视网膜血管瘤样增生性病变的眼底光学影像学特征观察及意义

The optical image features and clinic significances of retinal angiomatous proliferation

目的观察视网膜血管瘤样增生性病变（RAP）在眼底彩色照相、眼底荧光血管造影（FFA）、吲哚青绿血管造影（ICGA）及光相干断层扫描（OCT）的图像特征改变及意义。方法回顾性分析2008年1月至2014年3月在河北省眼科医院就诊的11例14只眼RAP患者的临床资料，重点观察患眼病变部位在眼底彩色照相、FFA、ICGA及OCT图像中的改变特征。结果I期RAP3只眼，眼底表现为黄斑中心凹旁有1个斑点状或结节状黄红色血管瘤样病灶分布，其在FFA及ICGA中均表现为对应的强荧光，且病灶两端有视网膜小动脉和小静脉相连，呈“发夹”状外观。OCT表现为病灶对应处视网膜内有斑点状或囊状强反光物质分布。Ⅱ期RAP6只眼，眼底检查显示黄斑区视网膜水肿增厚，并有较多出血及硬性渗出分布。FFA及ICGA均显示黄斑区有1—2个斑片状或结节状强荧光灶出现，并有多支视网膜小血管与其吻合。OCT检查显示病灶对应部位神经上皮内或神经上皮下有团块状强反光物质分布，伴有神经上皮层囊样水肿增厚、局限性脱离以及严重的PED。BI期RAP5只眼，眼底表现为黄斑区中央视网膜深层有黄红色盘状或片状新生血管样病灶分布。FFA及ICGA检查显示病灶呈强荧光改变，并均能观察到多支视网膜血管与其吻合。OCT显示病灶对应处神经上皮下有团块状强反光物质分布，并与向上隆起的Bruch膜与脉络膜复合体相连。结论各期RAP病变在各种光学影像学检查中有特征性改变，熟练掌握这些改变特征将有助于临床医师对其做出正确的诊断和分期，并指导治疗。

Objective To observe the angiographic characteristics and significances of the retinal angiomatous proliferation （RAP） in color fimdus photography, fundus fluorescein angiography （FFA）, indocyanine green angiography （ICGA） and optical coherence tomography （OCT）. Methods The clinical data of 14 eyes with RAP （11 patients） were analyzed retrospectively, mainly observed the angiographic characteristics of the RAP in the fimdus photography, FFA, ICGA and OCT. Results There were 3 eyes in the stage Ⅰ. There were punctate or nodular yellowish red angiomatous lesion located beside the fovea which showed hyperfluorescence in the FFA and ICGA, as ＂hairpin＂ shape owing to retinal arterioles and venules connected with it. There was blotchy or cystic highly reflective material within the inner retina corresponding to the RAP lesions in the OCT. There were 6 eyes in the stage Ⅱ. The macula presented gray color because of the edema, and there were hemorrhages and hard exudates distribution. There were patchy or nodular lesions appearing hyperfluorescence, which connected with a number of small vessels in the FFA and ICGA, and the ICGA was not only displayed the lesion clearer but also filled earlier than the FFA. There were lumps highly reflective material within or under the neuroepithelium with the retina cystoid edema, thickening and the severe PED in OCT. There were 5 eyes in the stage Ⅲ. There were a yellowish red disc-form or patching neovascular lesion in the central of macula, with many hemorrhages and hard exudates around it. They showed hyperfluorescence and with a number of small vessels connected with it in the FFA and ICGA, and the ICGA was not only displayed the lesion clearer but also filled earlier than the FFA. There were lumps highly reflective material under which connected with the uplift Bruch＇s membrane and choroid complex in OCT. Conclusions All the RAP lesions have their respective features in a variety of optical imaging. Mastering the features will help clinicians diagnose and treat them correctly and timely.