摘要目的:观察拟诊的结核性视网膜血管炎的多模式影像特征。方法:回顾性系列病例研究。2018年1月至2021年4月于扬州大学附属医院苏北人民医院眼科检查并拟诊的结核性视网膜血管炎且抗结核治疗（ATT）有效患者15例22只眼纳入研究。其中，男性5例，女性10例；双眼、单眼受累分别为7、8例；年龄（49.3±11.1）岁。所有患者均行最佳矫正视力（BCVA）、眼底彩色照相、广角荧光素眼底血管造影（FFA）、光相干断层扫描（OCT）检查。行吲哚青绿血管造影（ICGA）检查7只眼。采用国际标准视力表行BCVA检查，统计时换算为最小分辨角对数（logMAR）视力。全身结核相关检查包括胸部CT、血清结核感染T细胞斑点试验、结核菌素试验等结核相关检查。所有患者行全身ATT。随访时间>12个月。观察患眼的眼底多模式影像特征。治疗前后BCVA比较行非参数检验。结果:所有患眼视网膜血管纡曲扩张，其中伴血管白鞘3只眼；视网膜散在出血点5只眼，其中沿血管走行3只眼。病变主要分布于视网膜中周部及周边部，部分累及后极部。单纯视网膜血管炎12只眼（54.5%，12/22）；视网膜血管炎合并脉络膜炎10只眼（45.5%，10/22）。FFA检查，视网膜血管不同程度荧光素渗漏，以视网膜静脉和毛细血管渗漏为主，未累及动脉。周边闭塞性视网膜血管炎16只眼（72.7%，16/22），其中合并视网膜新生血管4只眼（18.2%，4/22）。合并脉络膜炎的10只眼，视网膜下多个大小不一的局灶性脉络膜炎性病灶。行ICGA检查的7只眼，脉络膜炎性病灶呈弱荧光暗点（HDD）5只眼（71.4%，5/7），表现为大小不一的点状HDD，多分布于后极部及中周部。ATT后，视网膜血管炎合并脉络膜炎的10只眼，视网膜色素上皮层间沉积的强反射物质逐渐吸收，但未完全消失，视网膜结构紊乱多数未能恢复。治疗前及末次随访时患眼logMAR BCVA分别为0.61±0.57、0.36±0.55；治疗前后logMAR BCVA比较，差异有统计学意义（ Z=－3.102， P<0.01）。 结论:拟诊的结核性视网膜血管炎FFA最常见表现为周边闭塞性视网膜血管炎，可伴局灶性脉络膜炎性病灶；广角FFA及ICGA对于结核性视网膜血管炎诊断较为重要，OCT有助于炎症变化的监测。

abstractsObjective:To observe the multimodal imaging characteristics of the eyes in patients with presumed tuberculous retinal vasculitis.Methods:A retrospective case series study. A total of 15 patients (22 eyes) diagnosed with presumed tuberculous retinal vasculitis and receiving anti-tuberculosis treatment (ATT) effectively in Department of Ophthalmology, Subei People's Hospital Affiliated to Yangzhou University from January 2018 to April 2021 were included. Among them, there were 5 males and 10 females. Seven had bilateral involvement and 8 had unilateral involvement. The age was 49.3±11.1 years old. The best corrected visual acuity (BCVA), fundus colour photography, wide-angle fundus fluorescein angiography (FFA), and optical coherence tomography (OCT) were performed in all patients. Indocyanine green angiography (ICGA) was performed in 7 eyes. The BCVA examination was performed with the international standard visual acuity chart, which was converted into the logarithm of minimal angel resolution vision (logMAR). Systemic tuberculosis-related examinations included chest CT, serum T-spot, purified protein derivative and other tuberculosis-related tests. All patients were treated with systemic anti-tuberculosis therapy. The follow-up time was >12 months. The multimodal imaging characteristics for affected eyes. Nonparametric test was used to compare BCVA before and after treatment.Results:The retinal vessels of all the affected eyes were tortuously dilated, including 3 eyes with vascular white scabbard, 5 eyes with scattered bleeding point at the retina inculding 3 eyes walking along the vessels. The lesions were mainly distributed in the middle and periphery of the retina, and some of them involved the posterior pole; 12 eyes (54.5%, 12/22) with simple retinal vasculitis and 10 eyes (45.5%, 10/22) with retinal vasculitis complicated with choroiditis. Tuberculous retinal vasculitis showed different degrees of retinal vascular leakage on FFA, mainly retinal vein and capillary leakage, not involving arteries; 16 eyes (72.7%, 16/22) of retinal vasculitis showed peripheral occlusive retinal vasculitis and 4 eyes (18.2%, 4/22) were associated with retinal neovascularization. In 10 eyes with choroiditis, there were multiple focal choroiditis lesions of different sizes under the retina. Of the 7 eyes examined by ICGA, the choroidal inflammatory lesions showed hypofluorescent dark dots (HDD) in 5 eyes (71.4%,5/7), showing HDDs of different sizes, most of which were distributed in the posterior pole and middle periphery. In 10 eyes with retinal vasculitis complicated with choroiditis after ATT, the accumulation of hyper-reflective substances above and below the retinal pigment epithelium layer of the retina was gradually absorbed, but not completely disappeared, and most of the disorders of retinal structure could not be recovered. The average logMAR visual acuity was 0.61±0.57 before treatment and 0.36±0.55 after treatment. The BCVA after treatment was significantly higher than that before treatment ( Z=-3.102, P<0.01). Conclusions:Peripheral occlusive retinal vasculitis is the most common manifestation of tuberculous retinal vasculitis in FFA, which may be accompanied by focal choroidal inflammatory lesions. Wide-angle FFA and ICGA are more important in the diagnosis of tuberculous retinal vasculitis. OCT can be used for monitoring the changes of inflammation.