年龄相关性黄斑变性中视网膜色素上皮脱离的临床观察

Retinal pigment epithelium detachment in age-related macular degeneration

目的探讨年龄相关性黄斑病变(age-related macular degeneration,AMD)中不同病变类型视网膜色素上皮脱离(pigment epithelial detachment,PED)的特征,以期为AMD不同类型的诊断及预后评估提供参考依据。方法通过影像学检查将96例(124眼)患者分为视网膜血管瘤样增生(retinal angiomatous proliferation,RAP)、息肉样脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)、脉络膜新生血管(choroidal neovascularization,CNV)。通过光学相干断层扫描(optical coherence tomography,OCT)结合眼底彩色照相、眼底荧光素血管造影、眼底自发荧光等检查方法对以上几类病变中PED大小、形态、病变性质、预后等重要特征进行回顾分析并对比总结。结果 96例患者中RAP-PED为10例(10. 42%)、PCV-PED为32例(43. 75%)、CNV-PED为54例(45. 83%)。RAP-PED多为浆液性、双眼发病。PCV-PED多为多灶性、出血性,且多为单眼发病。CNV-PED的数量形态表现多样,大小不等相连,形成"波浪样"外观。结论加深对各类型AMD中PED发生的几率、类型、合并症以及预后等的认识,有助于更为精确指导诊断治疗及预后分析。

Objective To investigate the characteristics of pigment epithelial detachment(PED)in different types of age-related macular degeneration(AMD)in order to provide reference for different types of diagnosis and prognosis of AMD.Methods Totally 96 patients(124 eyes)were divided into patients with retinal angiomatous proliferation(RAP),polypoidal choroidal vasculopathy(PCV),choroidal neovascularization(CNV)by imaging examination.Important features such as PED size,morphology,lesion properties,and prognosis in the above types of lesions by optical coherence tomography(OCT),fundus color photography,fundus fluorescein angiography,and fundus autofluorescence were compared and summarized.Results Together 98 patients included 10 cases of RAP-PED(10.42%),32 cases of PCV-PED(43.75%)and 54 cases of CNV-PED(45.83%).RAP-PED mostly were serous and binocular.PCV-PED were mostly multifocal,hemorrhagic,and monocular different from RAP-PED.The number of CNV-PED was diverse,which was generally different from the other two types of isolated morphology,CNV-PED forming a“wavy”appearance.Conclusion Deepening the understanding of the incidence,types,complications,and prognosis of PED in various types of age-related maculopathy will guide the diagnosis,treatment and prognosis analysis accurately.