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超广角扫描激光检眼镜在结节性硬化症相关视网膜星形细胞错构瘤检出中的应用研究
The Application of Ultra-wide-field Scanning Laser Ophthalmoscopy in the Detection of Tuberous Sclerosis Complex-associated Retinal Astrocytic Hamartomas
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摘要:目的 比较超广角扫描激光检眼镜(ultra-wide-field scanning laser ophthalmoscopy, UWF-SLO)与传统彩色眼底照相(color fundus photography, CFP)对结节性硬化症(tuberous sclerosis complex, TSC)相关视网膜星形细胞错构瘤(retinal astrocytic hamartomas, RAH)的检出情况, 评估UWF-SLO在TSC相关RAH识别及随访中的应用价值。方法 回顾性分析2018年10月至2021年3月就诊于北京协和医院内科和眼科且明确诊断为TSC合并RAH患者的临床资料。以散瞳前置镜检查结果为参照标准, 比较两种眼底成像技术的TSC相关RAH检出率, 分析可能影响病灶检出的相关因素。结果 共24例TSC合并RAH患者参与本研究。在TSC相关RAH病灶检出方面, UWF-SLO(合成"伪彩"双激光通道成像)检出率显著高于9点固视CFP98.6%(138/140)比65.7%(92/140), P＜0.001, 检出差异主要在于对中周部和远周部RAH的检出(P＜0.001)。在UWF-SLO病灶检出方面, 单红激光(633 nm)通道成像检出率显著低于单绿激光(532 nm)52.1%(73/140) 比98.6%(138/140), P＜0.001和合成双激光通道成像52.1%(73/140) 比98.6%(138/140), P＜0.001。单红激光通道成像中未检出的病灶均为1型RAH, 且病灶检出组光学相干断层扫描中RAH病灶最大厚度显著高于未检出组(527.3±134.7)μm比(389.7±76.6)μm, P＜0.001, 但两组病灶分布及病灶累及深度无显著统计学差异(P=0.812, P=1.000)。结论 相较于传统CFP, UWF-SLO可能具有更高的TSC相关RAH检出率, 可考虑将其应用于TSC相关RAH的临床评估。Abstract:Objective To evaluate the clinical value of ultra-wide-field scanning laser ophthalmology(UWF-SLO) in tuberous sclerosis complex (TSC)-associated retinal astrocytic hamartoma (RAH) by comparing the detection rate of RAH lesions between UWF-SLO and traditional color fundus photography (CFP).Methods The clinical data of patients with established TSC-associated RAH diagnosis by the Department of Internal Medicine and Ophthalmology of Peking Union Medical College Hospital from October 2018 to March 2021 were retrospectively reviewed. The detection rate of TSC-associated RAH lesions between 9-fixation-point CFP and UWF-SLO was compared with fundoscopic recordings as the reference standard. The factors that may affect the detection of lesions were analyzed.Results A total of 24 patients with TSC-associated RAH were included in this study. UWF-SLO (composed pseudocolor dual-channel images) performed better than 9-fixation-point CFP in the identification of TSC-associated RAH lesions98.6%(138/140)vs. 65.7%(92/140), P < 0.001, especially for RAH lesions located in the mid and far peripheral retina (P < 0.001). In UWF-SLO, red-channel (633 nm) images showed significantly lower detection rate than green-channel (532 nm) 52.1% (73/140) vs. 98.6% (138/140), P < 0.001 and composed dual-channel images52.1%(73/140) vs. 98.6%(138/140), P < 0.001. Undetected RAH lesions in red-channel UWF-SLO images were all type 1 RAH, and the lession thickness was significantly higher in the detected group than that in the undetected group (527.3±134.7)μm vs. (389.7±76.6)μm, P < 0.001, while the location and retinal involving depth of type 1 RAH were not significantly different(P=0.812, P=1.000).Conclusions Compared to CFP, UWF-SLO may be associated with higher detection rate of TSC-associated RAH and could be applied to the evaluation of TSC-associated RAH.
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