摘要
目的分析急性黄斑旁中心中层视网膜病变(PAMM)的临床特征。方法采用回顾性系列病例观察方法,收集2016年1月至2017年12月在河南省立眼科医院确诊为PAMM的11例11眼临床资料,包括一般情况、眼科常规检查、彩色眼底照相、红外线成像(IR)、频域光相干断层扫描(SD-OCT)、光相干断层扫描血管成像(OCTA)、荧光素眼底血管造影(FFA)、视野检查和多焦视网膜电图(mf-ERG)检查。对其临床表现、诊断要点及治疗情况进行分析。结果11例患者中男9例,女2例;年龄50~71岁,平均60岁。10例有系统性疾病史,其中高血压病者3例,高血压并发颈动脉粥样斑块者1例,糖尿病并发颈动脉狭窄者2例,高血压并发糖尿病者2例,颈动脉粥样斑块者2例,另外1例是胸部外伤。PAMM表现为眼前暗影伴轻度视力下降,病程在1周内。最佳矫正视力(BCVA)为0.6~1.0,视野检查示中心、旁中心暗点或敏感度下降。mf-ERG检查示8眼黄斑中心区P1波振幅密度降低。彩色眼底照相示黄斑旁灰白色病灶者8眼,无明显病变者3眼。IR发现11眼黄斑旁弱反射。FFA检查均未见荧光素渗漏。SD-OCT示11眼均有黄斑旁内核层(INL)强反射带。OCTA检查示11眼病变区黄斑旁视网膜深层毛细血管(DCP)密度稀疏。治疗后,3眼中心暗影变淡,11眼视力均未改善。结论PAMM多见于年龄大的男性,并伴有系统性疾病。PAMM病变位于黄斑旁视网膜中层,病变隐匿,形态和功能检查联合应用有助于确诊,但治疗效果不佳。
Objective To analyze the clinical features of paracentral acute middle maculopathy(PAMM).Methods A retrospective series case observation was carried out.Clinical data of 11 eyes from 11patients with PAMM were included in this study from January 2016 to December 2017 in Henan Eye Hospital.All of the patients received general information inquiry,regular ophthalmic examination,color fundus photography,fundus infrared imaging(IR),spectral-domain optical coherence tomography(SD-OCT),OCT angiography(OCTA),fundus fluorescence angiography(FFA),visual field examination and multifocal electroretinography.Results The ages of the patients ranged from 50 to 71 years old,with the average age of 60 years old.There were 9 males and 2 females,including hypertension in 3 patients,hypertension carotid atherosclerotic plaque in 1 patientd,diabetes with carotid stenosis in 2 patients,hypertension with diabetes in 2 patients,only carotid atherosclerotic plaque in 2 patients and chest trauma in 1 patient.The symptoms of PAMM were central or paracentral scotoma within 1 week.The best corrected visual acuity(BCVA)of the patients ranged from 0.6 to 1.0.All of the patients had central or paracentral scotoma or decrease of visual sensitivities.Mf-ERG showed that amplitude density of P1 waves was reduced in 8 eyes.With subtle-white lesion was seen in fundus of 8 eyes and no obvious symptom in 3 eyes.IR imaging demonstrated hypo-reflection in paracentral macula area in all eyes,and their FFA imaging seemed normal.SD-OCT scanning across lesion area revealed hyper-reflection in inner nuclear layer(INL).OCTA demonstrated perfusion deficit in deep capillary plexuses(DCP).After treatment,there was no improvement in BCVA for all the eyes but scotomas were lessened.Conclusions PAMM easily occurs in older males with systemic diseases.PAMM lesson is a occult paramacular middle layer of retinopathy.The combination examination of morphological and functional methods is avaiable for diagnosis.
作者
王志立
陈晓
柳慧
李翔
Wang Zhili;Chen Xiao;Liu Hui;Li Xiang(Henan Eye Hospital,Henan Eye Institute,Henan People's Hospital,Zhengzhou 450003,China)
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2019年第1期16-20,共5页
Chinese Journal Of Experimental Ophthalmology
关键词
黄斑旁中心
视网膜病变
中层
临床特征
诊断治疗
Paracentral macular area
Maculopathy,middle layer
Clinical features
Diagnosis and treatment
