早产儿视网膜病变的荧光素眼底血管造影特征

目的 观察早产儿视网膜病变（ROP）患眼的荧光素眼底血管造影（FFA）特征。 方法 经间接检眼镜检查确诊为ROP的84例患儿168只眼纳入研究。所有患儿均为双眼发病。其中，1期病变4只眼，2期病变52只眼，3期病变80只眼，4期病变8只眼，5期病变8只眼；急进性后部型ROP（AP-ROP）16只眼。伴有附加病变18只眼。均在全身麻醉下散瞳，采用二代广角数码视网膜成像系统行FFA检查。观察各期患眼视网膜动静脉形态特征、毛细血管充盈状态、新生血管形态和荧光渗漏情况。结果 FFA检查发现，1期病变周边部视网膜毛细血管分支增多并扩张纡曲，毛细血管末梢渗透性增加，可见少量荧光渗漏。有血管区与远端无血管区之间形成明确分界线。2期病变视网膜颞侧血管末梢分支增多并呈形似扫帚的平行分布，末端血管相互吻合形成环路，病变边缘纤维组织增生呈嵴样改变，并伴有“爆米花”现象（popcorn）。3期病变视网膜嵴继续增宽，新生血管纤维增生膜形成并突破视网膜内界膜向玻璃体方向伸展，大量荧光渗漏。嵴与远端无血管区境界清楚。4、5期病变视网膜非脱离区的血管改变与2、3期无异，脱离的视网膜部分显示为血管扩张伴荧光渗漏。伴有附加病变的患眼后极部视网膜动脉纡曲、扩张，周边部大量无灌注区，同时伴有点片状出血呈遮蔽荧光。AP-ROP患眼后极部视网膜血管纡曲、粗大，毛细血管极度扩张。而在后极部以外的视网膜仅见少数纡曲的大血管，无毛细血管形成，在无血管区边缘可见大量团状新生血管荧光渗漏。 结论 ROP患儿1~3期病变周边视网膜有血管区与无血管区分界线明显，荧光渗漏情况逐渐加重；4期及5期病变，脱离视网膜焦距显示不清楚；附加病变主要以后极部动脉纡曲为主；APROP后极部动静脉均纡曲扩张，新生血管荧光渗漏明显。

Fundus fluorescein angiography in retinopathy of prematurity

Objective To analysis the fundus characteristics of fundus fluorescein angiography (FFA) of retinopathy of prematurity (ROP). Methods Eighty-four cases (168 eyes) who were diagnosed with ROP by a binocular indirect ophthalmoscope were included in the study. Among the 84 cases, there were 2 cases (4 eyes) of stage 1 ROP, 26 cases (52 eyes) of stage 2 ROP, 40 cases (80 eyes) of stage 3 ROP, 4 cases (8 eyes) of stage 4 ROP, and 4 cases (8 eyes) of stage 5 ROP, 9 cases (18 eyes) of plus disease, 8 cases (16 eyes) of aggressive posterior ROP (APROP). All infants received FFA with RetCam II under general anesthesia and mydriasis. The retinal vein morphology, capillary filling state, neovascularization morphology and fluorescein leakage were observed. Results FFA revealed increased branching, expansion and tortuous peripheral retinal capillaries, increased capillary permeability with a small amount of fluorescein leakage in stage 1 ROP. There was a clear dividing line between the vascular area and the remote avascular area. In stage 2, the peripheral branches of temporal retinal blood vessels increased, and parallel distributed like a broom. The capillary end anastomosed with each other to form a loop. The fibrous tissues at the lesion edge proliferated as a ridge, with popcorn phenomenon. In stage 3, the ridge continued broadening, and the neovascular fibrous membrane formed breakthrough internal limiting membrane, stretched into the vitreous with a lot of fluorescein leakage. The ridge and remote avascular zone demarcated clearly. In stage 4 and 5, the vessel changes had similar phenomenon with the stage 2 and 3 in undetached retina, but the vessels in the detached retina expanded with fluorescein leakage. As for plus disease, the retinal arterioles in the posterior pole were tortuous, there were a large number of non perfusion area in the peripheral retina with hemorrhage and obscured fluorescence. The retinal vessels in posterior pole in AP-ROP were also tortuous, and the capillaries were extreme expanded, while there were very few tortuous vessels and no capillary formation in the other part of retina.At the avascular zone boundaries, there were a large group of neovascularization with fluorescein leakage. Conclusions The demarcation line separating the avascular from the vascularized retinal regions is formed in stage 1, 2 and 3, and the amount of fluorescein leakage gradually increase from stage 1 to stage 3 ROP. The detached retina of stage 4 and stage 5 has an unclear focal length in the FFA. The plus disease mainly has arteriolar tortuosity in the posterior pole retina. In the AP-ROP cases, both of the arterioles and venules in posterior pole of retina are tortuous and expanding with neovascularization leakage of fluorescein.