脉络膜骨瘤吲哚青绿与荧光素眼底血管造影对比观察

Comparative analysis of choroidal osteoma fundus angiography using indocyanine green and fluorescein

目的探讨脉络膜骨瘤的吲哚青绿血管造影（indocyanine green angiography，ICGA）与荧光素眼底血管造影（fundus fluorescein angiography，FFA）的表现，加深认识，深入了解脉络膜骨瘤继发新生血管与骨瘤丛状血管的表现。方法回顾分析2006年4月至2012年12月在邢台市眼科医院已确诊为脉络膜骨瘤13例16只眼的ICGA与FFA表现。结果FFA在脉络膜背景荧光显现前病变区16只眼均出现了斑点状荧光，7只眼并可见到骨瘤丛状血管的出现，随着视网膜动静脉的充盈逐渐增强晚期呈弥漫性强荧光，其中6只眼在病变区伴发新生血管性强荧光，5只眼并伴有出血性遮荧光；IC—GA早期也可见到FFA发现的丛状血管，并且还发现了这7只眼FFA所不能发现的蜘蛛网状血管。此血管与新生血管有一定的相似之处，但其不伴有出血或浆液性水肿。结论ICGA可以观察到FFA不能显示的蜘蛛网状血管，FFA仅观察到了丛状血管的存在；ICGA证实了FFA观察到的丛状血管与ICGA观察到的蜘蛛网状血管二者相连，均为骨瘤的固有血管，这两个网状血管的渗漏与骨瘤继发的新生血管所造成的渗漏相似，但二者有着本质的区别。

Objective To investigate the manifestations of choroidal osteoma between ICGA and FFA, to understand the different manifestations of choroidal osteoma and neovascularization second- ary to choroidal osteoma and to deepen the awareness of the disease. Methods Retrospective analysis of 13 cases （16 eyes） diagnosed with choroidal osteoma using ICGA and FFA from 2006 to 2012. Results FFA showed punctate fluorescence in the lesion in 16 eyes before choroidal back-ground fluorescence appeared. Plexiform vascular was appeared in 10 eyes and showed diffuse intense fluorescence gradually with the retinal arteriovenous filling, in which six eyes showed strong fluorescence associated with neovascular in lesions and four eyes showed strong fluorescence accompanied by hemorrhage. ICGA not only could show the plexiform vascular as FFA founded in early stage but also show spiderweb-like blood vessels. Spiderweb-like blood vessels had some similarities with neovascularization, but it was not associated with bleeding or serous edema. Conclusions ICGA can show spiderweb-like blood vessels except for plexiform vascular that FFA showed. ICGA confirm the connection between the plexiform vascular that FFA observed and spiderweb-like blood vessels that ICGA observed. Both are osteoma inherent vascular. Leakage caused by the two kinds of blood vessels is similar to leakage caused by the neovascularization secondary to osteoma, but they are essentially different.