荧光素眼底血管造影对脉络膜挫伤的诊断价值

目的 分析荧光素眼底血管造影(FFA)在脉络膜挫伤诊断中的价值.方法 对86例(86只眼)脉络膜挫伤常规进行散瞳后间接眼底镜及FFA检查.结果 86只眼中65只眼(75.83%)有脉络膜破裂,其中有50只眼破裂与出血并存.造影前检眼镜检查未发现脉络膜破裂者共6眼,占6.98%.结论 FFA能最大限度地发现脉络膜破裂,尤其是眼底镜下不能发现的微小、隐匿的破裂与出血,能准确地判断损伤部位、层次及损害程度.     

脉络膜破裂的临床与荧光素眼底血管造影表现

目的 分析外伤性脉络膜破裂的临床特点与荧光素眼底血管造影(FFA)表现,以及FFA在脉络膜破裂诊断中的应用.方法 对122例(123眼)外伤性脉络膜破裂的临床资料进行了回顾性分析,全部病例均行FFA及常规眼科检查.结果 123眼中86眼(69.92％)为脉络膜破裂与出血并存.造影前眼底检查未发现裂口者15眼,占12.20％.结论 FFA在诊断脉络膜破裂方面具有独特的优越性,能最大限度地发现脉络膜破裂病灶,尤其是检眼镜下未能发现的微小、隐匿的破裂与出血;在造影的晚期大都能清晰地显示出脉络膜破裂的部位、大小与形态.能客观地确定损伤的程度范围,有助于确诊及估计预后.     

眼挫伤荧光素眼底血管造影临床分析

目的 分析眼挫伤眼底改变及荧光素眼底血管造影(FFA)的表现.方法 对268例(339只眼)眼挫伤经直接检眼镜和三面镜检查及FFA检查.结果 眼挫伤视功能严重受损的主要原因是视网膜、视神经受损,常见的有视网膜震荡、视网膜出血、黄斑裂孔、脉络膜破裂、出血,视网膜脱离和视神经损伤.其中以视网膜震荡多见.结论 对于眼挫伤患者,只要屈光间质清晰,都应检查眼底,行FFA检查,以判断眼底病损伤部位及损害程度.     

眼底荧光血管造影在眼挫伤中的临床应用及分析

目的:探讨眼挫伤的眼底改变及眼底荧光血管造影(fundusfluorescein angiography,FFA)的表现。方法:对272例325眼眼挫伤分别经直接检眼镜和三面镜检查及FFA检查并进行分析结果:眼挫伤可导致视功能严重受损,主要原因为视网膜、视神经的损伤,常见的有视网膜震荡、视网膜出血、黄斑裂孔、脉络膜破裂、出血,视网膜脱离和视神经损伤,其中以视网膜震荡多见。结论:对于眼挫伤都应常规检查眼底,条件允许的情况下都要行FFA检查,以判断眼底的损伤部位及程度。     

外伤性脉络膜破裂的吲哚青绿血管造影

目的探讨脉络膜破裂(choroidal rupture,CR)的吲哚青绿血管造影(indocyanine green angiography,ICGA)和荧光素眼底血管造影(fundus fluore scein angiography,FFA)的影像学表现及其同步检查的意义。方法对17例眼挫伤致CR患者的17只患眼进行FFA和ICGA同步检查,并对FFA和ICGA结果进行对比分析。结果CR部位FFA显示为强荧光,ICGA显示为弱荧光;5只眼(29.4%)ICGA显示CR 长度较FFA所显示的长;有6只眼(35.3%)在出血灶内,ICGA显示出FFA不能显示的隐匿CR带。结论ICGA较FFA能更好地确定脉络膜裂伤的范围和程度 ,FFA和ICGA同步检查能全面地了解CR的程度和眼底各组织的病理变化。(中华眼底病杂志,2001,17:30-32)     

眼钝挫伤的吲哚青绿血管造影

目的观察眼挫伤后脉络膜、视网膜循环改变在影像学检查中的特征和临床意义。方法对30例眼挫伤患者的30只伤眼进行荧光素眼底血管造影(fundus fluorescein angiography,FFA)和吲哚青绿血管造影(indocyanine green angiography,ICGA)同步检查。结果19只眼FFA表现为视盘象限性或全部弱荧光(视盘缺血性改变),占63.3%,视盘象限性弱荧光区和脉络膜延迟灌注区相连。26只眼出现局部脉络膜灌注不良,占86.7%。其中16只眼为局限性充盈迟缓,脉络膜荧光完全充盈时间：最短1 min 50 s,最长5 min 43 s;10只眼为 局限性充盈缺损。视网膜脉络膜充盈时间倒置6只眼,占20.0%;脉络膜及视网膜中央血管系 统充盈均延迟者5只眼,占16.6%。在脉络膜局部灌注不良的部位均出现了视网膜色素上皮( retinal pigment epithelium, RPE)的损害。结论ICGA可清 楚地显示眼挫伤后脉络膜循环的改变,结合FFA同步检查,可对眼底损害作出更加全面的评价。(中华眼底病杂志,2001,17:122-124)     

眼挫伤32例42眼眼底荧光血管造影联合视觉电生理分析

目的:观察眼挫伤后进行眼底荧光血管造影(fundus fluorescein angiography,FFA)联合视觉诱发电位(visual evoked potential,VEP)和视网膜电图(electroretinigram,ERG)的特点和临床意义。方法:对32例42眼眼挫伤患者进行FFA,ERG和VEP检查。结果:FFA检查,视网膜震荡伤16眼(38.0%),视网膜挫伤9眼(21.4%),视神经损伤22眼(52.3%)黄斑裂孔2眼(4.7%),脉络膜破裂7眼(9.7%)。视觉电生理检查:32眼(76.1%)挫伤引起闪光ERG的a,b波波幅下降,视力<0.1者26眼(61.9%)闪光VEP的P波潜伏期延迟,波幅下降趋势明显。结论:FFA联合视觉电生理检查对眼挫伤引起的视网膜视神经改变能进行客观、可靠的评价。     

外伤性脉络膜破裂临床观察

目的探讨外伤性脉络膜破裂的临床特征、分型及眼底血管造影特点。方法回顾性分析17例（17只眼）外伤性脉络膜破裂患者临床资料。17例（17只眼）行荧光素眼底血管造影（FFA）检查，8只眼同时行脉络膜吲哚氰绿血管造影（ICGA）检查。结果FFA检查，17只眼中9只眼FFA早期病损部位呈条状或弯月形透见荧光或弱荧光，晚期呈现强、弱荧光或着染，或由于出血遮蔽难以显示破裂部位、大小及形态。ICGA检查，5只眼视网膜出血不多，早期表现为破裂灶周围脉络膜充盈缺损，破裂处可见脉络膜毛细血管断裂，大血管连续性良好，或者大血管亦断裂，晚期可清晰显示脉络膜破裂的部位、大小、形态及多少。3只眼合并浓厚的出血，造影早期亦看不到明显改变，晚期则可见破裂灶。结论外伤性脉络膜破裂如果合并眼底出血时，ICGA检查优于FFA，并可以根据ICGA检查将其分为脉络膜全层破裂和脉络膜毛细血管．玻璃膜一视网膜色素上皮复合体（CBRC）断裂。     

荧光素眼底血管造影和光学相干断层扫描在眼挫伤眼底病变中的临床价值

目的 探讨荧光素眼底血管造影( FFA)和光学相干断层扫描(OCT)在眼挫伤眼底病变中的临床应用价值.方法 对269例(314眼)的眼球挫伤的FFA和OCT检查结果进行回顾性分析.结果 眼球挫伤的FFA及OCT表现有:大致正常、视网膜水肿、出血、前膜、脱离、萎缩、黄斑孔、脉络膜破裂、脉络膜新生血管、视网膜色素上皮病变及视神经病变等.结论 FFA能及时准确地了解眼球挫伤的损伤部位及程度,OCT在活体上能清晰的显示眼挫伤病变类似病理组织的改变,两者相互印证、取长补短,为眼球挫伤眼底病变中的临床诊断及治疗提供依据,具有重要的指导价值,并可较准确的评估其预后.     

荧光素眼底血管造影在眼挫伤诊断中的应用

目的分析眼挫伤后荧光素眼底血管造影（FFA）的临床表现。方法对68例（78眼）眼球挫伤行眼底血管荧光造影检查。结果视网膜震荡43眼中33眼FFA表现为视网膜动脉静脉稍迂曲、黄斑区点状透见荧光。10眼FFA表现为低荧光，无荧光渗漏。视网膜出血8眼FFA表现出血区荧光遮蔽。脉络膜裂伤9眼FFA表现为血管下方弧形弱荧光、造影晚期呈高荧光。黄斑孔6眼：其中板层孔4眼，FFA未见异常荧光；全层孔2眼FFA显示为黄斑区圆形透见荧光。视神经挫伤12眼FFA表现视盘毛细血管扩张及渗漏，晚期呈强荧光；其中1眼视盘灌注时间晚于视网膜中央动脉灌注。结论眼底血管荧光造影能及时准确地了解眼球挫伤后损伤部位和程度，为指导临床诊疗提供依据，应作为眼球挫伤的常规检查。     

视神经挫伤后的眼底血管造影

目的：用荧光素眼底血管造影（Fundus fluorescein angiography,FFA)和吲哚青绿血管造影（Indocyanine green angiography,IGGA)探讨视神经挫伤后，视神经及周围视网膜，脉络膜的循环改变。方法：对30例（30只眼）不同程度的眼球挫伤致视神经损伤的患者进行FFA与ICGA同步检查，并对它们的图像进行分析（本组除外脉络膜破裂）。结果：除1例视盘及周围视网膜，脉络膜荧光大致正常外，其余29例均出现了异常的荧光表现。FFA主要表现为：在造影早期视盘呈象限性或全视盘性的荧光充盈不良，后期荧光素渗漏或始终不能充盈，ICGA主要表现为：在FFA显示的视盘象限性弱荧光区的相邻区域脉络膜充盈时间明显延迟；FFA显示的全视盘性的弱荧光，盘周的脉络膜充盈时间明显延长，在局限性脉络膜灌注不良的对应区均出现了视网膜色素上皮（Retinal pigment epithelium,RPE)的损害，而盘周脉络膜灌注不良的区域，有9例相应区视网膜并未出现RPE的损害；有2例合并视网膜分支动脉阻塞；有19例视盘缺血的部分正是“分水区”的位置，占63.3%，本组病例中有80%视力在0.1以下。结论：眼球挫伤不仅可使视神经损伤，其周围的视网膜，脉络膜均可受到损害，应尽早施行FFA与ICGA检查，它可以详细观察，正确判断视神经挫伤后的视盘缺血情况及周围视网膜，脉络膜损害的范围和程度，及时正确地指导治疗。     

Indocyanine green angiographic features of choroidal rupture and choroidal vascular injury after contusion ocular injury

PURPOSE: To report features of choroidal rupture and choroidal vascular injury after contusion ocular injury on indocyanine green angiography. METHODS: In a prospective study, nine patients (nine eyes) with choroidal rupture after ocular contusion underwent initial fluorescein angiography and indocyanine green angiography within 19 days after trauma. Eyes that had a distinct abnormality of the retinal pigment epithelium were excluded from this study. Subtraction indocyanine green angiography was also performed. Follow-up fluorescein angiographic and indocyanine green angiographic findings were also studied. RESULTS: Initial ophthalmoscopic examination revealed subretinal hemorrhage in all nine eyes. In five of the nine eyes, choroidal rupture was not seen on initial ophthalmoscopic or fluorescein angiographic examination because it was hidden beneath the subretinal hemorrhage, but it was detected on subsequent examinations. In the remaining four eyes, choroidal rupture was observed by ophthalmoscopy at the time of initial examination, and these eyes exhibited hyperfluorescent streaks on fluorescein angiography in the region of the subretinal hemorrhage. On initial indocyanine green angiography of all nine eyes, observed hypofluorescent streaks became more obvious with time. For each eye, there were more hypofluorescent streaks on indocyanine green angiography than hyperfluorescent streaks on fluorescein angiography. In one eye, the location of indocyanine green leakage nearly coincided with the location of a hyperfluorescent streak on fluorescein angiography. In this case, crescentic streaks of hypofluorescence were seen on the temporal side of the subretinal hemorrhage on indocyanine green angiography, although choroidal rupture was not observed in that region by ophthalmoscopy or fluorescein angiography. In two of the nine eyes, indocyanine green angiography and the subtraction technique demonstrated disturbance of flow into choroidal vessels, especially at the choroidal rupture site. CONCLUSION: After ocular contusion injury, various features of choroidal rupture and choroidal vascular injury were observed on indocyanine green angiography. This technique may contribute to the diagnosis of choroidal rupture and to the understanding of the clinical course after injury.     

眼球钝挫伤39例临床分析

目的 初步观察和探讨眼球钝挫伤的常见原因、临床表现、治疗经过和效果.方法 对39例(53只眼)的眼球钝挫伤患者的病因、病情、治疗经过及结果进行详细记录,随访时间3～15个月,平均7个月.根据损伤的病程、部位和严重程度,结合眼底荧光m管造影(fundus fluorescence angiography,FFA)、超声生物显微镜(ultrasound biomieroscope,UBM)、眼B超、光学相干断层扫描(optical coherence tomography,OCT)、视诱发电位(visual evoked potential,VEP)等辅助检查,对其进行药物或手术治疗并观察疗效,分析眼球钝挫伤的主要原因和视力预后及其主要影响因素.结果 拳击伤是引起眼球钝挫伤的最主要原因,其次分别为物体撞击伤、车祸外伤及爆炸伤.16只眼(30.19%)损伤仪累及眼前节,表现为角膜擦伤、水肿,前房积血,虹膜睫状体炎,外伤性扩瞳,虮膜根部断离,房角后退,睫状体脱离,晶状体混浊伴(或不伴)晶状体不全或全脱位;26只眼(49.57%)损伤仅累及眼后节,表现为玻璃体积血,视网膜震荡、裂孔及脱离,脉络膜破裂,视神经水肿、萎缩;其余11只眼(20.75%)前、后节均受累.伤后初诊时最佳矫正视力(best corrected visual acuity,BCVA)0.1者占32.08%;经药物或手术治疗,末次随访时51只眼(96.23%)视力较前有所提高,13只眼(24.52%)BCVA 0.5.伤后24h内就诊的患者中,41.18%末次随访时BCVA0.5.结论 通过及时和有效的治疗,大部分眼钝挫伤患者的视功能可有所提高.视力预后与损伤部位、严重程度和伤后就诊时间有关,钝挫伤臻眼后节并发症者视力预后相对较差.     

Blunt ocular trauma. Part II. Blunt posterior segment trauma

This review presents typical patterns of posterior segment injuries as well as diagnostic and therapeutic considerations after ocular contusion or rupture of the globe. Vitreal prolapse is associated with retinal detachment (20%), iridodialysis or ciliary body cleft (43%), and contusion cataract (41%). Berlin's edema (35%) and retinal detachment (5-7%) are frequent after ocular contusion. In cases of central Berlin's edema, choroidal infarction (Hutchinson-Siegrist-Neubauer syndrome) or choroidal rupture, macular hole or choroidal neovascularization should be ruled out. A central choroidal rupture is often associated with choroidal neovascularization (14-20%). Globe ruptures (5% of blunt injuries) are associated with hyphema grades III and IV (58 vs 5% in ocular contusions). The prognosis of globe ruptures to develop a visual function <20/200 is 51 times more frequent than in eyes with contusion. The risk of trauma-induced globe ruptures is higher in eyes after cataract surgery (27 x) (in females 5 x).     

漆样裂纹性高度近视黄斑出血的眼底特征及视力预后

目的 探讨不伴脉络膜新生血管(CNV)的高度近视黄斑出血的眼底改变特征和视力预后。方法 对37例(38眼)不伴CNV的高度近视黄斑出血患者行眼底彩色照相和荧光素眼底血管造影(FFA)及矫正视力的随访观察，其中11例(11眼)行吲哚菁绿血管造影(ICGA)检查。结果84．2％的患眼在出血吸收后于原出血下方可见新的漆样裂纹形成；行ICGA的11只患眼中，7眼(63．6％)于ICGA可透过出血发现呈弱荧光条索的早期漆样裂纹。81．6％的患眼于出血吸收后视力均有明显增进。结论 不伴CNV的高度近视黄斑出血与新漆样裂纹形成相关，建议称之为漆样裂纹性黄斑出血。大部分患眼视力预后良好。     

脉络膜挫伤

回顾６４例外伤性脉络膜挫伤。多发于２０－３０岁的青年男性；最常见有拳击伤；临床主要表现为视力下降，眼底可见脉络膜出血灶及裂伤口，荧光眼底血和造影可帮助诊断。脉络膜挫伤多发生于黄斑部，其次为视乳头周围，多为单个，１－ＰＤ大小，脉络膜破裂的形态多为长弧形，脉络膜出血多为圆形；脉络膜破裂与出血常同时出现。     

Stumpfes Augentrauma

This review presents typical patterns of posterior segment injuries as well as diagnostic and therapeutic considerations after ocular contusion or rupture of the globe. Vitreal prolapse is associated with retinal detachment (20%), iridodialysis or ciliary body cleft (43%), and contusion cataract (41%). Berlin’s edema (35%) and retinal detachment (5–7%) are frequent after ocular contusion. In cases of central Berlin’s edema, choroidal infarction (Hutchinson-Siegrist-Neubauer syndrome) or choroidal rupture, macular hole or choroidal neovascularization should be ruled out. A central choroidal rupture is often associated with choroidal neovascularization (14–20%). Globe ruptures (5% of blunt injuries) are associated with hyphema grades III and IV (58 vs 5% in ocular contusions). The prognosis of globe ruptures to develop a visual function <20/200 is 51 times more frequent than in eyes with contusion. The risk of trauma-induced globe ruptures is higher in eyes after cataract surgery (27×) (in females 5×).