黄斑毛细血管扩张症炫彩眼底激光成像特征分析

Multicolor scanning laser imaging in macular telangiectasia

目的观察黄斑毛细血管扩张症(MacTel)炫彩及多模式眼底影像特征。方法采用系列病例观察研究,分析2019年1—11月就诊于山东省眼科医院、经荧光素眼底血管造影(FFA)检查确诊为MacTel的患者12例16眼,其中MacTelⅠ型8例8眼,男4例4眼,女4例4眼,平均年龄(62.3±12.5)岁;MacTelⅡ型4例8眼,均为女性,平均年龄(58.7±10.5)岁。所有受试者均行最佳矫正视力、裂隙灯显微镜、彩色眼底照相、炫彩眼底激光扫描成像、FFA、光相干断层扫描(OCT)及光相干断层扫描血管成像(OCTA)检查,观察不同类型MacTel特征。结果彩色眼底照相结果显示,MacTelⅠ型患眼中,6眼黄斑区环形渗出合并水肿,1眼黄斑水肿不伴硬性渗出,1眼黄斑硬性渗出不伴水肿;MacTelⅡ型患眼中心凹颞侧视网膜透明度下降呈灰色。炫彩眼底激光扫描成像显示,MacTelⅠ型患眼黄斑渗出呈现点状黄色颗粒,黄斑水肿呈黄绿色,成像较彩色眼底照相清晰,蓝光及绿光反射图均见渗出的点状显影,且绿光反射图显影最强,蓝光显影次之,红外光显影最弱;MacTelⅡ型患眼黄斑颞侧呈绿色,成像较彩色眼底照相明显清晰,蓝光反射图显影最强,绿光显影次之,红外光显影最弱。在OCT检查中,MacTelⅠ型患眼表现为内层视网膜囊样水肿或外丛状层视网膜不均匀强反射信号;MacTelⅡ型患眼视网膜内外层结构缺失,空腔形成,其中2例出现外层视网膜萎缩等表现。在OCTA检查中,MacTelⅠ型和Ⅱ型患眼均表现为黄斑区浅层、深层毛细血管丛破坏,以深层毛细血管丛破坏更明显;MacTelⅡ型患眼血管间隙增大、血管密度降低、中心凹无血管区扩大更明显。在FFA检查中,MacTelⅠ型患眼表现为早期黄斑中心凹旁毛细血管充盈迟缓,颞侧血管扩张,部分呈瘤样扩张,后期瘤样扩张处局限性增强;MacTelⅡ型患眼表现为不同程度的早期黄斑中心凹旁小血管扩张,晚期黄斑区偏颞侧毛细血管呈弥漫性强荧光。结论炫彩眼底激光扫描成像技术能清晰地显示MacTel的形态特征,MacTelⅠ型与Ⅱ型影像特征差异明显。

Objective To observe the characteristics of macular telangiectasia(MacTel)in multi-color and multi-mode fundus images.Methods An abservational case series study was conducted.Sixteen eyes of 12 patients diagnosed with MacTel by fluorescein fundus angiography(FFA)from January to November 2019 in Shandong Eye Hospital were analyzed.There were 8 cases(8 eyes)with MacTel typeⅠ,among which 4 cases were male and 4 cases were female,with an average age of(62.3±12.5)years.The other 4 cases(8 eyes)had MacTel typeⅡ,all of which were female,with an average age of(58.7±10.5)years.Best corrected visual acuity,slit lamp microscopy,color fundus photography,multicolor scanning laser imaging,FFA,optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)were carried out in all the patients.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Shandong Eye Institute(No.2019S003).Results In color fundus images of MacTel typeⅠeyes,annular macular exudation with macular edema occurred in 6 eyes,macular edema without hard exudates in 1 eye,and hard macular exudates without macular edema in 1 eye.However,the transparency of retina in temporal fovea in MacTel typeⅡeyes decreased,showing a gray color.In multi-color fundus images of MacTel typeⅠeyes,punctate granular yellow macular exudation and yellow-green macular edema were observed,which were clearer than those in color fundus images.Punctate exudation was seen in both the blue and green reflectance images,which was clearest in green reflectance image,followed by blue reflectance image and then the infrared reflectance image.In OCT images of MacTel typeⅠeyes,cystoid edema of inner retina or uneven reflection signal of outer plexiform retina were observed.Loss of inner and outer retinal structures and cavities were observable in MacTel typeⅡeyes,and outer retinal atrophy appeared in 2 eyes.In OCTA images,the destruction of superficial and deep capillary plexus in macular area were observed in both MacTel typeⅠand typeⅡeyes,and the destruction of deep capillary plexus was more obvious.In addition,more obviously increased vascular space,decreased vessel density,and increased foveal avascular zone were found in MacTel typeⅡeyes.In early stage of FFA,delayed capillary filling near fovea was seen in MacTel typeⅠeyes,and dilated temporal vessels in fovea,some of which showed tumor-like dilation,and the limited tumor-like dilation was enhanced in the later stage.Different degrees of dilated parafoveal blood vessels in the early stage,and the capillary in the temporal side of the macula showing diffuse strong fluorescence in the late stage of FFA was observed in MacTel typeⅡeyes.Conclusions Multi-color scanning laser imaging can be used to observe the morphological characteristics of MacTel,and the imaging features of different types of MacTel are significantly different.