应用荧光素吲哚青绿同步眼底造影对中心性浆液性视网膜病变眼底微循环改变的观察  

Changes of ocular fundus microcirculation using simultaneous fluorescein and indocyanine green angiography for central serous chorioretinopathy

作　　者：彭锡嘉[1] 王波[1] 苏兰萍[1] 王登廷[1] 郝保安[1] 高琛[1] 

机构地区：[1]甘肃省康复中心医院眼科,甘肃省兰州市730000

出　　处：《眼科新进展》2009年第1期38-42,共5页Recent Advances in Ophthalmology

摘　　要：目的通过分析中心性浆液性视网膜病变(central serous chorioretinopathy,CSC)患者的视网膜-脉络膜同步造影特点,探究其发病机理。方法应用海德堡造影系统HRA2对26例(28眼)患者进行视网膜-脉络膜同步造影,并对结果进行分析。结果眼底照相:黄斑区神经上皮浆液性脱离,2眼伴色素上皮脱离。荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查显示:28眼均有视网膜色素上皮(retinal pigment epithelium,RPE)渗漏,2眼伴色素上皮脱离。吲哚青绿血管造影(in-docyanine green angiography,ICGA)检查显示:早期28眼均有区域性脉络膜血管扩张充血、脉络膜高通透性,24眼区域性脉络膜血管充盈迟缓,其余4眼脉络膜充盈大致正常;中、晚期23眼RPE渗漏处有脉络膜血管的高荧光扩散,5眼表现为高荧光点;18眼ICGA揭示的病灶要比FFA多。10眼可见RPE色素脱失。1例女性CSC患者激光光凝FFA渗漏点后1个月,FFA见黄斑下液体吸收、RPE渗漏点封闭,而ICGA仍见脉络膜活动性渗漏点。结论CSC的发生可能是由于脉络膜循环紊乱及脉络膜血管通透性增高导致RPE损害引起。激光能改善RPE渗漏,但对脉络膜病变本身没有作用。Objective To analyze the characteristics of indocyanine green angiography（ICGA） and fundus fluorescein angiography（FFA） in central serous chorioretinopathy（CSC） and study it＇ s pathogenetic mechanisms. Methods Twenty-six cases of CSC were examined with Heidelberg retina angiography 2 （HRA2）. Simultaneous images of ICGA and FFA were analyzed. Results Fundus photograph showed serous detachment of neural epithelium at macular area, and 2 eyes with pigment epithelial detachment. Twenty-eight CSC eyes in FFA revealed RPE leakage, 2 eyes combined with pigment epithelial detachment. In the early phase of ICGA,28 eyes showed regional choriocapillary dilatation and choroidal hyperpermeability; Twenty-four eyes showed regional choroidal delayed filling;In the middle and late phase of ICGA, 5 eyes revealed hyperfluorescent spots, 23 eyes showed diffuse choroidal hyperfluorescence. Eighteen out of 28 CSC eyes presented with more lesions in ICGA than in FFA. Ten eyes showed RPE depigmentation. Areas of choroidal leakage remained active stage in ICGA when subretinal exudation resolved and RPE leakage stopped a month after laser photocoagulation of the leakage sites seen in FFA of a woman. Conclusions The pathogenesis of CSC may be due to choroidal circulatory disturbance and choroidal vascular hyperpermeability which cause the damage of RPE. Laser photocoagulation can stop RPE leakage, but it is no use for churoidopathy of CSC.

关 键 词：中心性浆液性视网膜病变 荧光素眼底血管造影 视网膜-脉络膜同步血管造影 眼底微循环 

分 类 号：R774.1[医药卫生—眼科]