青少年高度近视Dome征伴黄斑区视网膜下积液的多模式影像特征

Multimodal imaging features of dome-shaped macula with subretinal fluid in adolescents with high myopia

摘要:

目的：观察青少年高度近视圆顶样黄斑(简称Dome征)伴黄斑区视网膜下积液(SRF)的多模式影像特征，探讨其典型特征与鉴别方法。

方法：回顾性研究。选取2021-01/2022-05于我院确诊为高度近视Dome征伴黄斑区SRF的青少年患者21例39眼，行彩色眼底照相(CFP)、眼底自发荧光(FAF)、频域光学相干断层扫描(SD-OCT)、光学相干断层扫描血管成像(OCTA)及眼电图(EOG)检查，其中18例36眼患者行荧光素眼底血管造影(FFA)检查，随访12mo，记录中心凹下视网膜厚度(CMT)变化情况。

结果：眼底检查可见患眼均呈高度近视豹纹状改变，中心凹可见颗粒样物质沉积； SD-OCT检查显示黄斑区全层呈圆顶样隆起，中心凹下神经上皮层局限性脱离，外界膜内表面可见中高反射附着，视网膜色素上皮(RPE)层反射不均匀； FAF检查显示黄斑区呈轻度“牛眼征”改变； FFA检查显示黄斑区拱环周围环绕颗粒状透见荧光； OCTA检查的En face 图中可见清晰的神经上皮脱离区边界，切线对应椭圆体带-RPE分层面，可见神经上皮脱离区内散在大小不一的颗粒状高反射，未见明显脉络膜新生血管(CNV)形成，OCTA检查随访可见黄斑区SRF可存在无规律的自行增多或吸收； EOG检查显示光峰与暗谷(LP/DT，或称Arden比)比值正常，均>1.55。基线、随访1、3、6、12mo，纳入患者CMT(246.95±11.46、247.10±13.03、246.62±12.23、248.05±14.00、247.92±11.66μm)无显著差异(F=0.144，P=0.965)。

结论：多模式影像检查有助于青少年高度近视Dome征伴黄斑区SRF的临床诊断，并且在与典型Best病病变前期的鉴别诊断中发挥重要作用。

Abstract:

AIM: To observe the multimodal image features of dome-shaped macula(DSM)with subretinal fluid(SRF)in adolescents with high myopia, and investigate its typical features and identification methods.

METHODS: This is a retrospective study. A total of 21 adolescent patients(39 eyes)who were diagnosed as DSM in high myopic eyes with SRF in the macula area in our hospital from January 2021 to May 2022 were selected. All patients underwent color fundus photography(CFP), fundus autofluorescence(FAF), spectral-domain optical coherence tomography(SD-OCT), optical coherence tomography angiography(OCTA)and electro oculography(EOG). Among them, 18 patients(36 eyes)underwent fundus fluorescein angiography(FFA), and they were followed-up for 12mo to record the change of the central macular thickness(CMT).

RESULTS: Fundus examination showed tessellated retina in affected eyes, and the deposition of granular material could be seen in the fovea of the macular area. SD-OCT showed a dome-like bulge of the whole layer in the macular area, localized detachment of the subfoveal nerve epithelial layer, the medium and high reflection attachment on the inner surface of the outer membrane, and the heterogeneous reflection of the retinal pigment epithelium(RPE)layer. FAF showed a mild “bull's eye sign” change in the macular area. FFA showed granular transmitted fluorescence around the foveal avascular zone. En face of OCTA could see a clear boundary of the neuroepithelial detachment zone. When the tangential line corresponds to the ellipsoid zone-RPE layer, the granular high reflection in different sizes scattered in the neuroepithelial detachment zone could be seen, and no obvious choroidal neovascularization(CNV)was formed. During the follow-up of OCTA, SRF in the macular area can be spontaneously increased or absorbed irregularly. EOG indicates that the ratio of light peak to dark trough(LP/DT, i.e. Arden ratio)was normal, with an Arden ratio>1.55. CMT at 1, 3, 6, 12mo(247.10±13.03, 246.62±12.23, 248.05±14.00, 247.92±11.66 μm)during follow-up period were compared with baseline(246.95±11.46 μm), and the difference was not statistically significant(F=0.144, P=0.965).

CONCLUSION: Multimodal imaging is helpful in the clinical diagnosis of DSM with SRF in the macula area in high myopic eyes of adolescents, and plays an important role in the differential diagnosis of the early stage of typical Best disease.