息肉样脉络膜血管病变伴视网膜色素上皮撕裂的临床特征  

Clinical features of polypoidal choroidal vasculopathy with retinal pigment epithelium tears

作　　者：于珊珊[1] 杨诚[1] 袁敏而[1] 闫宏[1] 欧杰雄[1] 梁小玲[1] 

机构地区：[1]中山大学中山眼科中心眼科学国家重点实验室,广州510060

出　　处：《中华眼底病杂志》2012年第5期458-461,共4页Chinese Journal of Ocular Fundus Diseases

基　　金：广东省科技计划项目（2007B031505008）;广东省科技计划项目（2009B060700106）

摘　　要：目的观察息肉样脉络膜血管病变（PCV）伴视网膜色素上皮（RPE）撕裂的临床特征。方法临床确诊为PCV伴RPE撕裂的12例患者12只眼纳入研究。其中，男性8例，女性4例；年龄39～71岁，平均年龄58．6岁。均为单眼发病，其中右眼8只，左眼4只。12只眼中，浆液性RPE脱离1只眼，出血性RPE脱离11只眼。所有患者均行眼底照相、荧光素眼底血管造影（FFA）及吲哚青绿血管造影（ICGA）检查，3例患者同时行光相干断层扫描（OCT）检查。以血管弓为界，将RPE撕裂区位置分为血管弓内、血管弓上及血管弓外。根据撕裂区的形状分为新月形、半月形及不规则形。观察患者眼底、FFA、ICGA及0cT表现特征。结果眼底检查发现，RPE撕裂区呈灰白色病灶。12只眼中，RPE撕裂区位于血管弓内4只眼，占33．3％；血管弓上5只眼，占41．7％；血管弓外3只眼，占25．0％。RPE撕裂区形状为新月形1只眼，占8．3％；半月形10只眼，占83．3％；不规则1只眼，占8．3％。FFA检查发现，所有患者表现为早期RPE撕裂区可见透见脉络膜荧光，晚期病灶内呈强荧光、边缘锐利。早晚期均无荧光渗漏，RPE撕裂区边缘可见卷曲皱缩的遮蔽荧光。ICGA检查发现，早期可见RPE撕裂区清晰的透见荧光，缺乏毛玻璃样荧光；晚期9只眼可见RPE撕裂区边缘清晰的分界线，卷曲皱缩的遮蔽荧光。行OCT检查的3只眼，其RPE撕裂区均可见RPE光带断裂缺失，边缘可见RPE层卷边的强反射区。结论PCV伴RPE撕裂区多呈半月形，多位于血管弓内及血管弓上。血管造影检查可见RPE撕裂区呈透见荧光，边缘呈卷曲皱缩的遮蔽荧光。OCT检查可见RPE撕裂区RPE光带断裂缺失，断裂的边缘RPE层卷边呈卷曲的强反射带。Objective To observe the clinical features of polypoidal choroidal vasculopathy （PCV） with retinal pigment epithelium （RPE） tears. Methods Twelve patients of PCV with RPE tears （12 eyes） were enrolled in this study. The patients included eight males and four females, with a mean age of 58.6 years （from 39 to 71 years old）. All the patients were affected unilaterally, including eight right eyes and four left eyes. There were one eye with serous RPE detachment and 11 eyes with hemorhagic RPE detachment. All the patients were examined for fundus photography, fundus fluorescein angiography （FFA） and indocyanine green angiography （ICGA）, three patients were examined for optical coherence tomography （OCT）. The location of RPE tear was classified as within vascular arcade, on vascular arcade, and outside vascular arcade. The shape of tear was classified as crescent, semilunar, or irregular. The features of fundus, FFA, ICGA and OCT were observed. Results Fundus examination presents a gray lesion in all eyes. The location of tear were within vascular arcade in four eyes （33.3%）, on vascular arcade in five eyes （41.7%） and outside vascular arcade in three eyes （25.0%）. The shape of tears were crescent （one eye, 8.3%）, semilunar （ten eyes, 83.3%） or irregular （one eye, 8.3%）. The RPE tear region present transimitted fluorescence of at the early stage of FFA and hyperfluorescence with a clear border at late stage. There was no leakage, and at the border of hyperfluorescence, blockage fluorescence of rolled and contracted RPE was present. In ICGA manifestation, transimitted fluorescence was found in RPE tear region at early stage, and a clear border was seen in nine eyes at late stage. There was also blockage fluorescence in ICGA of contracted RPE. In OCT manifestation, the RPE reflections were disappeared, and at the margin of tear, the contracted RPE present a dense rolled strong reflection. Conclusions In PCV patients, RPE tears are semilunar and usually located within o

关 键 词：脉络膜疾病/诊断 色素上皮 眼/损伤 荧光素血管造影术 吲哚花青绿/诊断应用 

分 类 号：R773.4[医药卫生—眼科]