息肉状脉络膜血管病变的分型研究

Polypoidal choroidal vasculopathy

目的:依据吲哚菁绿血管造影(indocyanine green angiography,ICGA)显示的息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)的形态进行分型,结合光学相干断层扫描(optical coherence tomography,OCT)及临床特征,探讨各型的特点,为PCV的治疗和预后评价提供依据。方法:回顾性分析在宁夏眼科医院就诊的33例PCV患者。所有病例均经过OCT和荧光素眼底血管造影(fundus fluorescein angiography,FFA)与ICGA等全面检查后确诊。根据ICGA的表现进行分型,同时对各亚型的病变特征进行比较。结果:共收集到33例54眼PCV患者,单眼12例,双眼21例;男20例,女13例;年龄42～86(平均70.63±9.42)岁。45眼病变部位位于黄斑区,占83%。根据ICGA的表现分为:息肉状扩张型(20眼,37%)、异常分支血管网型(16眼,30%)、经典型(18眼,33%)。27眼(50%)出现视网膜色素上皮脱离(pigment epithelial detachment,PED),其中分支血管网型及经典型出现PED的比例相对较高,分别为11眼(68.8%)和12眼(66.7%)。23眼(43%)出现视网膜神经上皮层脱离,其中分支血管网型10眼(62.5%)和经典型9眼(50.0%)易出现神经上皮脱离。31眼(57%)表现为活动型病变,其中分支血管网型和经典型常见,分别为13眼(81.3%)和13眼(72%)。10眼(19%)出现纤维机化膜,其中分支血管网型及经典型多见,分别为7眼(43.8%)和2眼(11.1%)。37眼(69%)有滋养血管的存在,其中分支血管网型和经典型分别为81%和94%。结论:分支血管网型及经典型易出现视网膜色素上皮脱离及视网膜神经上皮层脱离,多表现为活动型病变,存在滋养血管。而息肉型较少出现视网膜色素上皮脱离和神经上皮脱离,多表现为静止型,大多无滋养血管。异常分支血管网型易出现纤维机化膜。

· AIM：To explore the clinical feature of polypoidal choroidal vasculopathy （PCV） which would provide the basis for treatment and prognosis of PCV, according to the classification of indocyanine green angiography （ICGA） image, combined with fundus and optical coherence tomography （OCT） examination. · METHODS： Retrospective analysis of 33 PCV patients, who were diagnosed in Ningxia Eye Hospital with OCT, fundus fiuorescein angiography （FFA） and ICGA. Comprehensive analysis the classification of PCV which were based on the ICGA image, and take the feature of PCV lesion into consideration. · RESULTS： Thirty-three PCV patients （54 eyes） were collected, 12 patients （36%） had monocular disease and 21 patients （64%） had binocular lesion. There were 20 male （61%） and 13 female （39%） included in the study. The age was raged from 42-86 years old and the average age was 70.63± 9.42 years old. Forty-five eyes （ 83% ） PCV lesion was located in macular area. Three types of PCV were classified according to ICGA image： polyps expansion type （20 eyes, 37%）, abnormal branching vascular network type （16 eyes, 30%） and classical type （18 eyes, 33%）. Twenty-seven eyes （50%） were suffered from pigment epithelial detachment （PED）. The abnormal branching vascular network type （11 eyes, 68.8%） and classical type are （12 eyes, 66. 7%） was more likely to suffer from PED. Twenty-three eyes （43%） have retinal neuroepithelium layer detachment including 10 eyes （62. 5%） of abnormal branching vascular network type and 9 eyes （50.0%） of classical type. Thirty -one eyes （57%） shows active status 81.3% of abnormal branching vascular network type and 72% of classical type shows active status. Ten eyes （19%） appear fibrous membrane totally, including 7 eyes （43. 8%） of branching vascular network type and 2 eyes （11.1% ） of classical type. Thirty-seven eyes （69%） have nourishing vessels totally. Eighty- one percent of abnormal branching vascular network type and 94% of classical type have nourishing vessels. · CONCLUSION： The subtype of PCV such as branching vascular network type and classical type is apt to be active, the PED, retinal neuroepithelium layer detachment and nourishing vessels are more likely to appear in this two subtype rather than in the polyps expansion type, which always tend to be motionless. The branching vascular network type is easily to have fibrous membrane.