息肉状脉络膜血管病变的随访观察  

Clinical observation of polypoidal choroidal vasculopathy

作　　者：邹文军[1] 文峰[2] 武志峰[1] 黄时洲[2] 张洁[1] 罗光伟[2] 

机构地区：[1]南京医科大学附属无锡第二人民医院眼科,214002 [2]中山大学中山眼科中心

出　　处：《中华眼科杂志》2011年第1期39-44,共6页Chinese Journal of Ophthalmology

基　　金：国家重点基础研究发展计划（2007CB512206）

摘　　要：目的 观察息肉状脉络膜血管病变（PCV）患者的临床特征及其视力预后情况.方法 回顾性病例系列研究.对经眼底彩色照相、荧光素眼底血管造影及吲哚氰绿血管造影等确诊的45例（51只眼）PCV患者的临床资料进行回顾性分析,包括患者年龄、随访前视力、有无脉络膜视网膜病变、病灶面积、病灶是否累及黄斑中心凹、随访期间病灶消退且无新病灶出现等6项因素.对患者随访期间视力变化情况进行多因素相关回归分析.结果 45例（51只眼）PCV患者随访时间6～18个月,平均随访（11.1±2.0）个月.随访期间病变区出血、渗出增多者15只眼（29.4%）,出血、渗出减少者25只眼（49.0%）,盘状瘢痕与萎缩改变者分别为5只眼（9.8%）和6只眼（11.8%）.视力增加、稳定及下降者分别为11（21.6%）、21（41.2%）及19（37.2%）只眼.息肉状病灶累及黄斑中心凹者25只眼（49.0%）,未累及者26只眼（51.0%）.在病程进展过程中,息肉状病灶部分消退18只眼（35.3%）,稳定不变13只眼（25.5%）,扩大和新生13只眼（25.5%）,消退和新生并存7只眼（13.7%）.患者视力变化与年龄、随访前视力、息肉状病灶累及黄斑中心凹诸因素相关（b=-0.005,0.382,-0.430;P=0.034,0.000,0.000）,视力提高与息肉状病灶累及黄斑中心凹（b=-2.957,P=0.013,OR=0.052）、息肉状病灶消退且无新病灶出现相关（b=2.259,P=0.019,OR=9.578）.结论 PCV患者视力预后情况不同,年龄小者随访前视力较好;息肉状病灶未累及黄斑中心凹者随访视力相对较好,其中无新病灶出现者,随访期间视力提高的可能性较大.脉络膜视网膜病变情况和病灶面积不能作为判断预后的敏感指标.Objective To observe the natural course and evaluate the prognostic factors influencing the follow-up visual acuity of polypoidal choroidal vasculopathy （PCV）. Methods It was a retrospective case series. Forty-five consecutive patients （51 eyes） who were diagnosed with PCV by fundus photography,fundus fluorescein angiography （FFA） and indocyanine green angiography （ICGA） were followed up with （11.1 ± 2. 0 ）months （mean ± SD ）. Age, baseline visual acuity, the presence of pigment epithelium detachment （PED）, lesion size, the polypoidal lesions involving the fovea and the regression of polypoidal lesions were recorded. Multi-factor regression analysis of visual acuity at follow up was applied with SPSS 16. 0 statistics software. Results Among the 45 patients （51 eyes）, the hemorrhage or exudation were increased in 15 eyes （29. 4% ）, decreased in 25 eyes （49. 0% ）, 5 eyes （9. 8% ） developed macula scar and 6 eyes （11.8%） macula atrophy . During the follow-up period, the visual acuity was improved in 11 eyes （21.6%）, stable in 21 （41.2%） and regressed in 19 （37. 2% ）. Twenty-five eyes （49.0%）demonstrated polypoidal lesions involving the fovea and 26 eyes （51.0%） did not. ICGA revealed that the polypoidal lesions were unchanged in 18 eyes （ 35. 3% ）, regressed in 13 （ 25.5% ）, grew in 13 （25.5%）, and mixed in 7 eyes （ 13.7% ）. The changes of visual acuity at follow up were related to the age, baseline visual acuity, and polypoidal lesions involving in the fovea （ b = - 0. 005, 0. 382 and - 0. 430 ;P = 0. 034, 0. 000 and 0. 000）. Improvement of visual acuity at follow up was related to the regression of polypoidal lesions （ b = 2. 259, P = 0. 019, OR = 9. 578）. Conclusions There is a large variation in the visual prognosis in Chinese patients with PCV. The presence of PED and the lesion size had no effect on the visual prognosis of PCV. Better visual acuity during follow-up period is correlated with younger age, better baselin

关 键 词：脉络膜疾病 血管疾病 色素上皮 眼 随访研究 

分 类 号：R773[医药卫生—眼科]