OCT在Vogt-小柳-原田综合征治疗随诊中的应用

目的探讨Vogt-小柳-原田综合征(VKH)糖皮质激素治疗过程中相干光断层扫描(OCT)的成像特征,评价其对VKH病情监测及判断预后的可行性。设计回顾性病例系列。研究对象2010年10月至2011年8月在北京同仁医院眼科确诊,并进行系统治疗和随诊的13例(26眼)VKH急性葡萄膜炎期患者。方法对上述患者大剂量泼尼松龙治疗3～7天,之后继续减量治疗。分别在治疗前、治疗后4～7天、1个月、3个月、6～8个月检查患眼最佳矫正视力(BCVA),HRA-OCT检测黄斑中心视网膜形态及厚度(CRT),复诊OCT检查时启用follow-up模式以追踪治疗前同一部位定位扫描。对治疗前后BCVA、视网膜神经上皮形态及CRT进行对比分析。主要指标BCVA、黄斑中心视网膜神经上皮形态及CRT。结果 VKH急性葡萄膜炎期治疗后4～7天、1个月、3个月、6～8个月患眼平均BCVA(0.55±0.24、0.64±0.20、0.62±0.15、0.64±0.14)比治疗前(0.21±0.13)提高,差异有统计学意义(F=23.47,P=0.000);治疗后4～7天视力提高明显,治疗后1个月仍有改善,而3个月后视力变化无统计学意义。VKH急性葡萄膜炎期OCT检查所有患眼视网膜神经上皮层浆液性脱离、神经上皮外层结构破坏;治疗后1个月,神经上皮完全复位;治疗后1～3个月,57.69%患眼神经上皮外层及光感受器IS/OS光反射带连续性恢复。治疗前平均CRT(535.29±287.70)μm,治疗后4～7天、1个月、3个月及6～8个月分别为(252.33±54.02)μm、(177.25±22.39)μm、(188.25±25.50)μm、(176.43±21.35)μm,差异有统计学意义(F=13.01,P=0.00)。治疗后4～7天与治疗前相比,以及治疗后1个月与治疗后4～7天比较,CRT均降低,差异均有统计学意义(P=0.010,0.005);治疗后1个月与3个月、6～8个月相比较,差异均无统计学意义(P=0.984,1.000)。BCVA与CRT呈负相关(r=-0.380;P=0.04)。结论 OCT可明确显示VKH治疗过程中神经上皮形态、厚度及结构恢复情况,可为VKH病情监测及预后评价提供有价值的无创的客观指标。

The characteristics of OCT in follow-up of Vogt-Koyanagi-Harada disease

Objective To analyze the optical coherence tomography （OCT）characteristics of acute Vogt-Koyanagi-Harada disease （VKH） with standard eorticosteroid treatment, and to evaluate the possibility of using OCT to monitor the progress and to predict the prognosis in acute and recovering phase of VKH. Design Retrospective case series. Participants 26 eyes of 13 patients with acute-phase VKH disease treated and followed up in out-patient department of Beijing Tongren Hospital between Oct. 2010 and Aug. 2011 were included. Methods All the patients were treated with prednisone 1.5 mg/kg/d for three to seven consecutive days, and then the dose of prednisone was reduced gradually. Best corrected visual acuity （BCVA） was checked, and HRA-OCT images were obtained at the initial visit and 4 days to 8 months periodically after corticosteroid treatment. Follow-up technique was used to make sure the same scan line in every OCT checkup time. BCVA,retinal morphological characteristics and central retinal thickness （CRT） were analyzed before and after the treatment. Main Outcome Measures BCVA, retinal morphological characteristics and CRT. Results The mean BCVA at 4-7 days, 1 month, 3 months and 6-8 months after treatment was 0.55±0.24, 0.64±0.20, 0.62±0.15, 0.64±0.14 respectively, improved significantly than that before treatment（0.21±0.13, F=23.47, P=0.000）. The mean BCVA improved significantly in the first 4-7 days, and had little change in 1 month, then kept steady in 3 months. OCT showed serous retinal detachment and destruction in the outer part of neuro-retina in acute-phase of VKH. All of the sub-retinal exudates were absorbed 1 month after systemic cortieosteroid treatment. IS/OS reflex recovered in 57.69% of the eyes in 1 to 3 months. The mean CRT was 535.29±287.70μm before treatment, and 252.33±54.02, 177.25±22.39, 188.25±25.50, 176.43±21.35 μm respectively at 4-7 days, 1 month, 3 months and 6-8 months post-treatment, the difference had statistics significance （F=13.01,P=0.00） . The differences of CRT between pre-treatment and 4-7 days after treatment, 4-7 days and 1 month after treatment were statistically significant （P=0.010, 0.005 respectively）. The difference among the 1 month and 3 months post-treatment, 6-8 months post-treatment was not significant （P=0.984, 1.000）. The BCVA was significantly inversely correlated with CRT （r=-0.380, P=0.04）. Conclusion OCT may show the progress of neuro-retinal recovery and CRT changes, thus provide a valuable method to monitor the diagnosis and predict the prognosis of VKH.