老年性黄斑变性的吲哚青绿脉络膜血管造影分析（附42例报告）

为探讨吲哚青绿血管造影（ICGA）对老年性黄斑变性（AMD）的诊断价值,应用德国产扫描激光检眼镜对AMD患者42例（70眼）进行了眼底荧光素血管造影（FFA）和ICGA,对比分析其图像特征。结果显示：①28眼为萎缩型AMD,其中16眼FFA仅有透见荧光或无明显改变,而ICGA则出现簇状强荧光点。②42眼为渗出型AMD,其中FFA诊断为典型脉络膜新生血管（CNV）12眼（占28．6％）,隐匿性CNV30眼（占71．4％）;ICGA诊断为典型CNV25眼（占59．5％）,典型CNV伴明显供养血管8眼。③FFA诊断为隐匿性CNV的30眼中,ICGA诊断为典型CNV13眼（占43．3％）。提示ICGA可提高AMD典型CNV的诊断率,发现CNV的供养血管,从而扩大了激光光凝治疗AMD的范围;另外,ICGA还可了解萎缩型AMD的病变程度。     

眼底荧光血管造影在老年黄斑变性诊断中应用

目的 探讨眼底荧光血管造影（ＦＦＡ）在老年黄斑变性诊断中的应用价值。方法 用Ｋｕｗａ ｆｘ－５００型眼底照相机对黄斑变性（ＡＭＤ）患者进行ＦＦＡ检查,并结合临床其他检查进行分析。结果 ５１例ＡＭＤ患者６５只眼中,萎缩型４２只眼（６４．６％）,渗出型２３只眼（３５．４％）。萎缩型表现均为点状或斑驳样透见荧光,未见荧光素渗漏。渗出型早期可见脉络膜新生血管形态（ＣＮＶ）,晚期大量荧光素渗漏,周围有出血者     

彩色多普勒超声检测老年性黄斑变性脉络膜分水带区血流动力学特点

目的探讨老年性黄斑变性(AMD)黄斑区脉络膜分水带区(CWZ)的血液流体力学特点。方法选择渗出型AMD 40例,其中有脉络膜新生血管(CNV)47只眼,萎缩型AMD 10例20只眼;另选取年龄与AMD患者相匹配的无AMD患者40例80只眼作为对照组。AMD组、对照组均行眼底照相、荧光眼底造影(ICGA)、吲哚菁氯脉络膜造影、彩色超声Doppler血流检查和血液黏滞度检查并进行统计学分析。结果 AMD组和对照组相比全血黏滞度升高(P<0.01),渗出型AMD与萎缩型AMD相比全血黏滞度升高(P<0.01)。渗出型AMD组与萎缩型AMD及对照组比较,渗出型AMD组CWZ区的颞侧睫状后短动脉的血流速度下降、血流阻力增加(P<0.01)。结论渗出型AMD黄斑脉络膜CWZ可能存在脉络膜灌注障碍。     

内窥镜与荧光造影术在颅内动脉瘤手术中的初步应用

显微镜下吲哚青绿造影(mICG-VA)在颅内动脉瘤手术中已被广泛应用,降低了不完全夹闭动脉瘤和周围血管闭塞的发生率。但mICG-VA受显微镜下视野和位置较深动脉瘤的局限,包括动脉瘤囊或瘤颈后方。由于这些部位被动脉瘤、动脉瘤夹或周围结构遮盖,通常术者很难充分地评估动脉瘤的整体情况,而内窥镜下的视野更开阔。但目前神经外科领域的内窥镜应用只限于提供影像数据。比利时的专家们首次将吲哚青绿荧光造影与内窥镜技术相结合(eICG-VA),应用于前交通动脉动脉瘤夹闭术。这种新技术可以提供动脉瘤闭塞、载瘤动脉、分支血管和小穿支的相关信息。     

高龄患者行吲哚青绿荧光素钠眼底血管造影致过敏二例

1临床资料 例1,女性,80岁,因双眼视力下降20d,于2002年3月来我院眼科就诊,视力检查:右眼0.3,左眼0.5,眼压:双眼14 mm Hg(1 mm Hg=0.133 kPa).双眼晶体轻度混浊,黄斑区色素紊乱,中心凹反射消失,颞下有数个散在大小不等玻璃膜疣.初步诊断:双眼老年性黄斑变性.为进一步诊断行吲哚青绿脉络膜血管造影(indocyanine green angiography,ICGA)和荧光素钠视网膜血管造影(fundus fluorescein angiographyFFA).造影检查前详细询问病史,患者有糖尿病10年,无药物过敏史,无荧光眼底血管造影史,心电图检查结果正常,肝肾功能正常,按常规程序操作,先在前臂用吲哚青绿试验液做划痕皮试,20min后观察划痕处,无过敏反应,经肘前静脉缓慢注入1%荧光素钠稀释液5ml观察未见过敏反应,即刻注入25mg吲哚青绿粉剂加注射用水3ml溶解液和20%荧光素钠注射液3 ml混合快速推入,注射完后无不良反应.但造影进行至5 min 15 s时患者突然出现恶心胸闷,心前区不适,面色苍白,双腿瘫软,即刻平卧吸氧,肌肉注射地塞米松20ml,肾上腺素1 mg,注射时患者出现意识不清,抽搐,尿失禁,呼吸表浅25次/min,脉搏微弱96次/min.血压80～40mm Hg.用药10 min后病情逐渐平稳,意识恢复,面色转为红润,心率76次/min.给患者口服温开水,继续观察3 h血压,脉搏,呼吸直至正常.     

年龄相关性黄斑变性中药治疗的研究进展

正年龄相关性黄斑变性(ARMD)是因视网膜色素上皮细胞与视网膜退行性病变导致的不可逆性视力下降、致盲的眼部疾病~([1])。每年全球约有3 000万老年患者罹患老年性黄斑病变,其中约有50万患者失明~([2])。ARMD主要分为两大类,即萎缩型ARMD与渗出型ARMD,其中前者主要以视力进行性下降、黄斑区色素紊乱、脉络膜毛细血管萎缩、玻璃膜疣等为主要表现;后者以单眼发病、脉络膜新生血管生成为主要特点,此外其还会引起眼部渗血、出血、机化等系列病理改变~([3,4])。临床针对该病的治疗,方法     

探讨眼底荧光血管造影在糖尿病性视网膜病变诊断及治疗中的应用价值

目的研究眼底荧光血管造影在诊断与治疗糖尿病性视网膜病变中的应用价值。方法对糖尿病患者拟诊为视网膜疾病的500例患者的临床资料进行分析,患者实施检眼镜检查后进行荧光素眼底血管造影,对患者的视网膜病变情况进行诊断与分级,并根据诊断结果进行治疗。结果 965只眼中,检眼镜检查后共有670只眼发生视网膜病变,病变率为69.43%,其中I期、II期、III期、IV期、V期分别为220只、135只、147只、85只、83只;荧光素眼底血管造影后存在视网膜病变的眼有868只,病变率为89.95%,其中I期、II期、III期、IV期、V期分别为288只、210只、173只、103只、94只;荧光素眼底血管造影的诊断正确率明显高于检眼镜检查,(P0.05)差异存在统计学意义。结论在糖尿病患者视网膜病变的检查中,眼底荧光血管造影的检出率较高,能够进行分期,是进行疗效评价与指导治疗的重要手段,应用价值显著。     

不同浓度吲哚菁绿在胆囊手术中的应用及其对肝功能的影响

目的探讨在胆囊手术中应用不同浓度吲哚菁绿进行荧光造影的效果及其对患者肝功能的影响。方法选取我院2016年3月—2017年5月收治的行胆囊手术患者60例,将其按照随机数字表法分为对照组和研究组各30例,所有患者均应用吲哚菁绿进行荧光造影,其中高浓度为对照组,低浓度为研究组。结果两组患者的血管显影、血管消退、胆管显影、胆管消退时间均没有明显区别出现(P0.05);治疗前两组患者的肝功能并没有明显区别出现(P0.05),经过治疗后研究组患者肝功能情况显著优于对照组患者(P0.05);研究组不良反应发生率为16.7%明显高于对照组患者的66.7%(P0.05);两组患者的住院时间、术中出血量、排便时间、排气时间以及手术时间没有明显区别出现(P0.05)。结论应用不同浓度的吲哚菁绿对胆囊手术患者进行造影的效果差异并不明显,较低的浓度就能够达到很好的效果,且高浓度吲哚菁绿还可能会影响患者的肝功能,所以低浓度吲哚菁绿值得进一步推广及应用。     

120例中心性浆液性脉络膜视网膜病变的眼底荧光血管造影分析

作者对120例中心性浆液性脉络膜视网膜病变患者125只眼,进行了眼底荧光血管造影,对异常荧光的分类、位置,神经上皮脱离渗漏点形态、大小、数目和荧光渗漏与检眼镜下黄斑部水肿的相应关系进行了观察研究。结果表明,此项新技术不仅反映出眼底病灶形态学改变,而且能独特地显示病变渗漏的动力学变化,能动态观察病变的演变过程。     

视神经炎18例护理体会

近年来,我院收治视神经炎患者１８例。现把护理体会报告如下。 临床资料：本组１８例２６只眼中,男１０例,女８例;年龄２０～５２岁;双眼８例,单眼１０例;急性球后视神经炎５例８只眼,慢性球后视神经炎１１例１６只眼,其他２例２只眼。病程最长４２天,最短５天。全部病例治疗前后都进行视力、视野、眼底、眼底荧光血管造影,治疗前视力低于１．０者２４只眼,视神经乳头充血水肿者２６只眼,中心视野生理盲点扩大２３只眼,眼底荧光血管造影视盘荧光渗漏者２６只眼。方法：寻找病因,清除病灶,及时给予皮质类固醇静滴或球后注射…     

Choroidal neovascularization secondary to half-dose photodynamic therapy for chronic central serous chorioretinopathy: A case report

Rationale:Half-dose or reduced-fluence photodynamic therapy (PDT) with verteporfin has been well acknowledged to be the most effective and permanent treatment with very low rates of complications. However, we report a case of chronic central serous chorioretinopathy (CSC) who developed choroidal neovascularization (CNV) secondary to half-dose PDT within only 3 weeks. Such an occurrence following this short a course of treatment has not been reported previously.Patient concerns:A 46-year-old Chinese man who had been diagnosed as acute more than 1 year ago revisited our department recently and complained of blurred vision again in his left eye.Diagnoses:Fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA) revealed patchy hyperfluorescent dots and optical coherence tomography (OCT) indicated irregular flat pigment epithelium detachment (PED) in the central macula. The patient was diagnosed with chronic CSC.Interventions:The patient was treated by half-dose PDT with verteporfin. Three weeks later, the patient complained of sudden blurred vision and fundus examination showed macular hemorrhages with a best-corrected visual acuity (BCVA) of 20/250. OCT angiography (OCTA) showed a distinct area of flower-like CNV located within the deep retinal slab. Secondary CNV had developed after a quite short course of half-dose PDT treatment. Subsequently, the patient was administered by 2 intravitreal injections of aflibercept (2 mg).Outcomes:Two months after the second intravitreal injection, macular hemorrhages and secondary CNV were completely resolved, and the BCVA improved to 20/25.Lessons:Patients of chronic CSC with irregular PED who undergo PDT should be warned of secondary CNV within a short course after treatment. If happened, it should be treated by intravitreal injections of anti-vascular endothelial growth factor agents as soon as possible.     

贝伐单抗抑制脉络膜新生血管的实验研究

目的 建立氪激光引导的棕色挪威大鼠(BN)脉络膜新生血管(choroidal neovascularization,CNV)模型,观察3周内CNV的生长情况,对贝伐单抗治疗试验性CNV的疗效做初步探讨.方法 对4组48只BN大鼠单眼进行氪激光光凝,建立CNV模型,随机分为治疗组和对照组.1周后,经眼底荧光血管造影(FFA)证实有CNV形成,药物治疗组玻璃体腔内注射1 μl贝伐单抗(25 μg/1 μl),对照组则在光凝眼行玻璃体腔内注射平衡盐溶液1 μl.注射后1、2、3周行FFA检查,造影早期计算CNV面积.在上述各时间点各处死大鼠6只,摘除眼球,制作石蜡切片.免疫组化对FⅧ-Rag蛋白的表达进行半定量检测.结果 在EN大鼠CNV动物模型采用玻璃体腔内注射1 μl贝伐单抗(25 μg/1 μl)后,1、2、3周分别与对照组进行比较,CNV面积及荧光渗漏明显降低(P＜0.01),FⅧ-Rag蛋白表达较对照组降低(P＜0.01);其中给贝伐单抗后第2周新生血管面积为(0.920±0.634)mm2,FⅧ-Rag蛋白表达量为35.57±10.52,对照组分别为(2.489±0.590)mm2和175.37±25.20,表明CNV的形成较对照组明显降低.结论 玻璃体腔内注射贝伐单抗可以抑制氪激光诱导的BN大鼠CNV的形成和发展.     

眼底荧光血管造影对早期诊断糖尿病性视网膜病变的意义

目的研究眼底荧光血管造影(FFA)对糖尿病性视网膜病变(DR)早期诊断的临床价值。方法选取2017年2月-2019年2月该院完成FFA检查的T2DM患者87例(174眼)临床资料进行回顾性研究,分析FFA图像特征并以临床诊断结果为金标准,探讨其诊断和分期准确性。结果 174眼中FFA检查诊断为DR者135眼(77.59%),其中非增生性DR 38眼(28.15%),增生前DR 41眼(30.37%),增生性DR 35眼(25.93%),糖尿病性黄斑病为16眼(11.85%),糖尿病性视神经乳头病变5眼(3.70%);与临床诊断结果相比,FFA检查诊断灵敏度为94.20%,特异度为86.11%,阳性预测值为96.30%,阴性预测值为79.49%,准确率为92.53%,一致性Kappa值为0.779;FFA检查和临床诊断对DR分期结果差异无统计学意义(P>0.05)。结论 FFA用于DR早期诊断不仅准确率较高,同时还有助于病情严重程度判断,为治疗方案选择提供参考信息。     

Bilateral retinal pigment epithelial tears in acute central serous chorioretinopathy without bullous retinal detachment: A case report

Rationale:Several reports have described retinal pigment epithelial (RPE) tears in central serous chorioretinopathy (CSC). However, there have been no reports of spontaneously large RPE tears in acute CSC without bullous retinal detachment (RD). Herein, we report and provide sequential images of a case of bilateral spontaneous large RPE tears in patient with acute CSC without bullous RD.Patient Concerns:An 88-year-old female patient was admitted with impaired vision in both eyes, which began 10 days prior. The visual acuity was 0.4 and 0.5 in the right and left eye, respectively. She had started taking oral steroids 2 weeks prior for polymyalgia.Diagnosis:Ophthalmologic examinations, including fundus photography, optical coherence tomography, and fluorescence angiography, were performed, and she was diagnosed with steroid-induced acute CSC in both eyes with large pigment epithelial detachment (PED) of approximately 4-disc diameter. Discontinuation of steroids and follow-up ophthalmic examinations were performed. However, a spontaneous large RPE tear occurred in the right eye.Interventions:We performed follow-ups more frequently and CSC treatment such as laser photocoagulation, photodynamic therapy, and anti-vascular endothelial growth factor injections were not performed.Outcomes:Nine months later, a spontaneous large RPE tear occurred sequentially in the left eye. Her final visual acuity was 0.3 and 0.15 in the right and left eye, respectively.Lessons:Patients may spontaneously develop large RPE tears in both eyes, despite no treatment for acute CSC with non-bullous RD. Large PED and old age may affect this. Therefore, for a CSC patient with a large PED and advanced age, attention must be paid when determining treatment.     

Optical coherence tomography angiography for the diagnosis of granulomatosis with polyangiitis with serous retinal detachment: A case report

Rationale:Granulomatosis with polyangiitis (GPA) is a rare systemic autoimmune disease of unknown etiology. GPA affects multiple ocular tissues, most commonly the orbit, conjunctiva, cornea, and sclera. Retinal and choroidal manifestations are rare in GPA, but they often include choroidal neovascularization (CNV).Patient concerns:A 36-year-old man was diagnosed with GPA. He had been taking oral steroid treatment for 8 years. He experienced disease recurrence and the dose of oral prednisolone was increased after steroid pulse therapy. Fundus examination showed small retinal pigment epithelial detachment and serous retinal detachment (SRD). Optical coherence tomography (OCT) revealed a protruded lesion inside the SRD. Fluorescein angiography (FA) showed a small, dot-shaped fluorescein leakage in the SRD, and indocyanine green fluorescein fundus angiography showed choroidal vascular hyperpermeability that was consistent with the hyperfluorescence seen with FA. We had to determine whether the protruded lesion inside the SRD was CNV secondary to the inflammation due to GPA or whether it was central serous chorioretinopathy (CSC)-like condition caused by high-dose steroid treatment.Diagnoses:We confirmed that the SRD was due to CSC but not CNV because the protruded lesion examined by B-scan OCT angiography (OCTA) showed no blood flow.Interventions:We decided to reduce the dose of steroid.Outcomes:Since the reduction of steroids, no sign of worsening in the protruded lesions with SRD has been observed.Lessons:We therefore propose the effectiveness of this advanced function of OCTA for the examination of blood flow signal images to detect CNV.     

To evaluate the microcirculation of retinochoroid capillary between acute and chronic central serous chorioretinopathy with OCTA

To investigate the difference in chorioretinal microcirculation between acute central serous chorioretinopathy (aCSC) and chronic central serous chorioretinopathy (cCSC) using optical coherence tomography angiography.In total, 65 patients previously diagnosed with central serous chorioretinopathy (33 aCSC and 32 cCSC) were included in our cross-sectional study. All patients underwent complete ophthalmologic assessment including logarithm of the minimum angle of resolution best-corrected visual acuity, fundus fluorescein angiography, and optical coherence tomography angiography. Sixty eyes of 60 refractive error and age matched healthy people were selected as control.The vessel density of inner retina in patients with aCSC were higher than that in patients with cCSC (51.32 ± 2.01 vs 49.15 ± 3.68, P = .004), however, the vessel density of superficial choroid layer in aCSC were significantly lower than that in cCSC (49.83 ± 6.96 vs 53.42 ± 6.28, P = .033). Further analysis of the data reveals the presence of a distinct choroidal neovascularization (CNV) in 8 patients (25%) with cCSC while there was no evidence of CNV in patients with aCSC.Our study can contribute to a better understanding of the difference in retinochoroid microcirculation between aCSC and cCSC. The vessel density of inner retina was lower and the vessel density of superficial choroid was higher in cCSC, and patients with cCSC were more susceptible to CNV than patients with aCSC.     

Choroidal osteoma masquerading as central serous chorioretinopathy

We report a rare case of choroidal osteoma masquerading as central serous chorioretinopathy. A 39-year-old man complained of intermittent episodes of blurred vision in the left eye for 2 months. Fundus examination of the left eye showed a dome-shaped elevation at the macular center. Fluorescein angiography showed a patch of pinpoint leakage resulting in a well-defined pool of dye at the macular center. Initial diagnosis was recurrent central serous chorioretinopathy with sequelae in the left eye. Five months later, serous detachment recurred. Computerized tomography and ultrasonography showed a bony plaque at the choroid level, and choroidal osteoma was diagnosed.     

Choroidal retinal anastomosis in age-related macular degeneration as demonstrated by fluorescein angiography--a case report

Pathological choroidal retinal anastomosis is relatively rare. It has been described in age-related macular degeneration (AMD) with fibrous scarring or occult pigment epithelial detachment or actively proliferating classic choroidal neovascular membrane (CNV). We report a case of disciform macular scar with the occurrence of a choroidal retinal anastomosis, which directed blood flow from an occult choroidal neovascular membrane into a retinal vein through the fovea in a 52-year-old female with unilateral AMD. Fluorescein angiography (FA) clearly demonstrated the anastomosis.