45岁以上中心性浆液性脉络膜视网膜病变与渗出型老年性黄斑变性眼底血管造影对比分析

Characteristics of fundus angiograms of central serous chorioretinopathy and exudative age-related macular degeneration in patients more than 45

目的观察45岁以上的中心性浆液性脉络膜视网膜病变（CSC）与渗出型老年性黄斑变性（AMD）患者眼底血管造影图像特征的异同。方法回顾分析45岁以上CSC患者32例39只眼和渗出型AMD患者20例22只眼的眼底彩色像、荧光素眼底血管造影（FFA）和吲哚青绿血管造影（ICGA）检查资料。结果39只CSC眼中，FFA显示典型CSC11只眼，占28．2％；扩散性视网膜色素上皮病变（DRPE）28只眼，占71．8％。ICGA显示39只眼早期脉络膜充盈迟缓及随后的脉络膜血管扩张，占100％；中期均有多灶性脉络膜血管通透性增强，占100％，16只眼中后期呈现渗漏点强荧光，占41．0％；后期5只眼见脉络膜大血管负影，占12．8％。22只未伴明显出血的渗出型AMD眼中，ICGA显示焦点状脉络新生血管（CNV）13只眼，占59．1％；斑状CNV8只眼，占36．4％；结合型CNV1只眼，占4．5％。造影早期5只眼黄斑区及周围脉络膜血管代偿性扩张，占22．7％；中期均未见脉络膜血管通透性增强，后期均未见脉络膜大血管负影。结论45岁以上的CSC与渗出型AMD不同的ICGA特征为局灶性或多灶性的RPE渗漏点强荧光；多灶性脉络膜血管通透性增强；造影后期脉络膜血管负影；造影期间无焦点状或斑状CNV性强荧光。

Objective To compare the characteristics of fundus angiograms of central serous chorioretinopathy （CSC） with exudative age related macular degeneration （AMD） in patients more than 45. Methods The colorized photographs of ocular fundus, and results of fundus fluorescein angiography （FFA） and indocyanine green angiography （ICGA） of 32 patients （39 eyes） with CSC and 20 patients （22 eyes） with exudative AMD more than 45 were collected and analyzed retrospectively. Results In 39 eyes with CSC, the results of FFA revealed classic CSC in 11 （28. 2%） and diffuse retinal pigment epitheliopathy （DRPE） in 28 （71. 8%）; the results of ICGA showed localized choroidal delayed filling associated with dilated vessels in 39 （100%） in the early phase, choroidal hyperpermeability in 39 （100%）, identifiable hyperfluorescence of leakage from RPE in 16 （41.0%） was observed in the middle phase, and a distinctive silhouetting of the larger choroidal vessels in 5 （12.8%） was detected in the late phase. In 22 eyes with exudative AMD without evident hemorrage, the results of ICGA exhibited focal CNV in 13 （59.1%）, plaque CNV in 8 （36.4%）, and combination CNV in 1 （4.5%）;choroidal delayed filling around macular region vicariously was found in 5 （22. 7%） in the early phase, choroidal hyperpermeability was not observed in the middle phase and silhouetting of the larger choroidal vessels was not showed in the late phase. Conclusions The differences of the ICGA features between CSC and exudative AMD in patients more than 45 include focal or multifocal hyperfluorescence of leakage from RPE, multifocal choroidal hyperpermeability in the middle phase, silhouetting of the larger choroidal vessels in the late phase, and no focal or plaque CNV.