Wilkins Carl S, Andrade Romo Jorge S, Chui Toco Y P, Rosen Richard B, Llop Stephanie
Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY 10003, USA.
Case Rep Ophthalmol Med. 2020 Jul 27;2020:8897394. doi: 10.1155/2020/8897394. eCollection 2020.
. We present a case of serpiginous choroidopathy (SC) with novel OCTA and en face OCT reflectance findings which help identify subclinical disease progression. . En face OCT reflectance images demonstrated outer retinal tubules (ORT) at the serpiginous lesion margins of affected and unaffected retina on multimodal imaging. OCTA findings demonstrate variable dropout of choriocapillaris in "normal" retina beyond lesion borders which was not visible on standard imaging and which demonstrated a clear transition zone beyond the ORT. . This is the first report of choriocapillaris atrophy identified on OCTA not identified on traditional multimodal imaging in serpiginous choroidopathy. Damage to vasculature only visible with OCTA may help characterize the distribution of inflammation, aiding in monitoring of suppression not illustrated by traditional imaging and which may threaten the central macula. ORT in SC suggest death and reorganization of outer segments from dysfunction of the choriocapillaris and RPE, as well as serve to demarcate the area of chronic or old inflammation, supporting the hypothesis that the choriocapillaris is the primary site of inflammation in SC. Based on these findings, we recommend OCTA on all patients with serpiginous choroidopathy to monitor underlying state of inflammation and help determine immunosuppressive threshold.
我们报告一例匐行性脉络膜病变（SC），其具有新颖的光学相干断层扫描血管造影（OCTA）和正面光学相干断层扫描（OCT）反射率结果，有助于识别亚临床疾病进展。正面OCT反射率图像在多模态成像中显示，在受影响和未受影响视网膜的匐行性病变边缘存在外层视网膜小管（ORT）。OCTA结果显示，在病变边界以外的“正常”视网膜中，脉络膜毛细血管存在不同程度的缺失，这在标准成像中不可见，且在ORT之外显示出一个清晰的过渡区。这是关于匐行性脉络膜病变中，在OCTA上发现脉络膜毛细血管萎缩而在传统多模态成像中未发现的首次报告。仅通过OCTA可见的血管损伤可能有助于表征炎症分布，有助于监测传统成像未显示的炎症抑制情况，而这种炎症抑制可能会威胁到黄斑中心。SC中的ORT提示脉络膜毛细血管和视网膜色素上皮（RPE）功能障碍导致外层节段死亡和重新组织，同时也用于划定慢性或陈旧性炎症区域，支持脉络膜毛细血管是SC炎症主要部位的假说。基于这些发现，我们建议对所有匐行性脉络膜病变患者进行OCTA检查，以监测潜在的炎症状态并帮助确定免疫抑制阈值。
