目的:探讨白塞病性葡萄膜炎(Behçet's uveitis, BU)并发视盘新生血管(neovascularization of the optic disc, NVD)和(或)视盘以外视网膜新生血管(retinal neovascularization elsewhere, NVE)的临床及影像特征。方法:回顾性分析2022年1月—2024年9月就诊的BU并发NVD和(或)NVE患者的临床资料和眼底影像学检查结果,包括眼底彩照、荧光素眼底血管造影(fluorescein fundus angiography, FFA)、光学相干断层成像(optical coherence tomography, OCT)和光学相干断层血管成像(OCT angiography, OCTA)。并分析NVD和(或)NVE面积与患眼的改良的眼后段炎症评分以及视网膜血管渗漏评分的相关性。结果:共纳入27例患者(30只眼),年龄为(27.70±12.58)岁,男女比例约为1:1。3例(11%)患者双眼并发NVD和(或)NVE;25只眼(83%)存在NVD:17只眼(57%)仅有NVD;8只眼(27%)存在NVD和NVE。仅2只眼(7%)存在视网膜无灌注区,7只眼(23%)同时发生玻璃体积血。FFA眼后段炎症评分为(20.93±4.37)分。FFA血管渗漏评分为(7.57±1.25)分。NVD和(或)NVE面积与眼后段炎症评分(rs = 0.403,P = 0.027)及视网膜血管渗漏评分(rs = 0.518,P = 0.003)均呈正相关。FFA与OCTA在检测NVD和NVE上表现完全一致(κ= 1.0)。结论:BU并发NVD和(或)NVE并不罕见,以NVD为主,绝大多数与视网膜无灌注不相关,可能由BU炎症诱发。
Purpose: To investigate the clinical and imaging characteristics of retinal neovascularization of the optic disc (NVD) and/or elsewhere in the retina (retinal neovascularization elsewhere, NVE) in eyes with Behçet's uveitis (BU). Methods: This retrospective analysis reviewed the clinical data and fundus imaging findings of patients diagnosed with BU complicated by NVD and/or NVE from January 2022 to September 2024. Imaging modalities included fundus photography, fluorescein fundus angiography (FFA), optical coherence tomography (OCT), and OCT angiography (OCTA). The study analyzed the correlation between the areas of NVD and/or NVE and the modified posterior segment inflammation scores, as well as retinal vascular leakage scores of the affected eyes. Results: The study included 27 patients (30 eyes) with an average age of (27.70 ± 12.58) years and a gender ratio of approximately 1:1. Bilateral NVD and/or NVE was observed in three patients (11%); 25 eyes (83%) had NVD, of which 17 eyes (57%) had only NVD and 8 eyes (27%) had both NVD and NVE. Two eyes (7%) showed areas of retinal non-perfusion, and seven eyes (23%) had concurrent vitreous hemorrhage. The average score for posterior segment inflammation on FFA was 20.93 ± 4.37, and the average score for vascular leakage was 7.57 ± 1.25. There was a significant positive correlation between the area of NVD and/or NVE and both the inflammation score (rs = 0.403, P = 0.027) and the vascular leakage score (rs = 0.518, P = 0.003). FFA and OCTA showed perfect agreement in detecting NVD and NVE (κ = 1.0). Conclusion: NVD and/or NVE in BU are not uncommon and are predominantly presented as NVD, mostly not associated with retinal nonperfusion, likely induced by inflammatory factors related to BU.
荧光素眼底血管造影(fundus fluorescein angiography, FFA)是眼底疾病诊疗不可或缺的检查技术。虽然开展已有半个世纪,但临床工作者在FFA操作的规范性、科学性、安全性和结果同质性仍有不少顾虑和问题,同时缺乏相关指南和共识可供参考。中国微循环学会眼微循环专业委员会眼影像学组专家就FFA操作规范达成本共识,就开展FFA的条件和配置、适应证和禁忌证、检查前准备、检查操作程序、不良反应及处理、造影后患者告知和处理、造影报告等方面为FFA临床操作工作者提供建议和指导,以期在临床实践中获取良好眼底影像、减少不良反应、提高检查质量效率。
Fundus fluorescein angiography (FFA) is an indispensable examination for the diagnosis and treatment of ocular fundus diseases. Although FFA has been carried out for half a century, clinicians still have many concerns and problems in the standardization, scientificity, safety and result homogeneity of FFA practice, and there is a lack of relevant guidelines and consensus for reference. The experts of the Ophthalmic Imaging Group of the Ocular Microcirculation Division of the Chinese Society of Microcirculation reached a consensus on the standardized practice of FFA, providing suggestions and guidance for FFA operators about the clinical conditions and configurations, indications and contraindications, pre-examination preparation, examination procedures, adverse reactions and treatment, patient notification, and angiography reports, in order to obtain good fundus images, reduce adverse reactions, and improve the quality and efficiency of FFA examinations in clinical practice.
目的:研究IgG4相关性眼病(IgG4-related ophthalmic disease, IgG4-ROD)患者的影像学特征与外周血免疫球蛋白G4(IgG4)水平之间的相关性,为评估IgG4相关性疾病全身性严重程度提供新思路。方法:收集2023年8月—2024年9月在吉林大学第二医院眼科医院经术后组织标本病理确诊的29例IgG4-ROD阳性患者。回顾性分析患者眼眶影像学特点与血清IgG4水平相关性,探讨影像学中特征性表现包括泪腺肿大、三叉神经分支增粗、眼外肌增粗、鼻黏膜类炎症改变、眼睑软组织肥厚,以及其他眶内软组织增生等特征性影像学改变出现比例,并按照累及组织结构情况分级评分,评估特征性影像学改变与血清IgG4水平之间的相关性。结果:29例病理确诊IgG4-ROD患者中,泪腺均受累,占比100%;眼外肌受累17例,占比58.62%;三叉神经分支受累5例(4例眶下神经受累,3例额神经病受累,2例眶下神经与额神经同时受累),占比17.24%眼睑软组织肥厚24例,占比82.76%鼻黏膜出现类炎症反应15例,占比51.72%;合并眶内其他软组织增生性病变2例,占比6.90%。影像学中特征性受累组织结构分级评分与血清IgG4水平呈正相关(P < 0.05)。结论:IgG4-ROD影像学中特征性组织结构受累及范围与血清IgG4水平明显相关,可以辅助评估IgG4相关性疾病全身性严重程度。
Objective: To investigate the correlation between the imaging characteristics of patients with IgG4-related ophthalmic disease (IgG4-ROD) and the serum immunoglobulin G4 (IgG4) levels, providing new insights for assessing the systemic severity of IgG4-related diseases. Methods: This study collected postoperative tissue samples from 29 patients with histopathologically conffrmed IgG4-ROD at the Ophthalmology Department of Jilin University Second Hospital from August 2023 to September 2024. TTis study retrospectively analyzed the correlation between patients' orbital imaging features and serum IgG4 levels, and explored the proportion of characteristic imaging changes including enlargement of the lacrimal gland, thickening of the trigeminal nerve branches, thickening of the extraocular muscles, inffammatory like changes of the nasal mucous membranes, hypertrophy of the eyelid soft tissues, as well as hyperplasia of other intraorbital soft tissues in the imaging. A grading score for affected tissue structures was established to evaluate the correlation between characteristic imaging changes and serum IgG4 levels. Results: Among the 29 patients diagnosed with IgG4-ROD, lacrimal gland involvement was observed in all patients (100%). Extraocular muscle involvement was present in 17 patients (58.62%). Five patients had involvement of the trigeminal nerve branches (including 4 with infraorbital nerve involvement and 3 with frontal nerve involvement, with 2 patients having simultaneous involvement of both nerves), accounting for 17.24% of the cases. Eyelid soff tissue hypertrophy was observed in 24 patients (82.76%), and nasal mucosal inflammatory responses were noted in 15 patients (51.72%). Additionally, two patients (6.90%) presented with other proliferative lesions within the orbit. The correlation analysis between the grading scores for imaging features and serum IgG4 levels demonstrated a significant positive correlation. Conclusions: The extent of characteristic structural involvement observed in the imaging features of IgG4-ROD is significantly correlated with serum IgG4 levels. TTis correlation can assist in evaluating the systemic severity of IgG4-related diseases and provides clinical evidence supporting the need for comprehensive systemic evaluations, such as PET-CT, in patients whose initial presentation is IgG4-related ophthalmic disease.
眼缺血综合征(ocular ischemia syndrome,OIS)是由一系列诱因引发的以慢性眼部低灌注为主要临床表现的眼部疾病。临床相对少见,但对视力的影响较大,其症状主要包括一过性黑朦、缺血性眼痛、永久性视力丧失等。近年来医疗美容行业逐步兴起,自体脂肪填充技术使用逐渐增多,其所引起的OIS不可忽视。本文分析1例自体脂肪填充患者术后致OIS病例,研究该类疾病眼底影像学特征。
Ocular ischemia syndrome (OIS), featuring as chronic ocular hypoperfusion, is an eye disease caused by a series of incentives. It is relatively rare in clinical practice, but has a great impact on vision. The symptoms of OIS mainly include transient amaurosis, ischemic eye pain, permanent vision loss, etc. In recent years, with the rise of the Aesthetic Medicine industry, the technology of autologous fat filling has been increasingly adopted. The OIS caused by the surgery of autologous fat filling is nonnegligible. In this paper, by means of analyzing a case that an autologous fat filling surgery resulted in the OIS, discusses features of fundus angiography of OIS.