in the vitreous body were observed by optical coherence tomography. There were partial detachment between the neuronal retina and RPE layer with fine-sand like hypereflective dots. The lesion size and morphology on autofluorescence (AF), fundus fluorescence angiography (FFA) and indocyanine green angiography (ICG) were almost consistent with those on fundus photography. The lesions were hyperautofluorescent in a placoid or massive shape. The lesions on FFA showed slight hyperfluorescence with unclear edges from the venous phase, and the fluorescence increased with the time and leaked in the late phase. Vascular walls showed blood staining in the late phase. The lesions on ICG showed hypofluorescence with hyperfluorescence and hypofluorescence dots like fine needles in the middle and late phases. ASPPC mainly occurs among the young adults without gender difference. The characteristic is the contradiction between sever clinical symptoms and slight signs on the fundus. The lesion area shown on fundus photography, FFA, ICG and AF is consistent, as well as injuries of the ellipsoid layer, RPE nodules and cells in the vitreous body. The above manifestations and imaging characteristics of ASPPC are significant for the diagnosis and differential diagnosis. -.
探讨急性梅毒性后极部扁平状脉络膜视网膜炎（ASPPC）的临床表现及影像学特征。回顾性研究2011年至2016年在北京同仁医院眼科确诊为ASPPC的10例患者，其中男性6例（累及10只眼），女性4例（累及8只眼），年龄为（43.4±11.6）岁（范围26 - 60岁）。总结其临床表现及影像学特征。10例ASPPC患者均诉视力下降，多数累及双眼。初始视力范围从指数到0.8，平均为0.4，中位视力为0.3。眼压在正常范围。仅1例患者（1/10）出现前房炎症。眼底照片显示病变位于后极部。有6个扁平状病变、4个黄色大块状病变和7个混合性病变（扁平状和黄色大块状病变）。光学相干断层扫描观察到椭圆体层部分或全部消失、异常及混浊，视网膜色素上皮（RPE）结节，以及玻璃体中的细胞。神经视网膜与RPE层之间存在部分脱离，伴有细沙样高反射点。自发荧光（AF）、眼底荧光血管造影（FFA）和吲哚菁绿血管造影（ICG）上病变的大小和形态与眼底照片上几乎一致。病变呈扁平状或大块状高自发荧光。FFA上的病变从静脉期开始显示轻度高荧光，边缘不清，荧光随时间增强并在晚期渗漏。晚期血管壁出现血染色。ICG上的病变在中晚期显示低荧光，伴有高荧光和细针状低荧光点。ASPPC主要发生于青壮年，无性别差异。其特点是临床症状严重与眼底体征轻微相矛盾。眼底照片、FFA、ICG和AF上显示的病变区域一致，以及椭圆体层损伤、RPE结节和玻璃体中的细胞。ASPPC的上述表现及影像学特征对诊断和鉴别诊断具有重要意义。 -
