病理性近视黄斑出血的眼底荧光素血管造影、吲哚青绿血管造影及相干光断层扫描的影像学改变分析

Characteristics of pathological myopia revealed by FFA,ICGA and OCT

目的分析病理性近视(PM)黄斑出血的荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)及相干光断层扫描(OCT)的影像学特征及临床意义。方法对病理性近视黄斑出血28例(31只眼)进行FFA、ICGA及OCT检查,并对比分析其检查图像。结果单纯型出血15只眼(48.4%),FFA表现:出血部位遮蔽荧光,其中8只眼(53.5%)可见漆样裂纹透见荧光;ICGA表现:造影期间出血部位为淡的低荧光,晚期均可见漆样裂纹性条状低荧光;OCT表现:9只眼(60%)在神经上皮层下和4只眼(26.7%)在色素上皮(RPE)下可见中高反射光团,周围神经上皮无水肿增厚,其下脉络膜光带连续,其中2只眼(13.3%)OCT无明显改变;新生血管(CNV)型出血16只眼(51.6%),FFA表现:14只眼(87.5%)为典型性CNV,2只眼(12.5%)为隐匿性CNV;ICGA表现:14只眼(87.5%)为焦点状CNV,无明显染料渗漏,2只眼(12.5%)未见CNV改变;OCT表现:14只眼(87.5%)为RPE光带断裂,RPE上梭形或类圆形中、高反射光团,2只眼(12.5%)为RPE层断裂伴不规则增厚中高反射信号,神经上皮层均增厚水肿。结论病理性近视黄斑出血分为单纯型和新生血管型,新生血管多表现为典型CNV,不同类型的出血其FFA、ICGA、OCT的改变各具特征,合理选择检查方法可提高诊断率,节省费用。

Objective To investigate the morphological characteristics of pathological myopia using fundus fluorescein angiography（ FFA）,indocyanine green angiography（ ICGA） and optical coherence tomography（ OCT）. Methods We studied 28 cases（ 31 eyes） of pathological myopia with macular hemorrhage. FFA,ICGA,and OCT examinations were performed to characterize the morphological changes in these patients. Results Uncomplicated macular hemorrhage was identified in 15 eyes（ 48. 4%）. Among these eyes,FFA showed masked fluorescein in the bleeding region. Striated bands of fluorescein could be observed in 8 eyes（ 53. 5%）. ICGA showed similar masks at initial phase and fluorescein bands at later phases. OCT revealed high reflection in neurosensory retina（ 9 eyes,60%） or in RPE（ 4 eyes,26. 7%）. There was no retina edema. Choroid appeared to be continuous. In 2 eyes,OCT were completely normal. Another group of eyes exhibited choroidal neovascularization（ CNV; n = 16,51. 6%）. FFA identified overt CNV in 14 eyes（ 87. 5%） and occult CNV in 2 eyes（ 12. 5%）,while ICGA detected scattered CNV in 14 eyes（ 87. 5%） and in two eyes there was no fluorescein leakage. OCT showed discontinuation and spindle or round shaped high reflection within RPE in 14 eyes. In 2 other eyes,RPE discontinuation was also found along with irregular thickened RPE and neurosensory retina edema. Conclusion Pathologicsl myopia can present with two different types of pathological changes,uncomplicated macular hemorrhage and choroidal neovascularization. Different morphological characters can be identified through FFA,ICGA and OCT examinations.