特发性水螅状脉络膜血管病变的临床分析

Clinical Features of Idiopathic Polypoidal Choroidal vasculopathy

目的:探讨特发性水螅状脉络膜血管病变（idiopathic polypoidal choroidal vasculopathy,IPCV）的临床特征。方法:回顾分析161例（202只眼）在1995年11月～2001年4月期间诊断为湿性型老年黄斑变性（age-related macular degenera-tion,AMD）患者的临床资料,并对其荧光素眼底血管造影（fundus fluorescein angiography,FFA）和吲哚青绿血管造影（indo-cyanine green angiography,ICGA）进行了重新分析。结果:14例（8.7％）17只眼原诊断为湿性型AMD的患者重新诊断为IPCV。国人IPCV多发生于男性（78.6％）,且单眼受累为主（78.6％）。发病年龄48～78岁,平均61.5岁。ICGA显示IPCV病变呈一异常分支的脉络膜血管网,血管网的末梢有水螅状扩张、膨隆;病变位于黄斑区及颞上、下血管弓周围者12只眼（70.6％）,视乳头旁5只眼（29.4％）。结论:IPCV易误诊为湿性型AMD,但其ICGA显示的分支状脉络膜血管网及末梢的水螅状血管扩张有助于两者的诊断与鉴别诊断。

Objective: To investigate clinical features of idiopathic polypoidal choroidal vasculopathy (IPCV) in Chinese patients. Methods: A retrospective analysis of 161 consecutive patients previously diagnosed as exudative age-related macular degeneration (AMD) was performed. The data about the patients, including fundus photogram, fluorescein and indocyanine green (ICG) angiogram, were reviewed.Results: 17 eyes in 14 patients initially suspected of having AMD were ultimately diagnosed as having IPCV. The mean age was 61.5 years (range, 48-78 years). Men were predominantly affected (78.6%). 11 patients were unilaterally involved (78.6%). In all patients, indocyanine green angiography (ICGA) demonstrated branching vascular network with polypoidal dilations at terminals of the network beneath the retinal pigment epithelium. The predominant locations for these lesions were the macular region and arcade in 12 eyes (70.6% ) , and the peripapillary area in 5 eyes (29.4%).Conclusions: IPCV always masqueraded as AMD, but they were best identified with ICGA that could clearly show the branching choroidal vascular networks with polypoidal dilations.