黄斑中心凹旁渗出性血管异常复合体的临床及多模影像学特点分析

Clinical and multimodal imaging characteristics of perifoveal exudative vascular anomalous complex

目的分析黄斑中心凹旁渗出性血管异常复合体(PEVAC)的临床特点及多模影像学特点。设计回顾性病例系列。研究对象2011-2022年北京同仁医院PEVAC患者14例(14眼)。方法回顾患者的病历资料。主要指标彩色眼底像、FFA及OCTA的影像学特点;OCTA中不同部位包括中心凹处、中心凹旁、旁中心、2 mm直径范围的血流密度。结果14例(14眼)中女性9例,平均年龄(63.21±6.69)岁。均为单眼发病。有糖尿病病史者2例,高血压病史者4例。彩色眼底照相可见7例红色点状病灶,9例黄白色硬性渗出,5例黄色点状病灶,1例伴有少许出血。FFA表现为拱环周瘤样高荧光稍渗漏;高荧光病灶平均(1.47±0.74)个;其中18个病灶位于拱环颞侧,4个位于拱环鼻侧;瘤样高荧光距离拱环中心的平均距离为(690.68±168.68)μm。OCT上类圆形病灶分布在视网膜内层,未破坏外界膜进入视网膜外层。8例行OCTA检测者中1例浅层视网膜血管层内探及血流信号,7例深层视网膜血管层探及血流信号。浅层及深层视网膜黄斑区不同部位血管密度,患眼及健眼差异均无统计学意义(P均>0.05)。结论PEVAC发生于老年人,更常发生于旁中心凹区域拱环颞侧的视网膜内层,为单个或多个大动脉瘤样异常,常伴有渗出性改变,很少伴有出血,可在深层或浅层毛细血管层检测到异常血流信号。

Objective To observe the clinical characteristics and multimodal imaging characteristics of perifoveal exudative vascular anomalous complex(PEVAC).Design Retrospective case series.Participants 14 patients(14 eyes)with PEVAC in Beijing Tongren Eye Center during January 2011 to June 2022 were included.Methods The medical records data of all patients were reviewed.Main Outcome Measures The characteristics of color fundus image,FFA and OCTA;the blood flow density in different sections including whole image,fovea,parafovea,perifovea and 2 mm diameter.Results 14 patients(14 eyes)with PEVAC lesion included 9 females,with an average age of(63.21±6.69)years.There were 2 cases with diabetes and 4 cases with hypertension.On the color image,small red spots beside the fovea of the macula were seen in 7 cases,yellow white hard exudation changes were seen in 9 cases.FFA and ICGA showed punctate high fluorescence lesion with an average of(1.47±0.74);among them,18 lesions were located at the temporal side of fovea and 4 lesions were at nasal side.The average distance from fovea to lesion was(690.68±168.68)μm.OCTA was performed in 8 cases.Blood flow signals were detected in the superficial retinal vascular layer in 1 case and in the deep retinal vascular layer in 7 cases.The blood flow density in different section of the superficial and deep layers was not statistically significant between the affected eye and the healthy eye(all P>0.05).Conclusion PEVAC often occurs in the elderly.It is manifested as a single or multiple large aneurysmal abnormality located in the inner layer of the retina that often occur in the temporal side of parafovea.It is often accompanied by exudative changes and rarely accompanied by bleeding.Abnormal blood flow signals can be detected in the deep or superficial retinal vascular layer.