息肉状脉络膜血管病变的临床特征分析

目的观察息肉状脉络膜血管病变(PCV)的眼底表现及荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)与相干光断层扫描(OCT)特征。方法分析经眼底检查、FFA、ICGA及OCT确诊的PCV患者16例(16只眼)的眼底图像资料。其中OCT检查资料为8例(8只眼)。结果 16例(16只眼)全部为单眼发病,其中男性10例,占62.5%,女性6例,占37.5%。年龄36～75岁,平均年龄63.4岁。眼底检查14只眼病变部位位于黄斑区,占87.5%,2只眼病变位于视盘颞侧,占12.5%。在黄斑区4只眼见橘红色结节样隆起病灶,13只眼视网膜下有出血,11只眼见脂质沉着。FFA检查16只眼早期均呈强荧光,后期进行性渗漏。其中6只眼表现血液性视网膜色素上皮脱离(PED),1只眼为浆液性PED,2只眼为血液性合并浆液性PED,1只眼呈脉络膜血管网及息肉样结构。ICGA检查16只眼均可见强度不等、簇状或孤立的息肉状扩张灶,其中12只眼可见伞样或树枝样异常扩张的脉络膜血管网。OCT检查8只眼显示7只眼视网膜色素上皮(RPE)和脉络膜毛细血管高反射层呈穹隆状隆起,其下可见结节状改变。1只眼无脉络膜毛细血管高反射层改变。6只眼表现血液性PED,2只眼为浆液性PED合并神经上皮脱离。结论 PCV单眼发病为主,好发部位为黄斑区,最常见表现为视网膜下出血及脂性渗出,部分患眼存在PED。大部分患眼ICGA可见特征性的脉络膜血管网及其末梢的息肉状扩张灶。     

息肉状脉络膜血管病变的眼底血管造影表现

目的 观察息肉状脉络膜血管病变(PCV )的临床特征及眼底血管造影表现。 方法 回顾分析12例PCV患者12只眼的眼底检查、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)及其5例5只眼的光相干断层扫描(OCT)检查资料。 结果 12只眼均可见深层和(或)浅层出血，黄色脂质渗出。其中6只眼病变处见橘红色病灶，2只眼伴视网膜前出血。FFA检查，静脉期6只眼橘红色病灶内点状荧光，4只眼病变处可见脉络膜血管网。晚期均见息肉状强荧光点荧光素渗漏，2只视网膜前出血眼晚期未见荧光素渗漏。ICGA检查，12只眼晚期见强度不等、簇状或孤立的息肉状扩张灶，4只眼显示明显的脉络膜血管网。OCT检查，4只眼视网膜色素上皮（RPE）和脉络膜毛细血管高反射层呈穹窿状隆起，1只眼无改变。 结论 PCV眼底多见黄斑区出血性和(或)浆液性视网膜色素上皮脱离(RPED)和(或)神经上皮脱离，黄色脂质渗出。FFA及ICGA检查可见分支状脉络膜血管网及末梢膨大息肉状扩张灶。 （中华眼底病杂志，2004，20：310-312）     

息肉状脉络膜血管病变的临床特征

目的 观察息肉状脉络膜血管病变（polypoidal choroidal vascu lopathy,PCV）的临床特征 方法 回顾分析1999年8月～2002年10月临床诊断为脉络膜新生血管（choroidal neovascularization,CNV）性疾病的71例连续病例的142只眼的眼底检查、荧光素眼底血管造影（fundus fluorescein angiography,FFA）、吲哚青绿血管造影（indocyanine green angiography, ICGA）及其中9例9只眼的光相干断层扫描（optical coherence tomogra phy, OCT）检查的临床资料。 结果 11例11只眼诊断为PCV，分别占本组 CNV患者71例142只眼的15.49%和7.75%。全部为单眼发病，其中男性7例，占63.6%，女性4例，占36.4%。年龄32 ～75岁，平均年龄62.3岁。检眼镜检查8只眼可见出血性或浆液性视网膜色素上皮脱离（retinal pigment epithelial detachments,RPED），6只眼在黄斑区见结节样隆起病灶，9只眼视网膜下有出血，8只眼见脂质沉着。FFA检查显示脉络膜血管网及息肉样结构7只眼，早期呈边界清楚的强荧光，进行性渗漏，新生血管末梢膨大处出现点状强荧光。出血性RPED 4只眼，出血性同时有浆液性RPED 4只眼。ICGA检查11只眼均可见伞样或树枝样异常扩张的脉络膜血管网，以及血管网末梢多个息肉样膨大，与检眼镜眼底检查所见的结节样病变部位吻合。8只眼脉络膜血管网中心见滋养血管。OCT检查6只眼显示视网膜神经纤维层穹隆状隆起，视网膜色素上皮（retinal pigment epithelium,RPE）和脉络膜毛细血管光带可见结节样改变。3只眼见单纯RPED，5只眼见RPED合并神经上皮脱离。10只眼病变部位位于黄斑区，占90.9%，1只眼病变位于视盘颞侧，占9.1%。 结论 PCV好发于老年男性患者，单眼发病为主。多在黄斑区出现出血性或浆液性RPED及脂质沉着，ICGA可见特征性的伞样或树枝样异常扩张的脉络膜血管网及末梢息肉样膨大病灶。 （中华眼底病杂志，2003，19：269-332     

息肉样脉络膜血管病变的诊断及治疗

息肉样脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)特征是后极部视网膜下桔红色息肉样病变,伴有出血性和浆液性视网膜色素上皮及神经上皮脱离.荧光素眼底血管造影无特征性表现,吲哚青绿血管造影能显示分支血管组成的脉络膜血管网和血管末端息肉样或动脉瘤样扩张.OCT表现为视网膜色素上皮及脉络膜毛细血管高反射层呈陡峭的穹窿状隆起,其下见中等反射或结节状改变.本病应与湿性年龄相关性黄斑变性和某些长期不愈的中心性浆液性脉络膜视网膜病变进行鉴别.尽管PCV的治疗仍缺乏通用的方案,光动力疗法结合玻璃体内注射血管内皮生长因子抑制剂可改善或稳定患者视力.     

急性中心性浆液性脉络膜视网膜病变三维光相干断层扫描图像特征

中心性浆液性脉络膜视网膜病变(CSC)是常见的眼底病变,荧光素眼底血管造影(FFA)可观察到CSC视网膜色素上皮(RPE)水平的"墨渍"状,"炊烟"状等不同状态的渗漏[1].二维光相干断层扫描(OCT)可显示CSC视网膜神经上皮层和RPE脱离反光带等视网膜横截面图像特征[2],但二维OCT只能反映单一视网膜切面,无法提供整个视网膜神经上皮层脱离区域的RPE脱离状况.     

急性中心性浆液性脉络膜视网膜病变三维光相干断层扫描图像特征

中心性浆液性脉络膜视网膜病变(CSC)是常见的眼底病变,荧光素眼底血管造影(FFA)可观察到CSC视网膜色素上皮(RPE)水平的"墨渍"状,"炊烟"状等不同状态的渗漏[1].二维光相干断层扫描(OCT)可显示CSC视网膜神经上皮层和RPE脱离反光带等视网膜横截面图像特征[2],但二维OCT只能反映单一视网膜切面,无法提供整个视网膜神经上皮层脱离区域的RPE脱离状况.     

急性中心性浆液性脉络膜视网膜病变三维光相干断层扫描图像特征

中心性浆液性脉络膜视网膜病变(CSC)是常见的眼底病变,荧光素眼底血管造影(FFA)可观察到CSC视网膜色素上皮(RPE)水平的"墨渍"状,"炊烟"状等不同状态的渗漏[1].二维光相干断层扫描(OCT)可显示CSC视网膜神经上皮层和RPE脱离反光带等视网膜横截面图像特征[2],但二维OCT只能反映单一视网膜切面,无法提供整个视网膜神经上皮层脱离区域的RPE脱离状况.     

急性中心性浆液性脉络膜视网膜病变三维光相干断层扫描图像特征

中心性浆液性脉络膜视网膜病变(CSC)是常见的眼底病变,荧光素眼底血管造影(FFA)可观察到CSC视网膜色素上皮(RPE)水平的"墨渍"状,"炊烟"状等不同状态的渗漏[1].二维光相干断层扫描(OCT)可显示CSC视网膜神经上皮层和RPE脱离反光带等视网膜横截面图像特征[2],但二维OCT只能反映单一视网膜切面,无法提供整个视网膜神经上皮层脱离区域的RPE脱离状况.     

急性中心性浆液性脉络膜视网膜病变三维光相干断层扫描图像特征

中心性浆液性脉络膜视网膜病变(CSC)是常见的眼底病变,荧光素眼底血管造影(FFA)可观察到CSC视网膜色素上皮(RPE)水平的"墨渍"状,"炊烟"状等不同状态的渗漏[1].二维光相干断层扫描(OCT)可显示CSC视网膜神经上皮层和RPE脱离反光带等视网膜横截面图像特征[2],但二维OCT只能反映单一视网膜切面,无法提供整个视网膜神经上皮层脱离区域的RPE脱离状况.     

急性中心性浆液性脉络膜视网膜病变三维光相干断层扫描图像特征

中心性浆液性脉络膜视网膜病变(CSC)是常见的眼底病变,荧光素眼底血管造影(FFA)可观察到CSC视网膜色素上皮(RPE)水平的"墨渍"状,"炊烟"状等不同状态的渗漏[1].二维光相干断层扫描(OCT)可显示CSC视网膜神经上皮层和RPE脱离反光带等视网膜横截面图像特征[2],但二维OCT只能反映单一视网膜切面,无法提供整个视网膜神经上皮层脱离区域的RPE脱离状况.     

息肉状脉络膜血管病变与老年黄斑变性对比分析

目的探讨息肉状脉络膜血管病变(PCV)与湿性老年黄斑变性(AMD)临床特征的区别与联系,以指导临床。方法回顾分析已确诊的PCV及湿性AMD的眼底彩照,荧光素血管造影(FFA),吲哚青绿血管造影(ICGA),光学相干断层扫描(OCT)结果及临床资料。结果PCV15例,年龄48-70岁,平均62.3岁;湿性AMD38例,年龄50-80岁,平均65.8岁。PCV患者眼底视网膜出血、脂质渗出、桔红色结节样病灶分别为11只眼(73.3%)、6只眼(40%)、4只眼(26.7%);AMD患者45只眼中视网膜出血、脂质渗出、青灰色病灶、瘢痕形成分别为25只眼(55.6%)、18只眼(40.0%)、20只眼(44.4%)、3只眼(6.77%)。FFA显示PCV患眼脉络膜息肉状结构、出血性色素上皮脱离(PED)、浆液性PED分别为1只眼(6.7%)、7只眼(46.7%)、2只眼(13.3%),ICGA均可见息肉状扩张病灶(100%);FFA显示AMD患眼典型脉络膜新生血管(CNV)、PED分别为5只眼(11.1%)、14只眼(31.1%),ICGA显示CNV23只眼(51.1%),均未见息肉状结构。PCV的OCT表现为视网膜色素上皮及脉络膜内层呈穹窿状向视网膜神经上皮隆起,其下见结节状改变;AMD则显示视网膜色素上皮和脉络膜毛细血管层呈局部梭形或不规则强反射带。结论PCV与湿性AMD不尽相同,可能是AMD的另一种特殊类型,治疗可能应有所不同,有待于进一步研究。     

Tomographic features of branching vascular networks in polypoidal choroidal vasculopathy

PURPOSE: To identify the tomographic features of the branching vascular networks in patients with polypoidal choroidal vasculopathy (PCV). METHODS: We prospectively performed third-generation optical coherence tomography (OCT) and fluorescein angiography for 44 eyes of 42 patients (mean age +/- SD, 67.1 +/- 9.1 years) with PCV. All eyes had branching vascular networks and polypoidal lesions that were confirmed by indocyanine green angiography. RESULTS: OCT showed double reflective layers that consisted of retinal pigment epithelium (RPE) and another highly reflective layer beneath the RPE ("double-layer sign") in the area of the branching network vessels in 26 (59%) of 44 eyes. The remaining 18 eyes had no double-layer sign, but 17 (94%) of 18 eyes had a slightly elevated RPE. A serous retinal detachment was present in 23 (88%) of 26 eyes with a double-layer sign, while only 1 (6%) of 18 eyes without the sign had a serous retinal detachment. CONCLUSIONS: In PCV, the double-layer sign is seen frequently in the area of the network vessels, particularly in eyes with a serous retinal detachment. The sign may reflect fluid accumulation between RPE and Bruch membrane resulting from leakage from the network of abnormal vessels.     

Optical coherence tomography of idiopathic polypoidal choroidal vasculopathy

PURPOSE: To characterize cross-sectional images of idiopathic polypoidal choroidal vasculopathy (PCV). METHODS: A cross-sectional and retrospective study was performed involving 28 eyes with PCV and 112 eyes with exudative age-related macular degeneration. The frequency and dimensions of the retinal pigment epithelial detachment (RPED) with attenuation of internal reflectivity on optical coherence tomographic (OCT) examination were compared in both diseases. RESULTS: OCT showed the RPED with attenuation of internal reflectivity corresponding to the polypoidal structure in the indocyanine green angiogram in 75% of eyes with PCV, which was significantly more frequent than in eyes with exudative age-related macular degeneration (3.6%). In lesions suspicious of exudative age-related macular degeneration or PCV, the RPED with attenuation of internal reflectivity on OCT images strongly supported PCV diagnosis with a sensitivity of 84% and a specificity of 94%. The base diameter (p=0.010) and base diameter times height (p=0.028) of RPED were smaller in PCV than in exudative age-related macular degeneration. CONCLUSIONS: An RPED with attenuation of internal reflectivity in OCT examination is a highly sensitive and specific finding which characterizes PCV. Recognition of this RPED appearance, as well as the evaluation of its size, aids in the diagnosis of PCV.     

息肉样脉络膜血管病变的频域相干光断层扫描图像特征

目的 研究息肉样脉络膜血管病变(PCV)异常血管网和息肉样病变的频域相干光断层扫描(OCT)图像特征.方法 回顾性病例系列研究.对经吲哚氰绿脉络膜血管造影(ICGA)确诊的54例(63只眼)PCV患者的临床资料进行回顾性分析,观察其脉络膜异常血管网和息肉样病变的频域OCT图像特征.结果 ICGA图像中,有45只眼同时可见脉络膜异常血管网和血管息肉样扩张,8只眼仅见脉络膜异常血管网,10只眼仅见脉络膜血管息肉样扩张.53只眼异常血管网相对应部位均可见视网膜色素上皮层隆起,其中38只眼显示视网膜色素上皮层呈扁平波纹状隆起,视网膜色素上皮层信号与Bruch膜信号之间可见中至高的异常血管网反射信号;15只眼视网膜色素上皮层隆起较高,其下可见中高反射异常血管网和(或)出血信号,Bruch膜信号不完整.55只眼脉络膜息肉样病灶中,有28只眼为孤立性病灶,频域OCT图像显示为局限、轻度隆起的视网膜色素上皮层与Bruch膜之间的中等反射信号;27只眼ICGA图像显示为聚集性息肉样病变,而在频域OCT图像中表现为圆顶形、高度隆起的视网膜色素上皮层脱离,其下可见中等反射信号.结论 PCV异常血管网和息肉样病变大多表现为视网膜色素上皮层和Bruch膜之间的中高反射信号.

Abstract：

Objective To analyze the tomographic features of branching vascular networks and polypoidal lesions in patients with polypoidal choroidal vasculopathy (PCV) by spectral domain optical coherence tomography (SD-OCT). Methods It was a retrospective case series study. Retrospective review of 63 eyes of 54 patients with PCV identified with indocyanine green angiography (ICGA). Tomographic features of branching vascular networks and polypoidal lesions on SD OCT,ICGA and fluorescein angiography were analyzed. Results Both branching vascular network and polypoidal lesions were found in 45 eyes on ICGA,branching vascular network only was found in 8 eyes and polypoidal lesions only in 10 eyes. Retinal pigment epithelial detachment (RPED) was found in all 53 eyes with branching vascular networks on SDOCT. Thirty-eight eyes had areas of moderate reflectivity of branching vascular network between the fluctuating retinal pigment epithelium and Bruch membrane. Fifteen eyes had moderate reflectivity of branching vascular network and/or hemorrhage between high doom-like RPED and incomplete Bruch membrane. Solitary pelypoidal lesions in 28 patients showed local moderate reflectivity between the RPE and Bruch membrane on SDOCT. Other aggregate polypoidal lesions in 27 patients showed moderate reflectivity between high doom-like RPED and incomplete Bruch membrane. Conclusion The vascular abnormalities of PCV identified with ICGA were visualized on SD-OCT images as areas of moderate reflectivity between RPE and Bruch membrane.     

Cross-sectional and en face optical coherence tomographic features of polypoidal choroidal vasculopathy

PURPOSE: To correlate optical coherence tomography (OCT)-ophthalmoscope images with angiographic signs of polypoidal lesions and branching network vessels in eyes with polypoidal choroidal vasculopathy (PCV). METHODS: The authors prospectively examined 50 consecutive eyes with PCV using the OCT-ophthalmoscope and fluorescein and indocyanine green angiography (ICGA). RESULTS: ICGA showed polypoidal lesions in all eyes. In 18 of 22 eyes with a retinal pigment epithelial detachment (PED), OCT-ophthalmoscope cross-sectional B-scan images showed a central dome-shaped PED and a contiguous small PED corresponding to the polypoidal lesions on ICGA. Transverse C-scan images showed an irregularity or protrusion of the highly reflective retinal pigment epithelium (RPE) line of the PED corresponding to the polypoidal lesions on ICGA in all 22 eyes. In 28 eyes without a PED, the B-scan images showed polypoidal lesions as anterior protrusions of a highly reflective RPE line in 26 of 28 eyes; in those 26 eyes, C-scan images showed distinctive rings of a highly reflective RPE line corresponding to the polypoidal lesions on ICGA. ICGA showed an abnormal vascular network in 41 of the 50 eyes that appeared as a highly reflective area on C-scan images in 32 of the 41 eyes. In 20 of the 41 eyes, B-scan images showed two separate highly reflective RPE lines at the area of the abnormal vascular network. CONCLUSIONS: The OCT-ophthalmoscope C-scan images of the irregularity and the protrusion in the PED and the distinctive bright rings in eyes without a PED may be diagnostically important as indicators of polypoidal lesions in eyes with PCV.     

Evaluation of cases of polypoidal choroidal vasculopathy showing classic choroidal neovascularization in their natural course

BACKGROUND: Some cases of polypoidal choroidal vasculopathy (PCV) in their natural course develop into classic choroidal neovascularization(CNV) as shown by fluorescein angiography (FA) findings. SUBJECTS AND METHOD: We evaluated 8 eyes of 8 PCV patients showing classic CNV by FA findings, using indocyanine green angiography (IA) and optical coherence tomography(OCT). RESULT: All patients showed subretinal grayish exudates, which were considered fibrinous. Five cases were recognized as true subretinal CNV according to IA and OCT findings. The other 3 patients showed polypoidal dilatation with vascular networks by IA, and a moderately reflective mass considered fibrinous over the polypoidal elevation of retinal pigment epithelium (RPE) by OCT. CONCLUSION: Both true CNV and PCV with fibrin are present in PCV patients showing classic CNV. It requires care to determine proper treatment.     

渗出型老年黄斑变性患者眼底相干光断层成像结果分析

目的：了解渗出型老年黄斑变性（age-related macular degeneration,AMD）患者的眼底相干光断层成像（optical coherence tomography,OCT）特征。方法：对经常规检查、荧光素眼底血管造影（fundus fluorescein angiography,FFA）、吲哚青绿脉络血管造影（indocyanine green angiography,ICGA）确诊的渗出型AMD患者38例（42只眼）行眼底OCT检查,分析其图像资料,并与其FFA和ICGA检查结果进行比较。结果：OCT图像特征：典型纤维性新生血管膜34只眼,浆液性视网膜神经上皮脱离38只眼,视网膜神经纤维层脱离合并层间水肿8只眼,出血性和浆液性视网膜色素上皮（retinal pigment epithelium,RPE）脱离分别为11只眼和9只眼。结论：渗出型AMD患者眼底OCT图像特征为典型的纤维性新生血管膜合并浆液性视网膜神经上皮脱离、视网膜神经纤维层脱离、浆液性和出血性RPE脱离。上述图像特点证实和补充了FFA和ICGA检查结果,有助于渗出型AMD的诊断和评价。     

中心性渗出性脉络膜视网膜病变的相干光断层扫描结果分析

目的 探讨中心性渗出性脉络膜视网膜病变(CEC)黄斑部视网膜下脉络膜新生血管(CNV)患者的相干光断层扫描(OCT)图像特征。方法 对20例(21只眼)CEC连续治疗患者进行OCT检查,并与荧光素眼底血管造影(FFA)和吲哚青绿眼底血管造影(ICGA)结果进行对比;同时对光动力治疗后患者的OCT图像形态变化进行分析,以评价OCT图像特征对CEC患者的临床治疗价值。结果 21只眼中,有16只眼CNV呈类圆形团块状,自视网膜色素上皮层向上突出,位于视网膜神经上皮下间隙,呈强或中等强度反射;5只眼的CNV呈纺锤形或不规则形,亦呈强或中等强度反射,位于色素上皮层平面。21只眼中有9只眼伴有浆液性神经上皮脱离,6只跟伴有出血性色素上皮脱离,14只眼伴有不同程度的视网膜水肿和增厚。17只眼经光动力治疗后,随访3～12个月,平均6个月,FFA检查显示荧光素渗漏消退或减弱的患者,OCT检查均显示CNV团块不同程度退缩,其形态亦发生变化。OCT图像特征与FFA和ICG检查结果有互补性。结论 OCT检查可以确定CEC患者病变中CNV团块的形态、大小及位置。CEC病变中CNV的OCT图像以突出于色素上皮层的类圆形团块为特征,其形态和大小可因治疗和观察时间而变化。     

Optical coherence tomography of idiopathic polypoidal choroidal vasculopathy

PURPOSE: To document and study the cross-sectional structures of polypoidal elements using optical coherence tomography in eyes with idiopathic polypoidal choroidal vasculopathy. METHODS: Optical coherence tomography images of two eyes with idiopathic polypoidal choroidal vasculopathy were correlated with slit-lamp biomicroscopic findings, fundus photographs, fluorescein angiograms, and indocyanine green angiograms. RESULTS: Cross-sectional optical coherence tomographic images of retinochoroidal structures showed prominent anterior protrusion of the orange subretinal mass corresponding to the polypoidal structure in the indocyanine green angiogram. Hemorrhagic detachment of the retinal pigment epithelium was contiguous with the cone-shaped nodule beneath the retinal pigment epithelium in one eye, and an apparent discontinuity was observed in the highly reflective layer that delineates the polypoidal structure. CONCLUSIONS: Some of the polypoidal structures in eyes with idiopathic polypoidal choroidal vasculopathy are anteriorly protruding lesions in the inner choroid that may cause serosanguineous detachment of the retinal pigment epithelium through damage of the overlying Bruch membrane, retinal pigment epithelium, and the adhesion between them. Cross-sectional optical coherence tomographic images may increase understanding of the pathophysiology of idiopathic polypoidal choroidal vasculopathy.