Lombardo Marco, Ricci Federico, Cusumano Andrea, Falsini Benedetto, Nucci Carlo, Cesareo Massimo
Department of Experimental Medicine, Ophthalmology Unit, University of Rome Tor Vergata, 00133 Rome, Italy.
Macula & Genoma Foundation, 00133 Rome, Italy.
Diagnostics (Basel). 2024 Oct 15;14(20):2289. doi: 10.3390/diagnostics14202289.
The main objective of this study was to report and investigate the characteristics and longitudinal changes in dark-without-pressure (DWP) fundus lesions in patients with autoimmune diseases using multimodal imaging techniques.
In this retrospective observational case series, five patients affected by ocular and systemic autoimmune disorders and DWP were examined. DWP was assessed by multimodal imaging, including color fundus photography (CFP), near-infrared reflectance (NIR), blue reflectance (BR), blue autofluorescence (BAF), optical coherence tomography (OCT), OCT-angiography (OCT-A), fluorescein angiography (FA) and indocyanine green angiography (ICGA), and functional testing, including standard automated perimetry (SAP) and electroretinography (ERG). Follow-up examinations were performed for four out of five patients (range: 6 months-7 years).
DWP fundus lesions were found in the retinal mid-periphery and were characterized by the hypo-reflectivity of the ellipsoid zone on OCT. DWP appeared hypo-reflective in NIR, BR and BAF, and exhibited hypo-fluorescence in FA in two patients while showing no signs in one patient. ICGA showed hypo-fluorescent margins in one patient. SAP and ERG testing did not show alterations attributable to the DWP lesion. Follow-up examinations documented rapid dimensional changes in DWP even in the short term (1 month).
This study suggests a possible association between autoimmune diseases and DWP. New FA and ICGA features were described. The proposed pathogenesis hypotheses may operate as a basis for further investigation of a lesion that is still largely unknown. Large population studies would be necessary to confirm whether there is a higher incidence of DWP in this patient category.
本研究的主要目的是使用多模态成像技术报告并研究自身免疫性疾病患者无压迫性暗区（DWP）眼底病变的特征和纵向变化。
在这个回顾性观察性病例系列中，对5例患有眼部和全身性自身免疫性疾病及DWP的患者进行了检查。通过多模态成像评估DWP，包括彩色眼底照相（CFP）、近红外反射（NIR）、蓝色反射（BR）、蓝色自发荧光（BAF）、光学相干断层扫描（OCT）、OCT血管造影（OCT-A）、荧光素血管造影（FA）和吲哚菁绿血管造影（ICGA），以及功能测试，包括标准自动视野计检查（SAP）和视网膜电图（ERG）。5例患者中有4例进行了随访检查（范围：6个月至7年）。
DWP眼底病变位于视网膜中周部，其特征是OCT上椭圆体带反射率降低。DWP在NIR、BR和BAF中表现为低反射，2例患者在FA中表现为低荧光，1例患者无异常表现。ICGA显示1例患者边缘低荧光。SAP和ERG测试未显示与DWP病变相关的改变。随访检查记录了DWP即使在短期内（1个月）也有快速的大小变化。
本研究提示自身免疫性疾病与DWP之间可能存在关联。描述了新的FA和ICGA特征。提出的发病机制假说可能作为进一步研究这种仍知之甚少的病变的基础。需要进行大规模人群研究以证实该患者群体中DWP的发病率是否更高。
