三种类型视网膜大动脉瘤的眼底影像学特征分析

The fundus imaging features of three types of retinal arterial macroaneurysms

目的分析三种类型视网膜大动脉瘤的眼底影像学特征,为选择适合的检查方法提供参考。方法回顾性分析2010年2月至2018年12月在我院确诊的52例52眼视网膜大动脉瘤患者的临床资料,所有患者均行彩色眼底照相、荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查,6例同时行光学相干断层扫描(optical coherence tomography,OCT)检查,9例同时行吲哚青绿血管造影(indocyanine green angiography,ICGA)检查。依据眼底表现将视网膜大动脉瘤分为出血型、渗出型和静止型,分析三种类型视网膜大动脉瘤的眼底影像学特征。结果彩色眼底照相示,52眼中51眼位于颞侧动脉支,1眼位于鼻侧动脉支。FFA显示,出血型32眼瘤体合并周围出血,渗出型13眼瘤体合并周围小血管渗漏,静止型7眼(包括彩色眼底照相误判为渗出型的6眼)瘤体内动脉管壁接近正常。6眼行OCT检查者均为出血型视网膜大动脉瘤,瘤体腔壁在视网膜浅层呈环形强反射。9眼行ICGA者视网膜大动脉瘤瘤体均显影,包括未被FFA发现的出血型3眼。结论彩色眼底照相拟诊出血型视网膜大动脉瘤的患者可选择OCT和ICGA检查确诊,拟诊渗出型和静止型视网膜大动脉瘤的患者可选择OCT和FFA检查确诊。

Objective To observe the fundus imaging features of three types of retinal arterial macroaneurysms (RAM) and provide reference for selecting suitable examinations. Methods The clinic data of 52 patients (52 eyes) with RAM who were diagnosed in the Henan Eye Hospital from February 2010 to December 2018 were retrospectively analyzed.All patients received ophthalmologic examinations including visual acuity,fundus photography,and fundus fluorescein angiography (FFA),and 6 eyes were examinated by optical coherence tomography (OCT),9 eyes were diagnosed by indocyanine green angiography (ICGA).RAM was divided into hemorrhagic,exudative and quiescent type based on the ocular fundus appearance. Results Fundus photograph showed that all RAM of 52 eyes belonged to a single macroaneurysm,51 RAM were on temporal artery branches and 1 RAM was on nasal artery branch.FFA showed that Thirty-two eyes with hemorrhage around RAM was determined as hemorrhagic type,13 eyes with leakage of small vessels around RAM were exudative type,7 eyes with no hemorrhage or leakage around RAM were quiescent type,including 6 exudative eyes misjudged by fundus photograph.Six eyes of hemorrhagic type were clearly located in the superficial retina with strong reflection by OCT.All retinal arterial aneurysms of 9 eyes could be observed by ICGA,including the undetected 3 hemorrhagic type eyes by FFA. Conclusion The examinations of OCT and ICGA are the first choice for hemorrhagic retinal arterial aneurysms tentative diagnosed by fundus photography,and the examinations of OCT and FFA are suitable for exudative and quiescent retinal arterial aneurysms.