From the Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, the Netherlands.
From the Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, the Netherlands.
Am J Ophthalmol. 2023 Aug;252:45-58. doi: 10.1016/j.ajo.2023.03.022. Epub 2023 Mar 25.
To identify characteristics on multimodal imaging (MMI) in idiopathic multifocal choroiditis (MFC) that can identify inflammatory activity and distinguish choroidal neovascularization (CNV) activity from inflammatory activity.
Prospective cohort study.
MMI consisted of spectral-domain optical coherence tomography (angiography) (SD-OCT(A)), fundus autofluorescence, fundus photography, infrared imaging, fluorescein angiography (FA), and indocyanine green angiography (ICGA). MMI characteristics obtained during active and inactive disease were compared within the same lesion. Secondly, MMI characteristics were compared between active inflammatory lesions with and without CNV activity.
Fifty patients (110 lesions) were included. In 96 lesions without CNV activity, the mean focal choroidal thickness was increased during the active disease (205 µm) compared to the inactive disease (180 µm) (P ≤ .001). Lesions with inflammatory activity typically demonstrated moderately reflective material located in the sub-retinal pigment epithelium (RPE) and/or in the outer retina with disruption of the ellipsoid zone. During the inactive stage of the disease, the material disappeared or became hyperreflective and indistinguishable from the RPE. During the active stage of the disease, the area of hypoperfusion in the choriocapillaris significantly increased as visualized on both ICGA and SD-OCTA. CNV activity in 14 lesions was associated with subretinal material with a mixed reflectivity and hypotransmission of light to the choroid on SD-OCT and leakage on FA. SD-OCTA identified vascular structures in all active CNV lesions and in 24% of lesions without CNV activity (showing old, quiescent CNV membranes).
Inflammatory activity in idiopathic MFC was associated with several MMI characteristics, including focally increased choroidal thickness. These characteristics can guide clinicians in the challenging process of the evaluation of disease activity in idiopathic MFC patients.
确定特发性多灶性脉络膜炎（MFC）的多模态成像（MMI）特征，这些特征可以识别炎症活动，并将脉络膜新生血管（CNV）活动与炎症活动区分开来。
前瞻性队列研究。
MMI 包括频域光相干断层扫描（血管造影）（SD-OCT（A））、眼底自发荧光、眼底照相、红外成像、荧光素血管造影（FA）和吲哚青绿血管造影（ICGA）。在同一病变中比较活动期和非活动期的 MMI 特征。其次，比较有和无 CNV 活动的活动性炎症病变之间的 MMI 特征。
共纳入 50 例（110 个病灶）患者。在 96 个无 CNV 活动的病灶中，活动期病灶的平均局灶性脉络膜厚度（205 µm）高于非活动期病灶（180 µm）（P ≤.001）。有炎症活动的病灶通常表现为位于视网膜色素上皮（RPE）下和/或外视网膜的中等反射性物质，伴有椭圆体带的破坏。在疾病的非活动期，该物质消失或变得高反射性，与 RPE 无法区分。在疾病的活动期，脉络膜毛细血管的低灌注区在吲哚青绿血管造影和频域光相干断层扫描血管造影上均显著增加。14 个病灶的 CNV 活动与视网膜下物质相关，这些物质在频域光相干断层扫描和 FA 上表现为混合反射性和对脉络膜的光低透过性。SD-OCTA 在所有活动性 CNV 病变中均识别出血管结构，在 24%无 CNV 活动的病变中也识别出（显示陈旧、静止的 CNV 膜）。
特发性 MFC 的炎症活动与多种 MMI 特征相关，包括局灶性脉络膜增厚。这些特征可以指导临床医生在评估特发性 MFC 患者的疾病活动时，进行具有挑战性的评估。
