急性多灶性缺血性脉络膜病变临床分析

Clinical study on acute multifocal ischemic choroidoretinopathy

目的探讨急性多灶性缺血性脉络膜病变（AMIC）发病机制、诊断及其治疗。方法将8例AMIC患者的15只眼眼底彩照、吲哚氰绿血管造影（ICGA）和荧光素钠眼底血管造影（FFA）检查结果进行对比分析，并予抗炎、抗病毒或抗结核及改善微循环等药物治疗，抗炎选用非甾体类药物，未用糖皮质激素。结果ICGA：1只眼急性期病变呈斑片状充盈缺损；3只眼陈旧病灶色素遮蔽荧光。FFA：8例15眼中1眼急性病变病灶早期为弱荧光，之后着染荧光；3眼陈旧病灶为色素上皮脱色素的窗样缺损及色素沉着的遮蔽荧光。恢复期11眼兼有急性和陈旧性病变特征。急性期病例经3个月、恢复期病例经3～6周治疗后，视力、FFA及ICGA恢复。结论AMIC属脉络膜缺血性疾病，应查找病因积极治疗，大多预后良好。

OBJECTIVE To investigate the characteristic of acute multifocal ischemic choroidoretinopathy （AMIC）, and discuss its mechanism, diagnosis and treatment. METHODS Fifteen eyes （Scase） of AMIC were examined by fundus chromophotograph, ICGA and FFA, then we compared and analysed the results. All patients were treated respectively by antiinflammatory, anti-virus, anti-tubercle, to support and improve microcirculation. The anti-inflammatory agent used nonsteroidal anti-inflammatory drug, not glucocorticoid. RESULTS ICGA：at the acute stage the fluorescence of choroidlobules was often defected in 1 eye. And the stale 3 eyes showed sheltering due to pigment deposit. FFA： at acute stage the affected loci showed low fluorescence in the early phase in 15 eyes （Scases） of AMIC, and stained gradually in 1 eye; and the stale 3 eyes showed window defect fluorescence due to some RPE fading and fluorescences sheltering due to pigment deposit.The characteristics about acute and stale stage were showed in another recovering 11 eyes. The vision, FFA and ICGA of acute case and recovering cases were recovered respectively after 3 months and 3-6 weeks. CONCLUSIONS AMIC is an ischemic choroidoretinitis disease. It could be recovered if the causes could be found and treated actively.