视网膜大动脉瘤临床观察

Clinical observation of retinal arterial macroaneurysms

目的 总结视网膜大动脉瘤(retinal arterial macroaneurysms)的临床特点以提高其首诊诊断准确性。方法 对13例(13只眼)首诊诊断为其他眼底病的视网膜大动脉瘤患者行全身系统及眼科常规检查，重点是眼底荧光血管造影检查(眼底彩色照相+FFA，fundus fluorescein angiography)。部分行OCT(optical coherence tomography)检查。结果 13例患者均为单眼；12例患者为单个大动脉瘤，1例患者有2个大动脉瘤；瘤体均位于颞侧，颞上支6只眼，颞下支8只眼(有1例患者的大动脉瘤1个位于颞上支，另1个位于颞下支)；动脉瘤位于第1级分支1只眼，第2级分支9只眼，第3级分支3只眼。13例患者中有高血压病病史者11例，有糖尿病病史者2例；眼底可见动脉硬化10例，伴视网膜动脉血管先天异常2例。6例行OCT检查，发现黄斑视网膜神经上皮层水肿(包括囊样水肿)6只眼，黄斑区视网膜神经上皮层脱离2只眼，黄斑区视网膜前膜形成2只眼。结论 眼底血管造影及眼底彩照有助于视网膜大动脉瘤的早期正确诊断，OCT有助于发现轻微的黄斑形态改变。

Objective To summarize the clinical characteristic of the retinal arterial macroaneurysms and to improve its accuracy in the first diagnosis. Methods Systemic examination and ophthalmologic reoutine examination were carried out in 13 patients with retinal arterial macroaneurysm,focal points were put on fundus fluorescein angiography（FFA）. Some patients were examined with optical coherence tomography（OCT）. Results Onset happened in one eye all 13 cases,and isolated macroaneurysm showed in 12 cases with one patient had two macroaneurysms. Macroaneurysm locating in the superio-temporal and inferio-temporal artery happened in 6 and 8 eyes respectively with one case in both superio and inferio-termporal arteries. In 1, 9 and 3 eyes respectively, the macroaneruysms stayed in the first,second and third branch artery. 11 patients had systemic hypertension, 2 pteints had diabetis. 10 patients had arteriosclerotic retinopathy and 2 patients had congenital abnormality of the retinal arteries. OCT disclosed that two eyes had detachment of the macular retinal sensority layer,six eyes had edema or cystoedema of the macular retinal sensority layer and two eyes had epi-macular membranes. Conclusion FFA in helpful in the early correct diagnosis of macroaneurysms, OCT is useful in detecting some slight morphologic changes of macula.