息肉样脉络膜血管病变的诊断及治疗

Diagnosis and treatment of polypoidal choroidal vasculopathy

息肉样脉络膜血管病变（polypoidal choroidal vasculopathy，PCV）特征是后极部视网膜下桔红色息肉样病变，伴有出血性和浆液性视网膜色素上皮及神经上皮脱离。荧光素眼底血管造影无特征性表现，吲哚青绿血管造影能显示分支血管组成的脉络膜血管网和血管末端息肉样或动脉瘤样扩张。OCT表现为视网膜色素上皮及脉络膜毛细血管高反射层呈陡峭的穹窿状隆起，其下见中等反射或结节状改变。本病应与湿性年龄相关性黄斑变性和某些长期不愈的中心性浆液性脉络膜视网膜病变进行鉴别。尽管PCV的治疗仍缺乏通用的方案，光动力疗法结合玻璃体内注射血管内皮生长因子抑制剂可改善或稳定患者视力。（国际跟科纵览，2013，37：36-42）

Polypoidal choroidal vasculopathy （PCV） is a distinct clinical entity characterized by or- ange-red polypoidal subretinal lesions with recurrent serous and hemorrhagic detachments of the retinal pig- ment epithelium （ RPE ） and neurosensory retina. Fundus fluorescein angiography （ FFA ） has no typical manifestations while indocyanine green angiography （ICGA） can show the presence of ehoroidal networks of branching vessels as well as polypoidal or aneurismal dilations at the termination of choroidal vessels. Optical coherence tomography （OCT） findings often present as sharp protrusions of the RPE and the high reflective layer of ehoroidal capillaries with inner moderate reflections or nodular lesions. PCV should be differentiated from wet age-related macular degeneration and some chronic central serous choroidal diseases. Although there is no standard protocol for the treatment of PCV, photodynamic therapy combined with intravitreal anti- VEGF theraov can imorove or stabilize oatient~ vision. （Int Rev Oohthalrnol, 2013, 37： 36-42）