老年黄斑变性干性型向湿性型转化的临床观察和分析

Clinical observation and analysis of development of age related macular degeneration from dry form to wet form

目的：探讨干性型老年黄斑变性（ＡＭＤ）向湿性型转化的眼底变化特征及寻找转化的危险因素。方法：采用眼底彩色照相、吲哚青绿脉络膜血管造影（ＩＣＧＣＡ）和／或眼底荧光血管造影（ＦＦＡ）对１２例干性型向湿性型转化的ＡＭＤ患者进行了随访观察和分析。结果：１２例干性转为湿性的患者中，对侧眼为湿性型改变的有９例，其中对侧湿性型患眼的脉络膜新生血管（ＣＮＶ）位于黄斑无血管区（ＦＡＺ）内的有７例。湿性型病变由软性玻璃膜疣（ｄｒｕｓｅｎ）发展而来的有５例；由融合性ｄｒｕｓｅｎ发展的有４例；由低荧光ｄｒｕｓｅｎ发展的有２例；由色素上皮低色素发展的有１例。４例在发生湿性改变后同时作了ＦＦＡ和ＩＣＧＣＡ的病例显示ＩＣＧＣＡ有利于发现那些ＦＦＡ不能发现的、被大片深层出血或不规则色素上皮脱离所隐匿的ＣＮＶ。结论：对侧眼为湿性型、对侧眼的ＣＮＶ位于ＦＡＺ内及干性型患眼具有软性、融合性或低荧光ｄｒｕｓｅｎ等是干性型眼发生湿性改变的危险因素。ＩＣＧＣＡ比ＦＦＡ能更早期、精确地发现色素上皮脱离或出血所掩盖的ＣＮＶ。

To investigate the changes of macular lesions in the development of age related macular degeneration (AMD)from dry form to wet form and search for the risk factors in developing exudative AMD,12 cases (12 eyes)of AMD with dry form developed to wet form were followed up with fundus photograph,Fundus fluorescein angiography (FFA) and indocyanine green choroidal angiography (ICGCA).Of the 12 cases, the fellow eye with wet form was noted in 9 cases,7 of which had choroidal neovascularization (CNV) in FAZ.During the follow up periods,the wet form changes were developed from soft drusen in 5 cases,confluent drusen 4 cases,hypofluorescence drusen 2 cases and hypopigmentation 1 case respectively.ICGCA was very useful in evaluating the occult CNV of AMD with pigment epithelial detachment and hemorrhage that FFA cant delineate(4 cases).Our results showed that the wet form and CNV in FAZ of the fellow eye,and soft,confluent and hypofluorescence drusen of dry form AMD were the risk factors in developing exudative AMD;ICGCA was an important technique in diagnosing the occult CNV of AMD with pigment epithelial detachment and macular hemorrhage.