15例多发性大动脉炎眼底观察  

Clinical analysis of ocular fundus change in 15 cases Takayasu arteritis

作　　者：苏莉[1] 黄厚斌[2] 

机构地区：[1]甘肃省中医院眼科,兰州730050 [2]解放军总医院眼科,北京100853

出　　处：《中华眼视光学与视觉科学杂志》2014年第12期757-761,共5页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的 分析多发性大动脉炎眼底改变的视网膜微血管特征.方法 系列病例研究.收集多发性大动脉炎患者15例,均为女性,平均年龄（26.0±9.0）岁,所有患者均行眼科常规检查,包括视力、屈光、眼压、裂隙灯显微镜、眼底照相.12例行FFA,重点观察FFA表现,分析其眼底病变的特点.结果 15例患者中发病29眼（占97％）,正常1跟（占3％）,其中表现为缺血性眼底改变24眼（占80％）,表现为高血压性眼底改变5眼（占17％）.微动脉瘤是缺血型眼底病变的早期表现,且具有一些特征性的分布：广泛分布于周边部或中周部,大小基本一致,分布均匀,有向周边部分布更加密集的趋势.无灌注区广泛,从周边向视盘进行性发展.无灌注区边缘出现广泛的动静脉吻合,呈特征性的花冠状.晚期容易出现视盘新生血管,但没有视网膜新生血管.结论 多发性大动脉炎性眼底病变主要表现为缺血性眼底病变和高血压性眼底病变,以前者多见,这种慢性视网膜缺血具有一些特征性的眼底改变.2种病变也可同时表现于一眼眼底.Objective To analyze the retinal microvascular characteristics in the ocular fundus of Takayasu arteritis patients.Methods Fifteen female patients with Takayasu arteritis with an average age of 26.0±9.0 years were enrolled in a cases series study.All patients received routine ophthalmologic examinations,including visual acuity,refraction,intraocular pressure,slit lamp,and fundus photography.Twelve patients underwent fundus fluorescein angiography （FFA）.Observation was mainly made on the performance of FFA in order to analyze the characteristics of their fundus changes.Results Of the 15 patients,29 eyes （97％） presented with disease and 1 eye （3％） was normal.Twenty-four eyes （80％） showed ischemic retinopathy,and 5 eyes （17％） showed hypertensive retinopathy.Microaneurysm is the early manifestation of ischemic retinopathy with characteristics such as wide distribute peripherally and mid-peripherally with almost the same size and homogeneous distribution,yet there is a tendency for dense distribution towards the peripheral retina.A diffuse non-perfusion area presents progressive development from peripheral areas towards the optic disk.Extensive arteriovenous anastomosis appears at the edge of the non-perfusion area,demonstrating a characteristic corollaceous shape.In the advanced stage,new vessels on the disc are very common,without new vessels elsewhere.Conclusion Ocular fundus manifestation of Takayasu arteritis can mainly be categorized into two types：ischemic retinopathy and hypertensive retinopathy.While the former is more common,there are some characteristic changes in chronic arterial ischemia retinopathy.Both can occur in one eye simultaneously.

关 键 词：TAKAYASU动脉炎 缺血性眼底病变 高血压性眼底病变 

分 类 号：R543.5[医药卫生—心血管疾病]