Eye Clinic, Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy.
Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, Australia.
Br J Ophthalmol. 2018 Apr;102(4):433-437. doi: 10.1136/bjophthalmol-2017-310210. Epub 2017 Aug 1.
To compare optical coherence tomography (OCT) features of active necrotising infectious retinitis (NIR) due to toxoplasmosis or herpesviruses and to determine distinctive OCT signs for these two causes of infectious retinitis.
OCT scans from eyes with active NIR due to varicella zoster virus (VZV), herpes simplex virus (HSV), cytomegalovirus (CMV), and toxoplasmosis (TOXO) were reviewed. All images were evaluated for the presence of previously described OCT findings in TOXO-NIR and compared with the viral group. New OCT findings were recorded and compared. Retinal and choroidal thickness were measured at the site of NIR and compared.
10 eyes diagnosed with TOXO-NIR and 13 eyes affected by viral-NIR (9 CMV and 4 VZV) were analysed. All eyes showed full thickness hyper-reflectivity, disruption of the retina and a variable degree of vitritis. Among previously described OCT signs, hyper-reflective oval deposits and hypo-reflectivity of the choroid had a higher prevalence in TOXO (p=0.018 and p<0.0001, respectively). Among the new signs, hyper-reflective round deposits along the posterior hyaloid, retrohyaloid hyper-reflective spots and a disruption of the choroidal architecture were more frequent in TOXO eyes (all p<0.01). Intra-retinal oedema and hyper-reflective vertical strips within the outer nuclear layer were suggestive of a viral aetiology (p=0.045). Retinal thickness at the site of NIR did not differ between the two groups. Choroidal thickness was significantly higher in TOXO eyes (p=0.01).
The diagnosis of NIR is largely based on clinical and laboratory findings. OCT changes may be useful in differentiating different causes of NIR.
比较弓形虫病或疱疹病毒引起的活动性坏死性感染性视网膜炎（NIR）的光相干断层扫描（OCT）特征，并确定这两种感染性视网膜炎病因的独特 OCT 征象。
回顾了因水痘带状疱疹病毒（VZV）、单纯疱疹病毒（HSV）、巨细胞病毒（CMV）和弓形虫病（TOXO）引起的活动性 NIR 的 OCT 扫描。评估了所有图像中先前描述的 TOXO-NIR 的 OCT 发现，并与病毒组进行了比较。记录并比较了新的 OCT 发现。测量 NIR 部位的视网膜和脉络膜厚度，并进行比较。
分析了 10 只诊断为 TOXO-NIR 的眼睛和 13 只受病毒-NIR 影响的眼睛（9 只 CMV 和 4 只 VZV）。所有眼睛均显示全层高反射性、视网膜破裂和不同程度的玻璃体炎症。在先前描述的 OCT 征象中，高反射性椭圆形沉积物和脉络膜低反射性在 TOXO 中更为常见（p=0.018 和 p<0.0001，分别）。在新发现的征象中，在后玻璃体内沿后玻璃体内的高反射性圆形沉积物、后玻璃体内高反射性斑点和脉络膜结构的破坏在 TOXO 眼中更为常见（均 p<0.01）。视网膜内水肿和外核层内高反射性垂直条纹提示病毒病因（p=0.045）。NIR 部位的视网膜厚度在两组之间无差异。TOXO 眼的脉络膜厚度明显更高（p=0.01）。
NIR 的诊断主要基于临床和实验室发现。OCT 变化可能有助于区分不同原因的 NIR。
Zotero 插件