激光扫描眼底荧光血管造影在特发性视网膜血管炎诊断中的应用

Application of laser scanning fundus fluorescein angiography in diagnosis of idiopathic retinal vasculitis

目的评价HRA2激光扫描眼底荧光血管造影(fundus fluorescein angiography,FFA)在特发性视网膜血管炎(idiopathic retinal vasculitis,IRV)诊断、治疗中的指导价值。方法回顾分析HRA2激光扫描血管造影系统对55例(95眼)IRV患者的眼底检查及FFA的资料。所有患眼FFA检查常规30°视野成像,其中47例(81眼)150°前置广角镜眼底全景成像,分析比较2种视野检查成像影像学特征及结果。结果所有患眼周边病变区视网膜血管管径不均,可见血管白鞘51眼(53.68%)、全周边视网膜血管白线样改变7眼(7.37%)、玻璃体混浊或积血29眼(30.53%)、增生性玻璃体视网膜病变14眼(14.74%)、牵拉性视网膜脱离3眼(3.16%)。30°视野FFA检查,所有患眼可见受累静脉管壁渗漏或荧光着染,周边部无灌注区46眼(48.42%)、视网膜新生血管32眼(33.68%);32眼(33.68%)累及后极部静脉,13眼(13.68%)动脉同时受累局部管壁渗漏,视盘渗漏40眼(42.10%)、黄斑水肿19眼(20.00%)。47例81眼患者150°广角成像满意,其中初诊的62眼,30°视野检查可见无灌注区而150°视野未能确定者2眼(3.23%);150°全视网膜成像发现30°视野成像可见范围外周边血管渗漏3眼(4.84%)、无灌注区5眼(8.06%)、远周边视网膜新生血管3眼(4.84%)。玻璃体切割术和(或)眼底光凝后的19眼,周边发现无灌注区4眼(21.05%)、新生血管2眼(10.52%)。结论HRA2激光扫描眼底血管造影系统中,30°前置镜分辨率高,检查细节清晰,有助于发现小分支血管的渗漏及黄斑区细微的病变;附加应用150°广角镜,使可观测病变检查范围扩大到远周边;二者结合,有助于全面、细致观察IRV病变的程度和范围,降低病变漏诊率,对IRV的诊断和治疗提供更多帮助。

Objective To evaluate the value of HRA2 laser scanning fundns fluorescein angiography（FFA） in the diagnosis and treatment of idiopathic retinal vasculitis （IRV）. Methods The data of examination of ocular fundns and FFA were retrospectively analyzed in 55 IRV patients（95 eyes） with HRA2 laser scanning angiography. FFA was used to examine conventional 30° visual field imaging in all patients,and 47 patients （81 eyes） were checked with 150°preset wide-angle lens for full view imaging. Imageology characteristics and results were compared between two visual field examinations. Results Calibers of retinal vessel were uneven around diseased region in all eyes. There were 51 eyes（53.68% ） with vascular white sheath,7 eyes（7.37% ） with white line changes around retinal vessels, 29 eyes （ 30.53% ） with vitreous opacity or hemorrhage,14 eyes（ 14.74% ） with proliferative vitreoretinopathy and 3 eyes（3.16° ） with tractional detachment of retina. With FFA at 30° visual field, tubal wall leakage or fluorescence staining was found in veins of all eyes,and there were 46 eyes（48.42% ） without perfusion at periphery, 32 eyes （ 33.68% ） with retinal neovascularization, 32 eyes （33.68%） involving posterior veins,13 eyes（ 13.68% ） involving arteries with local tubal wall leakage,40 eyes（42. 10% ） with optic disk leakage and 19 eyes（20. 0096 ） with macular edema. Eighty-one eyes of 47 cases felt satisfactory with 150°wide-angie lens, and 62 eyes of them were with preliminary diagnosis. Two eyes（3.23% ） were without perfusion with 30° visual field imaging, but not determined with 150° visual field ima-ging. 150°wide-angie lens found that there were 3 eyes（4.84% ） with peripheral vessel leakage,5 eyes（8.06% ） without perfusion,3 eyes（4.84% ） with apo-peripheral retinal neovascularization beyond the 30° visual field imaging. After vitrectomy and （or） fundus photo-coagulation in 19 eyes, there were 4 eyes （21.05%） without perfusion at periphery, and 2 eyes （ 10. 52% ） with neovascularization. Conclusions In HRA2 laser scanning FFA system,30°lens can provide high resolution and detailed image for fmding small branch vessels leakage and tiny macular changes. Combined with 150° wide-angle lens can help to check far peripheral area. Combined use of the two lenses can help to roundly and clearly observe the degree and scope of IRV for lowering pathological leakage rate and giving more assistance to the diagnosis and treatment of IRV.