Maggio Emilia, Alfano Alessandro, Polito Antonio, Pertile Grazia
Sacrocuore Hospital, Via Don Sempreboni 5 - Negrar, 37024, Verona, Italy.
BMC Ophthalmol. 2018 Apr 10;18(1):87. doi: 10.1186/s12886-018-0756-8.
Indocyanine Green Angiography (ICG-A) and Enhanced Depth Imaging Spectral-Domain Optical Coherence Tomography (EDI-OCT) are essential imaging techniques for diagnosis, management and understanding of the pathophysiology of many chorioretinal diseases. Herein, we report the ICG-A and EDI-OCT findings from a case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE), in which these imaging techniques enable the visualization of more diagnostic details than those observable with other widely used diagnostic tools.
A 60-year-old white female presented with bilateral blurred vision for few days. Fundus examination showed multiple, yellow-white placoid lesions at the posterior pole of both eyes. The placoid lesions were also evident on Spectral-Domain Optical Coherence Tomography (SD-OCT), Fluorescein Angiography (FA), Fundus Autofluorescence (AF), and ICG-A. A complete ophthalmologic examination was performed and the diagnosis of APMPPE was made based on imaging and clinical features. Notably, all the lesions detected by FA, AF and OCT corresponded to focal areas of hypofluorescence seen on ICG-A, whereas several additional hypofluorescent areas that were not associated with FA, AF or OCT abnormalities, were also detected with ICG-A. On follow-up, the regression of outer retinal abnormalities detected on OCT preceded the restoration of choroidal perfusion abnormalities in the corresponding locations on ICG-A. This long-standing choroidal perfusion defect could not be detected with OCT. EDI-OCT scans revealed characteristic choriocapillaris changes beneath the placoid lesions and an increase in choroidal thickness during the acute phase, with subsequent decrease in the inactive stage of the disease.
Our findings show that ICG-A and EDI-OCT provide detailed morphologic information of choroidal abnormalities in APMPPE and allow accurate evaluation of definitive resolution of the lesions. Moreover, they support the acute choroidal hypoperfusion as the primary mechanism overlying the pathogenesis of the disease, and suggest that the non-perfused areas may extend beyond the damage of the outer retina.
吲哚菁绿血管造影（ICG-A）和增强深度成像光谱域光学相干断层扫描（EDI-OCT）是诊断、管理和理解许多脉络膜视网膜疾病病理生理学的重要成像技术。在此，我们报告一例急性后极部多发性鳞状色素上皮病变（APMPPE）的ICG-A和EDI-OCT检查结果，在该病例中，这些成像技术能够显示比其他广泛使用的诊断工具更多的诊断细节。
一名60岁白人女性，双眼视力模糊数天。眼底检查显示双眼后极部有多个黄白色鳞状病变。这些鳞状病变在光谱域光学相干断层扫描（SD-OCT）、荧光素血管造影（FA）、眼底自发荧光（AF）和ICG-A检查中也很明显。进行了全面的眼科检查，并根据影像学和临床特征诊断为APMPPE。值得注意的是，FA、AF和OCT检测到的所有病变均对应于ICG-A上所见的低荧光灶，而ICG-A还检测到几个与FA、AF或OCT异常无关的额外低荧光区。随访时，OCT检测到的视网膜外层异常的消退先于ICG-A上相应位置脉络膜灌注异常的恢复。这种长期存在的脉络膜灌注缺陷无法通过OCT检测到。EDI-OCT扫描显示鳞状病变下方脉络膜毛细血管有特征性改变，急性期脉络膜厚度增加，疾病静止期随后变薄。
我们的研究结果表明，ICG-A和EDI-OCT提供了APMPPE脉络膜异常的详细形态学信息，并能准确评估病变的最终消退情况。此外，它们支持急性脉络膜低灌注是该疾病发病机制的主要机制，并表明无灌注区域可能超出视网膜外层的损伤范围。
