息肉状脉络膜血管病变的眼底血管造影表现

・临床研究・息肉状脉络膜血管病变的眼底血管造影表现

邢怡桥　余运娴　郑红梅　江双红　陈茜　万玮

【摘要】　目的　观察息肉状脉络膜血管病变(PCV)的临床特征及眼底血管造影表现。　方法　回顾

分析12例P CV患者12只眼的眼底检查、荧光素眼底血管造影(F FA)、吲哚青绿血管造影(I CG A)及其5

例5只眼的光相干断层扫描(O CT)检查资料。　结果　12只眼均可见深层和(或)浅层出血,黄色脂质渗

出。其中6只眼病变处见橘红色病灶,2只眼伴视网膜前出血。F FA检查,静脉期6只眼橘红色病灶内点状

荧光,4只眼病变处可见脉络膜血管网。晚期均见息肉状强荧光点荧光素渗漏,2只视网膜前出血眼晚期未

见荧光素渗漏。ICG A检查,12只眼晚期见强度不等、簇状或孤立的息肉状扩张灶,4只眼显示明显的脉络

膜血管网。OCT检查,4只眼视网膜色素上皮(RP E)和脉络膜毛细血管高反射层呈穹窿状隆起,1只眼无改

变。　结论　PCV眼底多见黄斑区出血性和(或)浆液性视网膜色素上皮脱离(RPED)和(或)神经上皮脱

离,黄色脂质渗出。F F A及ICGA检查可见分支状脉络膜血管网及末梢膨大息肉状扩张灶。

【关键词】　视网膜疾病/诊断;　脉络膜疾病/诊断;　黄斑变性;　荧光素眼底血管造影;

吲哚花青绿/诊断应用

中图分类号:R774.12　R770.43　R443

Manifestation of fundus angiograph of polypoidal choroidal vasculopathy X I N G Y i-qiao,Y U Y un-x ian,

ZH EN G H ong-mei,et al.Dep ar tment of Op hthalmology,R enmin H osp ital,W uhan U niver sity,W uhan

430060,China

Corr esp onding author:Y U Y un-x ian,E mail:y xj ing930@

【Abstract】　Obj ective　T o obser ve the manifestatio n of fundus ang io gr aphs of po ly po idal chor oidal

vasculo pathy(PCV).　Methods　T w elve P CV pat ients invo lv ed7males and5females ag ing fr o m40to

69year o ld(av erag e56.4).Fundus exa minatio n,fundus fluo rescein a ng io gr aphy(FF A),and indocy anine

gr een ang io gr aphy(ICG A)wer e per for med o n12pa tients(12eyes)w ith PCV,out o f w hom5under w ent

optical coher enece to mog r aphy(O CT).　Results　In12ey es,deep and(o r)super ficial hemor r hage and

yellow har d ex udations w er e fo und,including or ange-red lesio ns in6and pr e-r etinal hemo rr hag e in2.T he

results o f FF A discov ered or ang e-r ed spott y fluo rescence in6ey es and cho ro ida l vascular netwo r k in4

eyes.A t the late phase,leakag e o f polypo idal hy per fluo rescence spo t in all of t he eyes ex cept2w itho ut

leaka ge w ere fo und.T he imag es o f ICGA show ed typical do tted or clustered polypoidal hyperfluor escence

in12eyes at the la te phase.O CT disclo sed pr ot rusio n o f the r etinal pigm ent epitelium(RP E)w ith a

bumpy sur face at po lypoidal st ructure in4eyes and no cha ng e in1eye.　Conclusions　P CV mainly

affects the elder ly per so ns and mostly on unilatera l eyes.M acular hemo rr hage,sero us RP ED,and(or)

neur oepit helial detachment w ith y ellow har d exudatio ns a re the main manifestations.Br anching chor oidal

vascular net w ith plo yplike ter minal ano ur ysmal dilatio ns can be discov er ed in F FA and I CG A.

【Key words】　Retinal disease/diagno sis;　Chor oids disea se/diagnosis;　M acular deg enerat ion;　

Fluor escein ang iog r aphy;　Indocayanine g reen/diagnostic use

息肉状脉络膜血管病变(PCV)是以异常分支的脉络膜血管网及血管网的末梢有息肉状扩张灶为特征的一种疾病,临床上极易将其同渗出型老年性黄斑变性(AM D)相混淆。现将我院于1999年11月～2004年6月从渗出型AM D中收集的12例PCV患者12只患眼的眼底血管造影表现分析如下。

1　对象和方法

作者单位:430060武汉大学人民医院眼科

通讯作者:余运娴,Email:yx jing930@sin 本组12例患者均为单眼患病,其中男性7例,女性5例,年龄40～69岁,平均年龄56.4岁。患者就诊主诉中心视力下降7例,视物变形3例,眼前黑影遮挡2例。从发病到就诊的时间为1周～12个月,平均为4个月。全身检查:6例有高血压,2例有糖尿病,4例身体健康。眼部检查:患眼视力0.1及其以下者6只眼, 0.12～0.2者4只眼,0.3者2只眼。均不能矫正。常规进行裂隙灯眼前节检查及检眼镜眼底检查;采用To pcon T RC50IX相机及Im ag enet2000系统行荧光素眼底血管造影(FFA)和吲哚青绿血管造影(ICGA)