周边渗出性出血性脉络膜视网膜病变的临床特征分析

Clinical analysis of peripheral exudative hemorrhagic chorioretinopathy

目的探讨周边渗出性出血性脉络膜视网膜病变(PEHCR)的临床特点及多模态影像学特征,及其治疗效果和预后情况。方法回顾性病例系列研究。收集2016年10月至2019年12月在北京大学人民医院眼科确诊的12例(12只眼)PEHCR患者的临床资料。分析患者的视力、裂隙灯显微镜检查、散瞳后间接眼底镜检查及眼底照相、眼部B超检查、相干光层析成像术、荧光素眼底血管造影术和吲哚青绿血管造影术等影像学资料及手术术式、治疗效果和随访情况等。结果12例患者中,男性7例,女性5例;年龄(58.0±8.8)岁;均为单眼发病,累及右眼6例,左眼6例。所有患者均以玻璃体积血就诊,其中9例伴眼内占位性病变。B超测量合并眼内占位病变患者眼内肿物的最大基底直径为(8.3±1.6)mm,隆起高度为(3.5±1.2)mm;A超显示为中高回波或中低回波。荧光素眼底血管造影术未见特征性表现,主要为遮蔽荧光。所有患者均接受玻璃体切除术治疗,术中显示眼内占位病变为出血、渗出性肿物。2例患者联合白内障摘除手术,3例患者术中行眼内容物填充术(1例气体填充、2例硅油填充),3例患者术后联合抗血管内皮生长因子药物治疗。患者随访时间为(30.0±12.6)个月,末次随访时11例患者视力较术前提高,1例维持稳定。结论PEHCR是一种以出血和渗出为特征的周边部脉络膜视网膜病变,可呈现为占位性病灶,缺乏特征性影像学改变,总体疗效和预后较好。

Objective To evaluate the clinical features and outcomes of eyes with peripheral exudative hemorrhagic chorioretinopathy(PEHCR).Methods It was a retrospective case series study.A total of 12 patients(12 eyes)diagnosed with PEHCR at Peking University People′s Hospital from October 2016 to December 2019 were included.The clinical data of visual acuity,slit-lamp microscopy,indirect ophthalmoscopy,fundus photography,B-ultrasound,optical coherence tomography,fluorescein fundus angiography and indocyanine green angiography,surgical procedures,therapeutic effects and follow-up were analyzed.Results Among all 12 patients included,7 were male and 5 were female.The age was(58.0±8.8)years.All patients had unilateral disease.The right eye was involved in 6 cases and the left eye in 6 cases.All cases presented with vitreous hemorrhage,9 of which presented with intraocular space-occupying lesions.In the patients with intraocular space-occupying lesions,the maximum basal diameter was(8.3±1.6)mm and the height was(3.5±1.2)mm measured by B-ultrasound.A-scan ultrasonography was characterized by intermediate high reflectivity or intermediate low reflectivity.Fundus fluorescence angiography revealed nonspecific alterations corresponding to the visible fundoscopic changes such as window defects,blockage,staining,but no neovascular membrane.No polyps were found on indocyanine green angiography.All patients received vitrectomy.The intraocular lesions were found to be subretinal bleeding and exudative masses intraoperatively.Two patients had combined cataract surgery;three patients received gas or silicone oil tamponade,and three patients received adjunct intravitreal anti-vascular endothelial growth factor drugs during the follow-up.The follow‐up period was(30.0±12.6)months.At the last visit,the visual acuity was improved in 11 patients and remained stable in 1 patient.Conclusions PEHCR is a peripheral hemorrhagic retinal degenerative disorder that simulates choroidal melanoma and lacks characteristic angiography changes.The overall therapeutic effect and prognosis are good.