眼底血管样条纹吲哚青绿血管造影特征及意义

The features and the significances of the angioid streaks in indocyanine green angiography

目的探讨眼底血管样条纹（angioid streaks，AS）患者在脉络膜吲哚青绿造影中的图像特征及临床意义。方法回顾性分析2008年1月至2012年12月在邢台市眼科医院临床确诊的29例58只眼眼底血管样条纹（AS）患者的临床资料。采用德国海德堡共焦激光视网膜扫描（HRA2）对所有患者进行眼底荧光血管造影fundus fluorescein angiograohy，FFA）及吲哚青绿血管造影（indocyanine green angiography，ICGA）同步检查，并对比观察、分析其图像特征。结果29只眼黄斑区有典型黄斑区新生血管（macular new vessels，CNV）者，ICGA早期26只眼（89．66％）病灶部位呈轻度强荧光，3只眼（10．34％）病灶部位无明显异常改变，但后期29只眼病灶部位均有强荧光着色，但在荧光强度上较FFA图像弱。3只眼FFA检查无异常荧光渗漏灶，但后期呈囊样强荧光潴留者，在ICGA检查中，2只眼黄斑区发现有隐匿性CNV，1只眼黄斑区有脉络膜血管息肉状膨隆呈强荧光斑（idiopathic polyp-oidal choroidal vasculopathy，PCV）。而在视网膜色素上皮层（retinal pigment epithelium，RPE）及眼底条纹方面，ICGA早期图像无特征性改变，ICGA后期所有患眼后极部可见一个大范围的类圆形弱荧光灶，其周边可见斑点状弱荧光带环绕，再往周边部则为正常的眼底荧光像。58只眼中有56只眼（96．55％）的眼底条纹呈显著的强荧光，仅2只眼（3．45％）的眼底条纹呈弱荧光。结论ICGA检查对于发现隐匿性的CNV及PCV优于FFA，但在发现典型性CNV的渗漏上比FFA差，并且ICGA后期眼底后极部呈弱荧光、周边为正常荧光、两者之间为斑点状弱荧光的图象特征及眼底条纹大部分呈强荧光改变，是AS患者的特征性改变。这些特点在临床上有助于对AS患者做出准确判断并指导治疗。

Objective To investigate the image features and its clinical significances of the angi-oid streaks （AS） in choroid indocyanine green angiography （ICGA）. Methods Retrospectively ana- lyzed the clinical data of 29 patients （58 eyes） with AS from January 2008 to December 2012. All the patients were performed the fundus fluorescein angiography （FFA） and ICGA with Heidelberg ret-inal confocal laser scanning （HRA2）, and the images were analyzed by contrast. Results During the early period of ICGA, 26 eyes （89.66%） lesions showed slight hyperfluorescence, 3 eyes （10.34%） lesions showed without abnormal changes of the 29 eyes with classic macular neovascular （CNV）, but they displayed the strong fluorescent staining in the late stage, and the intensity were weaker compared with the FFA images, 3 eyes showed strong cystic fluorescence retention but with-out abnormal fluorescence leakage during the FFA, 2 eyes had occult CNV, 1 eye had idiopathic pol-ypoidal choroidal vasculopathy （PCV） in the ICGA. The retinal pigment epithelium （RPE） and the streaks were no obvious changes on early-phase ICGA, but all eyes had a central area of de-creased fluorescence centered on the posterior pole. with a spotted transition zone surrounding it. while the more eccentric areas exhibit a normal late phase fluorescence on late-phase ICGA. In addi-tion, the angioid streaks showed hyloerfluorescent in 56 eyes （96.55%）, and appeared hypofluorescent in only 2 eyes （3.45%）. Conclusions ICGA is superior to FFA in detecting the occult CNV and PCV, but is worse than FFA in finding the leakage of the classic CNV. On late-phase ICGA, a cen- tral area of reduced fluorescence centered at the posterior pole, while more eccentric areas exhibit a normal fluorescence, in between these two areas, there is a spotted transition zone and the angioid streaks mainly showing hyperfluorescent are the characteristic finding in all patients. These features can help us judging the pathogenetic condition and guide therapy in clinic.