点状内层脉络膜病变的临床特征分析

Clinical features of punctate inner choroidopathy in Chinese patients

目的 观察国人点状内层脉络膜病变（PIC）的临床特征.方法 回顾分析经眼科常规检查及荧光素眼底血管造影（FFA）检查确诊的75例PIC患者112只眼的临床资料.所有患者均行眼科常规检查及FFA检查,其中28例患者同时进行了吲哚青绿血管造影（ICGA）检查.采用VISUPAC 3.3软件在FFA检查动静脉早期图像中进行测量,确定病灶大小.结果 患者中男性21例,占28%;女性54例,占72%;男女患者比率为1：2.6.首次出现症状的发病年龄为17～61岁,平均发病年龄32岁.伴有近视者60例87只眼,分别占所有患者和患眼的80%和78%.其中,轻度近视者8只眼,中度近视者22只眼,高度近视者57只眼.分别占所有患眼的7%、20%、51%.双眼累及者37例,占所有患者的49%.PIC活动病灶表现为视网膜下的黄白色奶油状病灶,直径20～500μm,FFA检查结果显示,动脉期或动静脉早期多表现为强荧光,晚期染色,或伴轻度渗漏;萎缩病灶表现为视网膜下的组织凿除状病灶,直径50～2000 pm,可伴不规则的色素增生.病灶仅位于后极部者106只眼,占所有患眼的95%.病灶数1～56个,其中≤10个者84只眼,占所有患眼的75%.并发脉络膜新生血管（CNV）70只眼,占所有患眼的63%;视盘水肿3只眼,占所有患眼的3%.FFA晚期视盘染色3只跟,占所有患眼的3%;节段性视网膜静脉炎2只眼,占所有患眼的2%.结论 PIC主要累及伴有中高度近视的青年女性,以后极部多发的黄白色点状病灶或（和）色索性小萎缩灶为特征.CNV是常见并发症.

Objective To characterize the clinical features of punctate inner choroidopathy （PIC） in Chinese patients. Methods The clinical data of 75 PIC patients （112 eyes） attending this center from June 1999 to October 2009 were reviewed retrospectively. All patients received routine examination and fluorescein fundus angiography （FFA）. Twenty-eight patients also received indocyanine green angiography （ICGA）. VISUPAC 3.3 software was used to determine the size of lesions in early image of FFA at the artery stage. Results Of the 75 PIC patients （112 eyes）, 54 patients （72%） were female, 37 patients （49%） were bilateral cases. Sixty patients （80%） were myopic, including eight patients （7%） with mild myopia, 22 patients （20%） with moderate myopia, and 57 patients （51%） with high myopia. The mean age at presentation was 32 years （range： 17 - 61）. Multifocal PIC lesions （1-56 lesions） were mostly restricted to posterior pole of affected eyes （95%）. Eighty-four eyes （75%） had 10 PIC lesions. Thc active lesions were yellow-white and butter-like, 20-500pm in diameter. FFA showed that most acute lesions were early hyperfluorescence, and stained or slightly leaked on late period. The atrophic lesions were pouched-out, 50-2000 μm in diameter, with irregular pigmentation. Choroidal neovascularization developed in 70 eyes （63%）. Papilledema （three eyes, 3%）, staining of optic disc on late-phase fluorescein angiography （three eyes, 3%）, and segmental retinal phlebitis （two eyes, 2%） were rare. Conclusions PIC primarily affects young women with moderate or high myopia. It is featured by multifocal small yellow creamy lesions and/or atrophic punched-out lesions principally in the posterior pole. Choroidal neovascularization is the most common complication.