旁中心凹渗出性血管异常复合体11例及其多模影像特征

Parafoveal exudative vascular anomalous complex and its characteristics of multi-modal imaging in 11 cases

目的:观察旁中心凹渗出性血管异常复合体(PEVAC)的多模式影像特征。方法:回顾性研究。纳入2021-02/2022-02于我院经多模式影像检查确诊的PEVAC患者11例11眼,均行最佳矫正视力(BCVA)、眼底彩色照相、荧光素眼底血管造影(FFA)、频域光学相干断层扫描(SD-OCT)、光相干断层扫描血管成像(OCTA)检查。结果:眼底检查显示11眼中,6眼为单侧、孤立病灶且直径≥150μm,5眼为多个病灶(2~4个)且病灶直径<150μm;7眼伴视网膜水肿和/或硬性渗出。所有病灶FFA检查均显示为中心凹旁独立的类圆形高荧光病灶,晚期荧光增强无渗漏,伴水肿时晚期可见周围毛细血管扩张渗漏。OCTA检查示浅层及深层毛细血管层可见中心凹旁小团状高反射呈动脉瘤样扩张,病灶周围毛细血管稀疏,对应B扫描断层图(B-scan)可见病灶内部血流信号丰富。4眼伴黄斑水肿者行玻璃体腔内抗血管内皮生长因子(VEGF)注射治疗,随访病灶无明显变化。结论:多模式影像学检查有助于明确PEVAC的诊断及鉴别诊断,PEVAC对抗VEGF治疗应答不佳。

·AIM:To observe the imaging characteristics of multi-modal imaging in perifoveal exudative vascular anomalous complex(PEVAC).·METHODS:A retrospective case analysis.There were 11 patients(11 eyes)diagnosed as PEVAC by multi-modal imaging in our hospital included in this study from February 2021 to February 2022.All patients underwent the examinations of best corrected visual acuity(BCVA),fundus photography,fluorescein fundus angiography(FFA),spectral-domain optical coherence tomography(SD-OCT)and optical coherence tomography angiography(OCTA).·RESULTS:On fundus examination,six out of eleven eyes presented as a unilateral and isolated lesion with diameter≥150μm,five out of eleven eyes presented as multiple lesions(ranging from 2 to 4)and the diameter of each lesion<150μm,seven eyes with retinal edema and/or hard exudation.FFA revealed an oval-like hyper-fluorescent lesion of parafoveal in the late phase with enhancement but no leakage.Late peripheral telangiectasia leakage is seen with oedema.OCTA examination revealed a parafoveal small mass hyper-reflex showed aneurysmal dilation in the superficial and deep capillary,and capillary rarefaction was observed around the lesion.B-scan showed strong blood flow signal inside.Anti-vascular endothelial growth factor(VEGF)therapy was performed in 4 patients with macular edema.However,there was no notable improvement after treatment.·CONCLUSION:Multi-modal imaging can help confirm the diagnosis and differential diagnosis of PEVAC,there is a poorly response to anti-VEGF therapy.