中医药治疗特发性黄斑中心凹旁毛细血管扩张症1例

Traditional Chinese medicine treatment of idiopathic macular fovea paracentric telangiectasia: A case report

患者,男,38岁,主因"右眼突然视力下降、视物变形1个月"就诊于河北省眼科医院。眼部检查:右眼视力0.5,眼底黄斑区可见一个约1/4 PD的黄白色病灶,周围可见散在出血斑,毛细血管扩张,黄斑颞下方可见黄白色渗出。荧光素眼底血管造影+吲哚青绿血管造影(fluorescein ang iography+indolegreenang iography,FFA+ICG A)示:可动态观察到黄斑区毛细血管扩张渗漏及晚期黄斑区的囊样水肿。光学相干断层扫描成像(optical coherence tomography,OCT)示:黄斑区局部神经上皮层隆起,呈囊样水肿表现。诊断:右眼特发性黄斑中心凹旁毛细血管扩张症(macular telangiectasia,MacTel)。中医辨证治疗,早期以清热凉血、健脾除湿为主;中期采用疏肝清热、健脾渗湿法;后期以补肾健脾为原则。治疗后,患者视力恢复正常,视功能明显改善,黄斑区水肿完全消退。随诊观察4年,患者病情控制良好。

The patient,male,38 years old,was treated in Hebei Eye Hospital for the main cause of“sudden visual acuity of the right eye and visual deformity for 1 month”.Eye examination:visual acuity of the right eye was 0.5.A yellow-white lesion of approximately 1/4 diameter of visual nipple was seen in the macular area at the fundus of the eye.Around the macular area,there were scattered bleeding spots,telangiectasia,and yellow-white exudation was seen below the temporal lobe of the macula.Fluorescein angiography+indole green angiography(FFA+ICGA)showed that the telangiectasia leakage in macular area and cystic edema in late macular area was observed dynamically.Optical coherence tomography(OCT)showed local neuroepidermal bulges in macular area with cystic edema.Diagnosis:right eye idiopathic macular central fovea paravicular telangiectasia.Traditional Chinese medicine offer differentiation treatment,early to clear heat and cool blood,improve the function of spleen and dispel moisture;in the middle stage,the method of soothing liver and clearing heat and strengthening spleen infiltration;in the later period to invigorate the kidney and invigorate the spleen as the principle.After treatment,the patient’s vision returned to normal,visual function improved significantly,and the edema in the macular area completely subsided.After 4 years of follow-up,the patient’s condition was well controlled.