误诊为渗出型老年性黄斑变性67例患者病因分析  

The causes of misdiagnosis in 67 patients with exudative age-related macular degeneration

作　　者：曹绪胜[1] 周辉[1] 周海英[1] 陈凤华[1] 彭晓燕[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730

出　　处：《眼科》2010年第1期50-53,共4页Ophthalmology in China

摘　　要：目的探讨临床上误诊为渗出型老年性黄斑变性(AMD)的常见病因及其临床特点。设计回顾性病例系列。研究对象初诊时诊为渗出型AMD而最终诊断为其他眼底病的67例患者。方法患者初诊时均接受病史询问,裂隙灯显微镜、双目间接检眼镜等常规检查,并得出初步诊断。全部患者均接受眼底荧光素血管造影(FA)检查,根据病情需要,部分患者接受吲哚青绿血管造影(ICGA)、相干光断层扫描(OCT)检查。6例患者随访时间超过3个月。结合辅助检查结果和疾病转归特点得出患者的最终诊断。主要指标发生误诊的常见病因及其临床特点。结果误诊为渗出型AMD的疾病包括黄斑小分支静脉阻塞25例(37.3%)、视网膜大动脉瘤20例(29.9%)、中心性浆液性脉络膜视网膜病变(CSC)16例(23.9%)以及血管样条纹并发脉络膜新生血管形成(CNV)6例(9.0%)。黄斑小分支静脉阻塞患者中,22例(88%)病程均大于3个月。眼底彩像显示受累区域视网膜水肿,视网膜出血多呈散在点状。视网膜大动脉瘤患者眼底彩像显示动脉管壁膨隆部位因出血遮挡或与陈旧出血紧贴而难以分辨,而FA和(或)ICGA有助于发现病变部位。全部CSC患者均为慢性CSC,ICGA有助于确诊。血管样条纹并发CNV患者眼底彩像视盘周围放射状条纹显示欠清,ICGA晚期使其显示较清楚。结论掌握容易误诊为渗出型AMD常见疾病的种类及其临床特点,并结合相关的辅助检查有助于正确诊断。Objective To analyse the causes and clinical characteristics of the diseases misdiagnosed as exudative age-related degeneration （AMD）. Design Retrospective case series. Participants 67 patients with initial diagnosis of exudative AMD, really without AMD. Methods The initial diagnosis was based on medical record inquest, slit lamp microscope and bionocular indirect ophthalmoscopic examination. All the patients received fundus fluoresceine angiography （FA） examination. 38 patients were examined with indocyanine green angiography （ICGA）, and 22 patients with optical coherence tomography （OCT） according to the situation. 6 patients were followed up more than 3 months. The definitive diagnosis was made based on auxiliary examination results and the prognosis of diseases. Main Outcome Measures The causes and clinical characteristics of the misdiagnosed diseases. Results The diseases misdiagnosed as AMD included macular branch retinal vein occlusion in 25 eases （37.3%）, retinal macroaneurysms in 20 cases （29.9%）, central serous chorioretinopathy （CSC） in 16 cases （23.9%）, and CNV associated with angioid streaks in 6 cases （9.0%）. Of the macular branch vein occlusion patients, the courses of disease were more than 3 months in 22 patients （88%）, and with retinal edema and punctiform retinal hemorrhage in the involved area on the fundus color photographs. Of the patients with retinal macroaneurysms, the retinal arteriole dilation was difficuh to discern because the aneurysm was completely obscured by the hemorrhage or close to the old hemorrhage, and FA and/or ICGA were helpful for finding it. All the CSC patients were chronic, and ICGA was helpful for the definitive diagnosis, Radial lines that surrounded the optic disc on the fundus photographs were blurred in CNV associated with angioid streaks patients, and the late images of ICGA were helpful to differentiate them. Conclusion To master the common causes and its clinical characteristics of the diseases misdiagnosed as AMD, and co

关 键 词：老年性黄斑变性 渗出型/诊断 

分 类 号：R770.4[医药卫生—眼科]