中心性浆液性脉络膜视网膜病变荧光素和吲哚氰绿血管造影及眼球后血流动力学分析

目的 探讨中心性浆液性脉络膜视网膜病变(CSC)患者眼球后血管血流动力学变化特征、脉络膜循环异常特点及其与视网膜色素上皮病变的关系.方法 病例对照研究.应用彩色超声多普勒检测57例(57只患眼,57只对侧眼)CSC单侧受累患者及25例(50只眼)正常对照者的眼动脉、睫状后动脉、睫状后短动脉,记录其血管收缩期峰值血流速度(PSV)和舒张末期血流速度(EDV)及阻力指数(RI),并对CSC患者的患眼、对侧眼及正常对照眼的血流参数两两间分别进行比较研究.采用海德堡激光扫描眼底造影系统,对57例患者行同步吲哚氰绿脉络膜血管造影(ICGA)、荧光素眼底血管造影(FFA),并对其图像进行对比分析.采用SPSS 12.0统计学软件.对CSC患者的患眼与对侧眼的眼动脉、颞侧睫状后动脉、颢侧睫状后短动脉的PSV、EDV、RI血流参数进行比较,采用自身配对t检验;对正常对照眼与CSC患者的对侧眼和患眼血流参数进行比较,采用成组设计t枪验.以P＜0.05作为差异有统计学意义.结果 CSC患者的患眼和正常对照者的颞侧睫状后动脉(PSV:t=3.044,P=0.005;EDV:t=3.731,P=0.001)、颞侧睫状后短动脉(PSV:t=2.822,P=0.008;EDV:t=3.194,P=0.003),患者对侧眼和正常对照者的颞侧睫状后动脉(PSV:t=3.219,P=0.003;EDV:t=3.807,P=0.001)、颞侧睫状后短动脉(PSV:t=3.931,P=0.000,EDV:t=3.145,P=0.003)血流参数均下降,差异有统计学意义(P＜0.05).患者的患眼与对侧眼的颞侧睫状后动脉(PSV:t=0.608,P=0.548;EDV:t=0.122,P=0.904)、颞侧睫状后短动脉(PSV:t=0.730,P=0.470;EDV:t=0.109,P=0.914)的血流参数比较,差异均无统计学意义(P＞0.05).ICGA、FFA检查结果显示,57例患者的患眼所有视网膜色素上皮渗漏点均出现在相对应的脉络膜弱荧光区内,其中52例在早期弱荧光区内继发脉络膜血管扩张,晚期呈现高荧光渗漏灶.患眼和对侧眼所有视网膜色素上皮窗样荧光处,相对应的脉络膜部位,在ICGA造影晚期均呈现高荧光渗漏灶.而20只患眼及其16只对侧眼的脉络膜在ICGA晚期呈现高荧光渗漏灶处,经FFA检查未见视网膜色素上皮窗样荧光.结论 CSC是与全身因素有关的舣眼疾病,其眼球后和脉络膜微循环异常的基本特征为血管的低灌注和缺血,视网膜色素上皮病变继发于脉络膜微循环异常.(中华眼科杂志,2009,45:243-247)

The analysis of fundus fluorescein angiography,indocyanine green angiography and hemodynamics of retrobulbar blood vessels in central serous chorioretinopathy

objectivc To analyze the characteristics of the retrobulbar blood vessels'hemodynamics changes and the choroidal circulation disorder,and to observe the relations between retinal pigment epithelium's(RPE)pathological changes and them.Methods It was a case control study.For 57(57 affected eyes and 57 contralateral eyes)unilateral eye affected patients and 25(50 eyes)normal health adults,we examined ophthalmic arteries(OA),posterior ciliary arteries(PCA)and short posterior ciliary arteryies(SPCA)by color Doppler flow Imaging(CDFI),and recorded the peak systolic velocities(PSV),end diastolic velocities(EDV)and resistance indexes(RI)of them.We compared each hemodynamic parameter of the normal eyes with it of the affected eyes and contralateral eyes in patients group respectively,and contrasted them between affected eyes and contralateral eyes of the patients.Fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA)were performed simultaneously on 57 patients with Heidelberg retina angiography,and the images were analyzed in contrast.We used SPSS 12.0 statistics software was used in the study.To the PSV,EDV and RI of the OA,PCA and SPCA in affected eyes and contralateral eyes of the patients,we used paired t-test for the same sample to compare their hemodynamic parameters:to compare normal health adults'eyes with the affected eyes and the contralateral eyes of patients group respectively,we used two-group t-test.When the P-value was less than 0.05,there was a statistical significanoe.Results There wag a more significant decrease of the hemodynamic parameters in beth PSVs and EDVs of temporal PCAs(PSV:t=3.044,P=0.005;EDV:t=3.731,P=0.001)and temporal SPCA8(PsV:t=2.822,P=0.008;EDV:t=3.194,P=0.003)compared the patients group's affected eyes with normal health adults group eyes,there was a more significant decrease of them of temporal PCAs(PSV:t=3.219,P=0.003;EDV:t=3.807,P=0.001)and temporal SPCAs(PSV:t=3.931,P=0.000,EDV:t=3.145,P=0.003)compared the patients group's contralateral eyes with normal health adults group eyes,and there was a statistical significance of them(P＜0.05).There was no difierence in hemodynamic parameters of both PsVs and EDVs of temporal PCAs(PSV:t=0.608,P=0.548;EDV:t=0.122,P=0.904)and temporal SPCAs(PSV:t=0.730,P=0.470;EDV:t=0.109,P=0.914)between affected eyes and contralateral eyes of the patients,and there was no statistical significance of them(P＞0.05).The results of FFA and ICGA showed that all the RPE's leaks of 57 affected eyes appeared at the hypofluoresceint regions of relative choroids;52 cases of 57 affected eyes were followed by choroidal vessels dilatation at the early hypofluoresceint regions,and appeared hyperfluorescence leakages in the late phase images:At the all regions of RPE's transmitted fluorescences of affected eyes and contralateral eyes,the corresponding choroids showed hyperfluorescence in the late phase images in ICGA;There were no RPE's transmitted fluorescences at the regions of 20 affected eyes and 16 contralateral eyes in FFA,which showed hyperfluoresceince leakages in the late phabe images of choroids in ICGA.Conclusions CSC is possibly a bilateral disease associated with systemic pathologic conditions.Hypoperfusion and ischemia are the basal characteristics of retrobulbar blood vessels'circulation disorder and choroidal ultracirculation disorder.The damage of RPE is following to the choroidal circulation disorder.(Clan J Ophthalmol,2009,45:243-247)