Objective:To report the clinical and fluorescein angiography features of arteriovenous(AV)malformation of the iris.Patients and Methods:We reviewed the medical records and photographs of our patients with iris AV malf...Objective:To report the clinical and fluorescein angiography features of arteriovenous(AV)malformation of the iris.Patients and Methods:We reviewed the medical records and photographs of our patients with iris AV malformation.The iris lesion was classified as simple if the blood vessel made a loop only and complex if it made intertwining convolutions.We reviewed systemic and ocular findings in each case.Results:Fourteen patients had an iris AV malformation.The mean age at diagnosis was 49 years(median age,50 years;range,16-79 years).All lesions were unilateral,without predilection for either eye or significant systemic associations.The lesion was classified as simple in 5 cases and complex in 9.The full extent of the lesion was not easily visualized with routine slitlamp examination.However,it was apparent with fluorescein angiography,which showed the vascular lesions to be uniformly hyperfluorescent in the early phases,with minimal or no late leakage of dye.There were typical areas of capillary nonperfusion in the iris stroma between the large abnormal vessels.A dilated episcleral blood vessel(“ sentinel vessel")was noted in the quadrant of the iris lesion in 7(50%)of the 14 cases.On follow-up ranging from 6 months to 14 years,none of the lesions changed or produced complications.Conclusions:Iris AV malformation has characteristic clinical and fluorescein angiographic features.It appears to be a benign stationary condition that has no apparent systemic associations and no local complications.展开更多
患者女性，54岁，因左眼视力下降2 d，于2013年8月21日于北京大学第一医院眼科就诊。患者无家族遗传病史，既往无全身病史。眼科检查示：裸眼视力右眼1.2，Jr7，左眼0.1，Jr7不见，眼压右眼14 mm Hg，左眼15 mmHg（1 mm Hg=0.133 kPa）...患者女性，54岁，因左眼视力下降2 d，于2013年8月21日于北京大学第一医院眼科就诊。患者无家族遗传病史，既往无全身病史。眼科检查示：裸眼视力右眼1.2，Jr7，左眼0.1，Jr7不见，眼压右眼14 mm Hg，左眼15 mmHg（1 mm Hg=0.133 kPa）；双眼前节检查未见异常；玻璃体腔未见混浊，视网膜在位，视乳头色泽、边界、形态正常，A：V=2：3，右眼黄斑中心凹反射可见，黄斑区未见异常，视网膜可见散在出血点及小片状出血灶（图1A）。左眼视乳头表面可见向玻璃体方向生长的增殖性血管膜，视乳头处视网膜动脉可见小的瘤样扩张，A：V=1：2，动脉管径粗细不均，黄斑中心凹反射消失，后极部可见呈强反光的视网膜前膜，后极部及周边视网膜可见散在的点状硬性渗出及小片状出血灶（图1B）。OCT检查右眼黄斑区视网膜各结构未见异常（图2A）；左眼黄斑中心凹变平，增厚的视网膜层间可见低反射腔隙，网膜内表面可见强反光带，表现为典型的黄斑水肿及视网膜前膜（图2B）。就诊后行超广角荧光素眼底血管造影（ultra-widefield fluo？rescein angiography，UWFA），见双眼动静脉充盈正常，视乳头表面及视网膜动脉分叉处瘤样扩张，后极部散在荧光渗漏灶，远端动静脉血管无充盈，形成大片毛细血管无灌注区，充盈区边缘血管末端相互吻合，晚期形成锯齿状强荧光边。右眼晚期视乳头呈高荧光，左眼视乳头处新生血管膜呈高荧光（图3，4）。诊断：双眼IRVAN综合征，左眼黄斑水肿，左眼视网膜前膜。患者遂于北京大学第一医院风湿免疫科会诊行血常规、血生化、免疫相关抗体、尿常规及颈动脉超声等检查，仅抗核抗体（ANA）呈阳性滴度1：320（正常值〈1：100），余未见明显异常。会诊意见：无全身炎性反应，单纯抗核抗体滴度升高不具诊断意义。予以强的松40mg口服，行双眼视网膜激光光凝术，在UWFA影像的指导下，眼底激光广泛彻底。术后2个月、6个月复查UWFA显示双眼原无灌注区处密布光凝斑，血管末端吻合区处激光斑尤为密集（图5）。术后9个月复查UWFA示双眼未见明显进展。展开更多
文摘目的研究糖尿病视网膜病变的毛细血管无灌注区与视野光敏感度关系。方法对处于增殖前期或早期糖尿病视网膜病变15例28眼进行视野检查,以没有或背景性糖尿病视网膜病15例21眼作对照组,得出中心视野光敏感度平均缺损(mean defect,MD)、视野指数矫正模式标准差(corrected pattern standard deviation,CPSD)。毛细血管无灌注区用眼底荧光造影确定。用计算机整合视野和荧光造影图观察毛细血管无灌注区对应的视野改变。结果26眼(26/28,92.9%)增殖前期或增殖早期糖尿病视网膜病变病人有毛细血管无灌注区,多位于中周部,表现为片状,而位于后极部多为小灶状,表现为中心视野光敏感度下降。在对照组未发现毛细血管无灌注区。增殖前期或早期糖尿病视网膜病变病人MD为(-11±8)dB,CPSD为(6.1±2.8)dB。MD和CPSD与正常参比值比较的P值小于0.05有27眼(27/28,96.4%);对照组MD为(-0.8±1.6)dB,CPSD为(1.8±0.6)dB,MD与正常参比值比较的P值小于0.05有6眼(6/21,28.6%),CPSD有4眼(4/21,19.0%)。两组差异有统计学意义(P<0.05)。Spearman’s分析发现毛细血管无灌注区的严重程度与MD呈负相关(γ=-0.736,P<0.01),与CPSD呈正相关(γ=0.593,P=0.001)。结论增殖前期和早期糖尿病视网膜病变病人的毛细血管无灌注区相对应的视野区光敏感度下降,视野检查可提示视网膜的缺血性改变。
文摘Objective:To report the clinical and fluorescein angiography features of arteriovenous(AV)malformation of the iris.Patients and Methods:We reviewed the medical records and photographs of our patients with iris AV malformation.The iris lesion was classified as simple if the blood vessel made a loop only and complex if it made intertwining convolutions.We reviewed systemic and ocular findings in each case.Results:Fourteen patients had an iris AV malformation.The mean age at diagnosis was 49 years(median age,50 years;range,16-79 years).All lesions were unilateral,without predilection for either eye or significant systemic associations.The lesion was classified as simple in 5 cases and complex in 9.The full extent of the lesion was not easily visualized with routine slitlamp examination.However,it was apparent with fluorescein angiography,which showed the vascular lesions to be uniformly hyperfluorescent in the early phases,with minimal or no late leakage of dye.There were typical areas of capillary nonperfusion in the iris stroma between the large abnormal vessels.A dilated episcleral blood vessel(“ sentinel vessel")was noted in the quadrant of the iris lesion in 7(50%)of the 14 cases.On follow-up ranging from 6 months to 14 years,none of the lesions changed or produced complications.Conclusions:Iris AV malformation has characteristic clinical and fluorescein angiographic features.It appears to be a benign stationary condition that has no apparent systemic associations and no local complications.
文摘患者女性，54岁，因左眼视力下降2 d，于2013年8月21日于北京大学第一医院眼科就诊。患者无家族遗传病史，既往无全身病史。眼科检查示：裸眼视力右眼1.2，Jr7，左眼0.1，Jr7不见，眼压右眼14 mm Hg，左眼15 mmHg（1 mm Hg=0.133 kPa）；双眼前节检查未见异常；玻璃体腔未见混浊，视网膜在位，视乳头色泽、边界、形态正常，A：V=2：3，右眼黄斑中心凹反射可见，黄斑区未见异常，视网膜可见散在出血点及小片状出血灶（图1A）。左眼视乳头表面可见向玻璃体方向生长的增殖性血管膜，视乳头处视网膜动脉可见小的瘤样扩张，A：V=1：2，动脉管径粗细不均，黄斑中心凹反射消失，后极部可见呈强反光的视网膜前膜，后极部及周边视网膜可见散在的点状硬性渗出及小片状出血灶（图1B）。OCT检查右眼黄斑区视网膜各结构未见异常（图2A）；左眼黄斑中心凹变平，增厚的视网膜层间可见低反射腔隙，网膜内表面可见强反光带，表现为典型的黄斑水肿及视网膜前膜（图2B）。就诊后行超广角荧光素眼底血管造影（ultra-widefield fluo？rescein angiography，UWFA），见双眼动静脉充盈正常，视乳头表面及视网膜动脉分叉处瘤样扩张，后极部散在荧光渗漏灶，远端动静脉血管无充盈，形成大片毛细血管无灌注区，充盈区边缘血管末端相互吻合，晚期形成锯齿状强荧光边。右眼晚期视乳头呈高荧光，左眼视乳头处新生血管膜呈高荧光（图3，4）。诊断：双眼IRVAN综合征，左眼黄斑水肿，左眼视网膜前膜。患者遂于北京大学第一医院风湿免疫科会诊行血常规、血生化、免疫相关抗体、尿常规及颈动脉超声等检查，仅抗核抗体（ANA）呈阳性滴度1：320（正常值〈1：100），余未见明显异常。会诊意见：无全身炎性反应，单纯抗核抗体滴度升高不具诊断意义。予以强的松40mg口服，行双眼视网膜激光光凝术，在UWFA影像的指导下，眼底激光广泛彻底。术后2个月、6个月复查UWFA显示双眼原无灌注区处密布光凝斑，血管末端吻合区处激光斑尤为密集（图5）。术后9个月复查UWFA示双眼未见明显进展。
