息肉状脉络膜血管病变与老年黄斑变性对比分析

Relationship of polypoidal choroidal vasculopathy and age-related macular degeneration

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。

Objective To investigate the relationship of polypoidal choroidal vasculopathy （PCV） and age-related macular degeneration （AMD）. Methods The data of patients who were dignosed with PCV and AMD by fundus fluorescein angiography（FFA）,indocyanine green angiography（ICGA）,optical coherence tomography （OCT） were analyzed. Results In 15 eyes with PCV, 11 eyes （73.3%）had subretinal hemorrhage, 6 eyes （40%） had lipid deposit,4 eyes（26.7%）had reddish-orange nodular elevation,FFA revealed hemorrhagic detachment of retina pigment epithelium（PED） in 7 eyes and serous PED in 2eyes,ICGA revealed polypoidal structure in all patients and were connected with choroidal vascular in 11 eyes;In 45 eyes with AMD, 25 eyes （55.6%） had subretinal hemorrhage, 18 eyes （40.0%） exudation, 20 eyes（44.4%） had black-grey lesion, 3 eyes （6.77%）had scar, FFA revealed PED in 14 eyes, classical CNV in 5 eyes, ICGA revealed CNV in 23 eyes. OCT ＇showed cone-like elevation of the RPE and inner choroids and nodular appearance in PCV patients. Fusiform and highly reflective band in AMD patients. Conclusion PCV could be a special type of CNV of exudative AMD.