高度近视性黄斑出血的荧光素眼底血管造影和靛青绿血管造影分析

The fluorescein angiography and indocyanine green angiography of high myopia with macular hemorrhage

目的探讨高度近视性黄斑出血及眼底变化特征。方法对３５例（３７只眼）眼底有黄斑出血的高度近视患者进行眼底彩色照像和荧光素眼底血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ，ＦＦＡ）检查，其中８只眼行靛青绿血管造影（ｉｎｄｏｃｙａｎｉｎｅｇｒｅｎａｎｇｉｏｇｒａｐｈｙ，ＩＣＧＡ）。结果高度近视黄斑出血的表现：（１）视网膜下新生血管（ｓｕｂｒｅｔｉｎａｌｎｅｏｖａｓｃｕｌａｒｉｚａｔｉｏｎ，ＳＲＮＶ）形成导致的黄斑出血（２３只眼），ＩＣＧＡ显示的ＳＲＮＶ较ＦＦＡ清晰；（２）无ＳＲＮＶ的黄斑出血（１４只眼），在出血下或边缘有漆样裂纹显露者９只眼；对其中６只眼进行了随访，发现其黄斑出血是由于出血下或其边缘有脉络膜毛细血管和Ｂｒｕｃｈ膜的破裂致新的漆样裂纹形成的缘故。结论高度近视黄斑出血的原因除常见的ＳＲＮＶ形成外，还有尚不伴ＳＲＮＶ的黄斑出血。ＦＦＡ结合ＩＣＧＡ能更早期、准确地确定引起高度近视黄斑出血的这两种表现。

Objective To investigate the causes and fundus changes of high myopia with macular hemorrhage. Methods Color photography and fundus fluorescein angiography (FFA) were performed on 35 patients (37 eyes) of high myopia with macular hemorrhages, and indocyanine green angiography (ICGA) was performed on 8 patients. Results The causes of high myopia with macular hemorrhage could be divided into two forms: (1) macular hemorrhage with subretinal neovascularization (23 eyes), (2) macular hemorrhage without subretinal neovascularization (14 eyes). ICGA noted the neovascularization more well defined and slightly bigger than FFA. In 9 of 14 eyes, lacquer cracks appeared at the sites of macular hemorrhage or around the hemorrhage. 6 eyes were followed up, the follow up period ranging from 3 to 20 months (mean, 8.6 months). ICGA was performed on two patients. The results show that the rupture of choriocapillaries and Bruch′s membrane can result in hemorrhage without subretinal neovascularization, and ICGA is more sensitive in detecting the lacquer cracks than FFA. Conclusion Subretinal neovascularization and the formation of lacquer cracks result in two forms of high myopia with macular hemorrhage. ICGA combined with FFA is more useful in evaluating the two forms of hemorrhage.