家族性渗出性玻璃体视网膜病变的荧光素眼底血管造影特征及其诊断价值

Objective To investigate the characteristics and diagnostic value of fundus fluorescein angiography(FFA)for familial exudative vitreoretinopathy(FEVR).Methods 34 children(68 eyes)with FEVR and 64 parents(1 28 eyes)were included.All the clients were received examinations of slit-lamp biomicroscopy and indirect ophthalmoscopy.Meanwhile the children were examined by Retcam Ⅱ,the best corrected visual acuity of parents were recorded.The children and their parents were classified according to the ocular findings.Among 68 eyes of children,3 eyes(4.41% )were normal,4 eyes(5.88% )were in stage 1,7 eyes(10.29% )were in stage 2,2 eyes(2.94% )were in stage 3,8 eyes(11.76% )were in stage 4 and 44 eyes(64.71% )were in stage 5.Among 128 eyes of parents,74 eyes(57.81% )were normal,51eyes(39.84% )were in stage 1,1 eyes(O.78% )were in stage 2 and 2 eyes(1.56% )were in stage 5.FFA was performed on the children with RetcamⅡunder anesthesia and on the parents with HR2 in order to observe the FFA characteristics in different stage.Results FFA characte ristics in children included uncompleted vascularization of the periphery,peripheral avascular zone(stage 1);neovascularization and/or peripheral subretinal and intraretinal exudation(stage 2);subtotal retinal detachment with attached foyea (stage 3);subtotal retinal detachment with detached foyea(stage 4)and total retinal detachment(stage 5).FFA characteristics in parents included abrupt cessation of the peripheral retinal capillary network and a peripheral avascular zone(stage 1); abnormal peripheral arteriovenous shunts, neovascularization or exudation(stage 2)and atrophia bulbi(stage 5).Conclusions FEVR in different stage has different FFA characteristics.FFA plays an important role in early diagnosis of FEVR.     

家族性渗出性玻璃体视网膜病变的荧光素眼底血管造影特征及其诊断价值

Objective To investigate the characteristics and diagnostic value of fundus fluorescein angiography(FFA)for familial exudative vitreoretinopathy(FEVR).Methods 34 children(68 eyes)with FEVR and 64 parents(1 28 eyes)were included.All the clients were received examinations of slit-lamp biomicroscopy and indirect ophthalmoscopy.Meanwhile the children were examined by Retcam Ⅱ,the best corrected visual acuity of parents were recorded.The children and their parents were classified according to the ocular findings.Among 68 eyes of children,3 eyes(4.41% )were normal,4 eyes(5.88% )were in stage 1,7 eyes(10.29% )were in stage 2,2 eyes(2.94% )were in stage 3,8 eyes(11.76% )were in stage 4 and 44 eyes(64.71% )were in stage 5.Among 128 eyes of parents,74 eyes(57.81% )were normal,51eyes(39.84% )were in stage 1,1 eyes(O.78% )were in stage 2 and 2 eyes(1.56% )were in stage 5.FFA was performed on the children with RetcamⅡunder anesthesia and on the parents with HR2 in order to observe the FFA characteristics in different stage.Results FFA characte ristics in children included uncompleted vascularization of the periphery,peripheral avascular zone(stage 1);neovascularization and/or peripheral subretinal and intraretinal exudation(stage 2);subtotal retinal detachment with attached foyea (stage 3);subtotal retinal detachment with detached foyea(stage 4)and total retinal detachment(stage 5).FFA characteristics in parents included abrupt cessation of the peripheral retinal capillary network and a peripheral avascular zone(stage 1); abnormal peripheral arteriovenous shunts, neovascularization or exudation(stage 2)and atrophia bulbi(stage 5).Conclusions FEVR in different stage has different FFA characteristics.FFA plays an important role in early diagnosis of FEVR.     

儿童遗传性视网膜疾病的眼底自身荧光表现

目的 观察儿童遗传性视网膜疾病的眼底自身荧光(FAF)特征.方法 回顾性分析22例临床资料完整、年龄5～14岁之问的遗传性视网膜疾病患儿的FAF检查结果.其中,Best卵黄样病变8例16只眼,Stargardt病3例6只眼,视锥细胞营养不良3例6只眼,原发性视网膜色素变性(RP)5例10只眼,X连锁青少年型视网膜劈裂症3例6只眼.仔细询问现病史及家族史,行视力、裂隙灯显微镜眼前节检查,间接眼底镜检查,彩色眼底像和FAF照相,其中部分患儿接受了荧光素眼底血管造影(FFA)、视网膜电流图、眼电图、光相干断层扫描检查.对上述患儿的FAF结果特征进行归纳总结,并与其眼底照相和/或FFA结果进行比较分析.结果 3例Stargardt病患儿的6只眼及3例视锥细胞营养不良患儿的6只眼FAF检查显示黄斑区可见对称性的圆形、近圆形弱荧光或荧光缺如区,2例视锥细胞营养不良患儿的4只眼及1例Stargardt病患儿的2只眼可见弱荧光或荧光缺如区外缘环以强荧光;Best卵黄样病变患儿黄斑区可见一个强度均匀或不均匀的强FAF病灶;RP患儿后极部视网膜FAF增强,黄斑区周围可见宽度不等的环形强荧光带,拱环区FAF正常;3例X连锁青少年型视网膜劈裂症患儿中5只眼中心凹部位FAF检查可见蜂窝或颗粒状强荧光.结论 Stargardt病及视锥细胞营养不良患儿黄斑区为近圆形弱荧光,部分病变区外缘环以强荧光;Best卵黄样病变患儿黄斑区为强度均匀或不均匀的强FAF病灶;RP患儿后极部视网膜FAF增强,拱环区FAF正常,黄斑区周围可见宽度不等的环形强荧光带;X连锁青少年型视网膜劈裂症患儿中心凹部位为蜂窝或颗粒状强荧光.

Abstract：

Objective To observe the autofluorescence (AF) manifestation in children with hereditary retinal diseases. Methods The clinical data of 22 children (aged from 5 to 14 years) with hereditary retinal diseases were retrospectively analyzed. There were 8 children (16 eyes) with Best vitelliform macular dystrophy, 3 children (6 eyes) with Stargardt macular dystrophy, 3 children (6 eyes) with macular cone dystrophy, 5 children (10 eyes) with primary retinitis pigmentosa, and 3 children (6 eyes) with X-linked juvenile retinoschisis. The routine clinical examinations included present history, family history, visual acuity, silt-lamp microscopy, indirect ophthalmoscopy, color fundus photography and fundus autofluorescence angiography (FAF). Some patients received fundus fluorescein angiography (FFA),electroretinogram (ERG), electrooculogram (EOG), and ocular coherence tomography (OCT). The characteristics of AF in all the children were analyzed, and were compared with the images of color fundus and/or FFA. Results Symmetry round macular fluorescent weak or absent area was found in all Stargardt disease and cone dystrophy. Weak AF area with surrounded circular increased AF was found in 2 children (4 eyes) with cone dystrophy and 1 child (2 eyes) with Stargardt macular dystrophy. A central round area with regular or irregular intense AF was observed in Best vitelliform macular dystrophy. RP children showed increased AF out of the macular region. Cellular or granular strong AF was found in the fovea of 3 children (5 eyes) with X-linked juvenile retinoschisis. Conclusion The children with hereditary retinal diseases had special AF changes.     

眼底荧光血管造影在1期糖尿病视网膜病变诊断中应用价值

目的 探讨糖尿病视网膜病变(DR)国际临床分类法1期病变患者眼底荧光血管造影(FFA)表现,评价FFA对早期DR的诊断价值.方法 对76例(152只眼)诊断为糖尿病视网膜病变国际临床分级标准1期病变患者进行眼底及眼底荧光血管造影检查,分析其造影表现.结果 检眼镜下152只眼眼底全部未见异常表现,FFA正常48只眼(31.58%).FFA异常104只眼(68.42%),异常表现中单纯微动脉瘤(MA)强荧光56只眼(53.84%),MA合并毛细血管扩张15只眼(14.41%),MA合并黄斑水肿5只眼(4.81%),黄斑拱环破坏3只眼(2.87%),小片状毛细血管无灌注2只眼(1.92%),窗样缺损23只眼(22.15%).结论 被诊断为DR国际临床分类法1期的患者,大部分已经出现了不同程度的FFA异常表现.因此,FFA是DR早期诊断的较好方法,能提高对DR早期诊断的准确度.

Abstract：

Objective To investigate the fundus fluorescence angiography (FFA) performance of diabetic retinopathy (DR) according to the international clinical classification of period l's patients. To evaluate the diagnostic value of FFA in early DR. Methods Fundus and fundus fluorescence angiography examination were performed and analyzed in 76 of period 1 patients (152 eyes) for the diagnosis of diabetic retinopathy according to the international clinical classification standard of. Results All 152 eyes fundus had no abnormal performance under ophthalmoscope, FFA normal 48 eyes (31.58%); FFA abnormal 104 eyes (68.42%), abnormal performance among a simple micro-aneurysms (MA), high fluorescence 56 eyes (53.84%), MA merge in telangiectasia 15 eyes (14.41%), MA merge in macular edema 5 eyes (4.81%), macular arch ring had damaged 3 eyes (2.87%), small flake with capillary nonperfusion 2 eyes (1.92%), window defect 23 eyes (22.15%).Conclusions DR is diagnosed with period 1 patients according to the international clinical classification, most of the emergence of difference degrees abnormal performance of the FFA. Therefore, FFA is the better method in early diagnosis of DR. It can increase the accurate of diagnosis for DR.     

原田病药物治疗后吲哚青绿眼底血管造影观察

目的 探讨利用吲哚青绿血管造影检查作为原田(Harada)病临床观察指标的意义.方法 对经药物治疗后19例(38只眼)原田病患者同时行荧光素眼底血管造影(fundus fluorescein angiography,FFA)及吲哚青绿血管造影(indocyanine green angiography,ICGA)检查资料进行分析.结果 FFA检查发现有4例(8只眼)视盘轻度染色,视网膜未发现异常改变;ICGA早期及中期无异常表现,但后期8只眼(包括FFA中视盘染色的4只眼)在中周及后极部出现了点状或斑片状弱荧光;3例6只眼FFA及眼底正常,在ICGA后期后极部出现了斑点状弱荧光;24只眼脉络膜大、中血管影像减少,其中12只眼dalen-fuchs结节着色.结论 ICGA可较好提供原田病的脉络膜循环损害的信息,并在评价疗效上有意义.

Abstract：

Objective To investigate the clinical value of indocyanine green angiography(ICGA)in patients with Harada disease.Methods Fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA)were used for comparative analyses in 26 cases(52 eyes)of Harada disease after treatment.Results Mild dyeing in disk was found only in 4 cases(8 eyes),and the others were not found any abnormal in FFA.There were no any abnormal found in early period and middle period of ICGA,but of 8 eyes(include 4 eyes of dyeing in disk in FFA)multifocal lower fluorescence were found in the mid-periphery and posterior pole of the fundus in the late phase.Of 3 cases(6 eyes)were normal in FFA,however multifocal lower fluorescence were found in the posterior pole of the fundus in the late phase of ICGA.Of 24 eyes were found decreased fluorescence in large and middle choroidal vessel,and 12 eyes of Dalen-Fuchs were colored.Conclusions ICGA may assist in providing valuable information on choroidal circulation of Harada disease and be useful in evaluating the curative effects.     

半剂量光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变

目的 观察半剂量维替泊芬光动力疗法(PDT)治疗慢性中心性浆液性脉络膜视网膜病变(CSC)的疗效.方法 慢性CSC患者27例32只眼纳入研究.男性22例,女性5例;年龄31～63岁,平均年龄45.0岁;病程6～32个月,平均病程16.2个月.所有患者均行最小视角对数(logMAR)视力表最佳矫正视力(BCVA)、直接检眼镜眼底检查,荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)和光相干断层扫描(OCT)检查.IogMAR BCVA 1.6～0.1.局限性神经上皮脱离者28只眼;合并色素上皮脱离(PED)者4只眼.中心视网膜厚度184～465μm,平均视网膜厚度318.6 μm.患者知情并答署同意书后行半剂量维替泊芬PDT治疗.治疗后每3个月复查,观察患眼BCVA、视网膜下液吸收情况及视网膜厚度变化.结果 末次随访时,OCT检查显示.局限性神经上皮脱离者28只眼中,视网膜下液吸收、视网膜完全平伏者25只眼,占89.3%;视网膜下液部分吸收、视网膜未完全平伏者3只眼,占10.7%.合并PED的4只眼中,视网膜下液吸收、视网膜完全平伏者2只眼,占50.0%;视网膜下液部分吸收、视网膜未完伞平伏者2只眼,占50.0%.视网膜完全平伏的27只眼,治疗前平均视网膜厚度为(321.4±88.2)μm,治疗后为(150.4±22.3)μm.治疗前后平均视网膜厚度比较,差异有统计学意义(t=9.09,P＜0.05);治疗前平均logMAR BCVA为0.68±0.09,治疗后平均logMAR BCVA为0.44±0.07,其中logMAR BCVA低于0.32者12只眼.治疗前后BCVA比较,差异有统计学意义(t=2.65,P＜0.05).相关性分析结果显示,视网膜完全平伏者治疗后BCVA与视网膜厚度呈显著正相关(t=0.96,P＜0.01).末次随访时,视网膜完全平伏者未见病变复发,亦未见与治疗相关的并发症.结论 半剂量维替泊芬PDT治疗慢性CSC安全有效,特别是不合并PED者.

Abstract：

Objective To observe the clinical effect of half-dose photodynamic therapy (PDT) for chronic central serous chorioretinopathy. Methods Thirty-two eyes of 27 patients (22 males and 5 females)with chronic central serous chorioretinopathy, diagnosed by best corrected visual acuity (BCVA) of logMAR, direct ophthalmoscope, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography, were enrolled. The age was ranged from 31 to 63 years old,with a mean of 45 years. The course of the disease was ranged from 6 to 32 months, with a mean of 16.2months. The logMAR BCVA was 1.6-0.1. The serous neuroepithelium detachment was found in 28 eyes,and serous neuroepithelium detachment combined with retinal pigment epithelium detachment (PED) was found in 4 eyes. The central retinal thickness was ranged from 184 to 465 μm, with a mean of 318.6 μm.All of the patients were treated with half dose PDT according to the methods in literatures. The above examinations were performed every 3 months after the treatment to observe the BCVA, subretinal fluid and retinal thickness. Results OCT showed that subretinal fluid were absorbed completely and retina remained attached in 25 of 28 eyes (89.3%) and 2 of 4 eyes (50.0%) with PED, while subretinal fluid were absorbed partly and retina attached incompletely in 3 of 28 eyes (10.7%) and 2 of 4 eyes (50.0%) with PED at the last visit. Twenty-seven eyes with retina remained attached, the mean central retinal thickness (CRT)decreased from (321.4±88.2) to (150.4±22.3) μm (t=9.09, P＜0.05); the mean logMAR BCVA improved from 0.68±0.09 to 0.44±0.07 0 = 2.65, P＜0.05). Among those, logMAR BCVA within 0. 32 were found in 12 eyes. There was a significant positive association between the CRT and BCVA (r=0. 96, P＜0. 01). No recurrence or side effect was observed at the last visit. Conclusion Half-dose PDT is a safe and effective approach for chronic central serous chorioretinopathy, especially for those without PED.     

虹膜荧光素血管造影在虹膜新生血管诊断中的应用

目的 探讨虹膜荧光素血管造影(IFA)在缺血性视网膜中央静脉阻塞(CRVO)虹膜新生血管(NVI)诊断中的价值.方法 经荧光素眼底血管造影(FFA)检查确诊的CRVO患者51例51只眼纳入研究.所有患者均行视力、裂隙灯显微镜检查、眼前节彩色照相、眼压及FFA+IFA检查.根据FFA检查结果分为非缺血性和缺血性CRVO,分别为20、31只眼.非缺血性CRVO20只眼中,男性11只眼,女性9只眼;年龄41～59岁.缺血性CRVO31只眼中,男性21只眼,女性10只眼;年龄28～62岁.采用德国海德堡眼底荧光血管造影仪进行FFA+IFA检查,将典型图像存入计算机图像处理系统进行分析.对比观察裂隙灯显微镜和IFA NVI的检出率.缺血性CRVO31只眼均行全视网膜激光光凝(PRP)治疗,其中,完成治疗27只眼,未坚持完成治疗4只眼.完成治疗后6个月,随访观察NVI消退情况.结果 非缺血性CRVO20只眼裂隙灯显微镜检查瞳孔缘及虹膜未见新生血管,占100.0%;IFA检查虹膜未见显影,呈色素遮蔽荧光,占100.0%.缺血性CRVO31只眼中,裂隙灯显微镜检查显示瞳孔缘及虹膜有细小新生血管13只眼,占41.9%;IFA检查显示NVI 23只眼,占74.2%.2种检查方法NVI检出率比较,差异有统计学意义(Z=-3.425,P=0.001).IFA检查NVI分别表现为小团状、细线状或不规则交叉网状强荧光染色及渗漏.完成PRP治疗的27只眼IFA检查结果显示,瞳孔缘及虹膜表面未见荧光染色及渗漏;未坚持完成PRP治疗4只眼,1～2个月后出现新生血管性青光眼(NVG).结论 IFA可以提示眼前节的缺血状态,具有较高的特异性,辅助CRVO缺血型早期诊断,预测是否发展NVG.

Abstract：

Objective To evaluate the application value of iris fluorescein angiography (IFA) in the diagnosis of ischemic center retinal vein occlusion (CRVO). Methods Fifty-one patients (51 eyes) with CRVO which had been diagnosed by fundus fluorescein angiography (FFA) were studied. All patients underwent the examination of visual acuity, slit lamp biomicroscope, anterior segment color photography,intraocular pressure, FFA and IFA. The patients were classified as non-ischemic CRVO (20 eyes) and ischemic CRVO (31 eyes). The 20 non-ischemic CRVO patients included 11 males and nine females, aged from 41 to 59 years. The 31 ischemic CRVO patients included 21 males and 10 females, aged from 28 to 62 years. FFA and IFA were performed for all the patients using Heidelberg retina angiograph, and the classic pictures were analyzed by the computer image processing system. The detection rate of iris neovascularization (NVI) by slit lamp biomicroscope and IFA was analyzed. All ischemic CRVO eyes underwent panretinal photocoagulation (PRP), and PRP was completed in 27 eyes and not completed in four eyes. Six months after PRP the regression of iris NVI was followed up. Results All non-ischemic CRVO eyes (100. 0% ) had no neovascularization on papillary margin and iris by slit lamp biomicroscopy, and had no fluorescence (pigment blocked fluorescence) on IFA. Thirteen eyes (41.9%) and 23 eyes (74.2%) of the 31 ischemic eyes had NVI by slit lamp biomicroscope and IFA, respectively. The NVI detection rate of those two methods was statistically different (Z= - 3. 425, P = 0. 001 ). NVI showed strong fluorescence and leakage with variable patterns (small blocks, thin lines and irregular cross-links) by IFA. There was no fluorescence staining and leakage on papillary margin and iris in 27 eyes who completed the PRP, but the neovascular glaucoma (NVG) occurred in one eyes who discontinued the PRP treatment after one to two months. Conclusions IFA has a high specificity in CRVO which hints the ischemic state of anterior segment. It is helpful to the early diagnosis of ischemic CRVO and the turnover of NVG.     

中心性浆液性脉络膜视网膜病变荧光素渗漏点的自身荧光改变

目的 观察中心性浆液性脉络膜视网膜病变(CSC)患者荧光渗漏点区域的眼底自身荧光(FAF)改变特点.方法 采用海德堡视网膜血管造影仪对CSC患者67例67只眼行荧光素眼底血管造影(FFA)检查.其中,年龄≤45岁者47只眼,＞45岁者20只眼;急性CSC患者25只眼,慢性或复发性CSC 患者42只眼.使用488 nm波长激光采集FAF图像,观察荧光渗漏点区域的FAF改变特点.结果 67只眼中,FFA荧光渗漏点位置FAF无异常者35只眼,占52.2%;FAF呈点状弱荧光者16只眼,占23.9%;FAF呈小片状弱荧光或斑驳荧光者10只眼,占14.9%;FAF呈强荧光者6只眼,占9.0%.年龄≤45岁的47只眼中,FFA荧光渗漏点区域FAF无异常者26只眼,占55.3%;FAF呈点状弱荧光者11只眼,占23.4%;FAF呈小片状弱荧光或斑驳荧光者7只眼,占14.9%.FAF呈稍强荧光者3只眼,占6.3%.＞45岁的20只眼中,FFA荧光渗漏点位置FAF无异常者9只眼,占45.0%;FAF呈点状弱荧光者5只眼,占25.0%;FAF 呈片状弱荧光或斑驳荧光者3只眼,占15.0%,FAF呈强荧光者3只眼,占15.0%.急性CSC 25只眼中,FFA荧光渗漏点位置FAF无异常改变者20只眼,占80.0%;FAF呈点状弱荧光者4只眼,占16.O%FAF 呈小片状弱荧光或斑驳荧光者1只眼,占4.0%.慢性或复发性CSC 42只眼中,FFA荧光渗漏点区域无异常改变者15只眼,占35.7%;FAF呈点状弱荧光者12只眼,占28.6%;FAF呈小片状弱荧光或斑驳荧光者9只眼,占21.4%;FAF呈强荧光者6只眼,占14.3%.结论 不同年龄和病程的CSC患者FFA荧光渗漏点位置具有特征性的FAF改变.

Abstract：

Objective To investigate the characteristics of fundus autofluorescence (AF) in the leakage site of central serous chorioretinopathy (CSC). Methods Sixty-seven CSC patients (67 eyes)underwent fundus fluorescein angiography (FFA) examination with a confocal scanning angiography (HRA2). Autofluorescence was elicited by the wavelength of 488 nm. The patterns of autofluorescence corresponding to the leakage site on FFA were observed. All the enrolled patients were grouped by age (age≤45 in 47 eyes and age ＞45 in 20 eyes) and courses (acute CSC in 25 eyes and chronic or recurrent CSC in 42 eyes). the patterns of autofluorescence were analyzed respectively. Results There are 4 patterns of AF in the leakage site on FFA of CSC patients: no AF changes, punctuate hypo-AF, expanded hypo-AF or speckled AF, hyper-AF. The percentages of those patterns in all 67 eyes are 52. 2%, 23. 9% , 14. 9% and 9.0% respectively. The percentages of those patterns in the group of age ≤45 (n=47) are 55.3%,23. 4% , 14. 9% and 6. 3% respectively. The percentages of those patterns in the group of age ＞45 (n=20)are 45. 0% , 25. 0% , 15. 0% and 15. 0% respectively. The percentages of those patterns in acute CSC (n=20) are 80.0%, 16.0%, 4.0% and 0% respectively. The percentages of those patterns in chronic or recurrent CSC (n=42) are 35.7%, 28.6%, 21.4% and 14.3% respectively. Conclusion There are different patterns of fundus autofluorescence in different age and courses of CSC patients.     

获得性免疫缺陷综合征合并巨细胞病毒性视网膜炎的眼底病变特征分析

目的 观察获得性免疫缺陷综合征(AIDS)合并巨细胞病毒性视网膜炎(CMVR)的眼底病变特征.方法 AIDS合并CMVR者27例44只眼纳入研究.所有患者均行视力、眼压、裂隙灯显微镜、散瞳间接检眼镜眼底检查,同时行眼底彩色照相.根据眼底表现将病变分为活动性病变和陈旧性病变,活动性病变又分为中心型、周边型、同时累及后极部和周边部的混合型.结果 27例44只眼中,活动性病变者19例29只眼.其中,中心型5例6只眼,占患眼的13.6%.眼底表现为后极部渗出、出血和血管鞘.周边型9例15只眼,占患眼的34.1%.眼底表现为视网膜周边部的黄白色颗粒状病灶.混合型5例8只眼,占患眼的18.2%.眼底表现为同时累及后极部和周边部的黄白病灶和出血.陈旧性病变者8例15只眼,占患眼的34.1%.眼底表现为沿血管支配区分布的色素和瘢痕性病灶.结论 AIDS合并CMVR眼底具有不同的病变特征.

Abstract：

Objective To observe the fundus characteristics of acquired immune deficiency syndrome (AIDS) with cytomegalovirus retinitis (CMVR). Methods Twenty-seven AIDS patients (44 eyes)with CMVR were studied. All the patients had undergone the examinations of visual acuity, intraocular pressure,slit lamp microscope, indirect ophthalmoscope and color fundus photography. The fundus lesions were divided into active lesions and chronic lesions, and the active lesions were subdivided into central, peripheral and mixed types which involving both the posterior and peripheral fundus. Results Of 27 patients (44 eyes), 19 patients(29 eyes)had active lesions. Five patients (six eyes, 13.6%) had central lesions (exudation, hemorrhage and vascular sheath in the posterior retina), nine patients ( 15 eyes, 34.1%) had peripheral yellow and white granular lesions. Five patients (eight eyes, 18.2 %) had mixed lesions. Chronic lesions were found in eight patients (15 eyes, 34.1%), which showed pigment and scarring lesions along vascular branches. Conclusion The fundus lesions of AIDS with CMVR have distinct features.     

曲安奈德辅助玻璃体后脱离联合不染色剥除内界膜治疗Ⅱ、Ⅲ期特发性黄斑裂孔的临床观察

目的 评价曲安奈德(TA)辅助玻璃体后脱离(PVD)联合不染色剥除内界膜(ILM)治疗Ⅱ、Ⅲ期特发性黄斑裂孔(IMH)的解剖和视力预后.方法 对Ⅱ、Ⅲ期IMH患者23例23只眼常规行最佳矫正视力(BCVA)、晶状体状态、光相干断层扫描(OCT)检查并进行黄斑裂孔分期.手术前BCVA为0.04～0.40,最小视角对数(logMAR)视力为0.398～1.398,平均0.846±0.310.患者均先在TA辅助下行人工PVD,然后在无染色条件下剥除黄斑区ILM.手术中联合白内障摘除手术5只眼.手术后随访时间6～16个月,平均随访时间9个月.统计分析黄斑裂孔解剖成功率、手术前后BCVA、手术并发症.结果 手术后1个月OCT检查显示,黄斑裂孔闭合22只眼,占95.7%;黄斑裂孔未闭合1只眼,占4.3%,再行气液交换后黄斑裂孔成功闭合.至随访期末,均未见黄斑裂孔重新开放.手术后6个月BCVA为0.12～0.90,logMAR视力为0.046～0.921,平均视力为0.410±0.209,手术前后BCVA比较,差异有统计学意义(t=6.636,P＜0.000 1).视力提高21只眼,占91.3%;视力不变者2只眼,占8.7%;无视力下降者.剥除ILM 时视网膜表面出现1～3个点状自限性出血者5只眼.手术后未发生视网膜脱离或玻璃体积血等严重并发症.手术后晶状体核密度增加9只眼,一过性眼压升高6只眼.结论 TA辅助PVD联合不染色剥除ILM治疗Ⅱ、Ⅲ期IMH是一种安全有效的方法.

Abstract：

Objective To evaluate the anatomic and visual outcomes of idiopathic macular holes treated with triamcinolone (TA)-assisted posterior vitreous detachment (PVD) and then internal limiting membrane (ILM) peeling without any dye. Methods Twenty-three patients (23 eyes) with stage Ⅱand Ⅲidiopathic macular holes were enrolled. The best-corrected visual acuity (BCVA), the lens, the duration,stage and size of the macular holes were measured before and after the surgery. The preoperative BCVA was 0.04 to 0.40; the logMAR was 0.398 to 1.398 with the mean of 0.846±0.310. All surgery involved TA-assisted PVD and then ILM peeling without any dye.Combined cataract extraction with vitrectomy was performed on 5 eyes.The follow-up ranged from 6 to 16 months with the mean of 9 months. Results Anatomic macular hole closure was achieved in 22 eyes (95.7%) at the first month after surgery and in 23eyes (100.0%) finally. At the 6th months after surgery, the BCVA was 0.12 to 0.90, logMAR was 0.046 to 0.921 with the mean of 0.410±0.209, compared with preoperative BCVA, the difference was statistically significant (t=6.636, P＜0.0001). BCVA increased in 21 eyes (91.3%) and kept unchanged in 2 eyes (8.7%). There are 1-3 spots self-limited bleeding on the retinal surface when the ILM was peeled in 5 eyes. Postoperative complications included progression of cataract in 9 patients and transient intraocular pressure elevation in 6 patients. Conclusions TA-assisted PVD and then ILM peeling without any dye is an effective and safe surgical technique in stage Ⅱ and Ⅲ idiopathic macular hole.     

家族性渗出性玻璃体视网膜病变的诊断与治疗

家族性渗出性玻璃体视网膜病变(familial exudative vitreoretinopathy, FEVR)是一种罕见的遗传性视网膜血管发育异常性疾病,目前已发现的致病基因有FZD4、NDP、LRP5、TSPAN12、ZNF408、KIF11。其临床表现多样,轻者无临床症状,重者可出现视网膜周边无灌注区、新生血管形成、视网膜渗出、玻璃体积血、视网膜褶皱、视网膜脱离等。荧光素眼底血管造影(FFA)检查能发现早期无症状者,可明确病变范围和预示病情发展,指导治疗。患者病变程度不同,治疗方法各异,主要包括：视网膜激光光凝术、巩膜外垫压术、玻璃体切割术及抗-VEGF药物的辅助治疗。随着本病基因研究的进展,有望在分子水平对本病进行诊断,获得更有效的治疗方法。     

急性视网膜坏死综合征的眼底血管造影

目的观察急性视网膜坏死综合征（ARNS）的荧光素眼底血管造影（FFA）和吲哚青绿血管造影（ICGA）图像特征及在临床诊断中的应用价值。方法回顾性分析20例临床诊断为ARNS的患者28只患眼的眼底、FFA和ICGA检查资料。结果FFA图像中，视盘边界不清、晚期强荧光24只眼，占85.71%；周边部病灶区视网膜动静脉血管广泛闭塞23只眼，占82.14%，部分仅见闭塞的血管暗影，检眼镜检查所见的部分呈白线状的血管仍有荧光素通过； 病灶区与较正常视网膜交界处较多荧光素渗漏点者22只眼，占78.57%；视网膜脱离20只眼，占71.42%，其中9只眼未发现视网膜裂孔，占视网膜脱离者的45.00% ；8只眼黄斑囊样水肿，占28.57%。ICGA图像中，视盘强荧光8只眼，占28.57%，其中有5只眼晚期视盘内见颗粒状染色；周边部病灶区脉络膜血管模糊不清者20只眼，占71.42%；病灶区脉络膜散在片状弱荧光区19只眼，占67.85%；ICGA晚期图像中，视网膜血管内栓子及视网膜血管闭塞区清晰可见。结论ARNS 的FFA表现主要是视盘强荧光和视网膜血管闭塞；ICGA主要表现是病灶区脉络膜血管模糊不清及散在片状弱荧光区。两种检查联合使用，可进一步了解病变损害的程度以及脉络膜与视网膜之间的相互关系，对ARNS的诊断有重要的参考价值。(中华眼底病杂志,2005,21:100-102)     

Vitrectomy for rhegmatogenous or tractional retinal detachment with familial exudative vitreoretinopathy.

OBJECTIVE: To examine the anatomic features and surgical indications of familial exudative vitreoretinopathy (FEVR) complicated with rhegmatogenous or tractional retinal detachment. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Twenty-eight eyes of 25 patients who had either clinically suspected or fully diagnosed FEVR. Of these, 25 had rhegmatogenous retinal detachment, 2 had tractional retinal detachment, and 1 had tractional retinal detachment plus vitreous hemorrhage. INTERVENTIONS: The authors carefully observed the vitreoretinal interface during surgery, studied the clinical and anatomic features of FEVR, and then evaluated the surgical results. RESULTS: The vitreoretinal adhesions were so strong in the peripheral avascular area that iatrogenic retinal breaks easily occurred in 22 of 28 eyes. In all cases, the bimanual technique with vitreous scissors and forceps was required to dissect the posterior vitreous membrane from the retinal surface. The retina was reattached in 24 of 28 cases (85.7%), and visual acuity improved in 20 eyes (71.4%). CONCLUSION: Dissection of the vitreous in the peripheral avascular area is very difficult in FEVR, and those patients for whom this procedure was not successfully performed may have a poorer prognosis.     

成年Coats病的临床特征和诊治

目的观察成年Coats病患者的临床表现及其治疗效果。方法回顾性分析1980年至2006年在中国医学科学院北京协和医院就诊, 经眼底检查和荧光素眼底血管造影检查确诊为Coats病的18例成年患者随诊1年以上的临床资料。所有患者均排除放射治疗史，眼内炎症、视网膜血管闭锁、老年性黄斑变性及渗出较多的糖尿病视网膜病变等类Coats反应疾病。患者中男性14例，女性4例；左眼11只眼，右眼7只眼，均为单眼患病；年龄37~55岁，平均年龄43岁；初诊视力0.02~1.5,视力中值为0.1。对17例17只眼用激光光凝治疗，1例联合视网膜手术放液和冷凝治疗。治疗后随访1.0~15.3年，平均随访3.7年。结果初诊时，18例18只眼中，玻璃体清晰14只眼，仅有少许混浊4只眼。所有患眼视盘正常。病变局限于1~2个象限以内，位于颞侧者为最多（15/18只眼），鼻侧者少（4/18只眼），正上仅有1只眼；有2只眼病变累及2个象限。病变处均有典型的视网膜血管不规则扩张，粟粒状动脉瘤、大动脉瘤、微动脉瘤和毛细血管无灌注区；病变相应区域有黄白色硬性渗出，呈大片块状或成簇的团状。过半数患眼有黄斑水肿或渗出；4只眼有局限性视网膜脱离，其中1只眼视网膜脱离范围较为广泛；3只眼有视网膜出血。治疗后全部患眼眼底渗出和（或）出血吸收，视网膜复位。与治疗前相比, 随访过程中绝大多数(64.3%)患眼视力增进2行或保持在1.2~1.5，无视力减退2行以上者；末诊时视力0.02~1.5,视力中值为0.1。结论成年首次确诊的Coats病患者具有与儿童患者相似的特征性视网膜血管异常和眼底渗出，与之不同的是受累范围较局限，出血少；黄斑受损害轻；随诊过程中病变发展缓慢；视力预后较好。 （中华眼底病杂志，2008，24：279-282）     

中心性渗出性脉络膜视网膜病变的相干光断层扫描结果分析

目的 探讨中心性渗出性脉络膜视网膜病变(CEC)黄斑部视网膜下脉络膜新生血管(CNV)患者的相干光断层扫描(OCT)图像特征。方法 对20例(21只眼)CEC连续治疗患者进行OCT检查,并与荧光素眼底血管造影(FFA)和吲哚青绿眼底血管造影(ICGA)结果进行对比;同时对光动力治疗后患者的OCT图像形态变化进行分析,以评价OCT图像特征对CEC患者的临床治疗价值。结果 21只眼中,有16只眼CNV呈类圆形团块状,自视网膜色素上皮层向上突出,位于视网膜神经上皮下间隙,呈强或中等强度反射;5只眼的CNV呈纺锤形或不规则形,亦呈强或中等强度反射,位于色素上皮层平面。21只眼中有9只眼伴有浆液性神经上皮脱离,6只跟伴有出血性色素上皮脱离,14只眼伴有不同程度的视网膜水肿和增厚。17只眼经光动力治疗后,随访3～12个月,平均6个月,FFA检查显示荧光素渗漏消退或减弱的患者,OCT检查均显示CNV团块不同程度退缩,其形态亦发生变化。OCT图像特征与FFA和ICG检查结果有互补性。结论 OCT检查可以确定CEC患者病变中CNV团块的形态、大小及位置。CEC病变中CNV的OCT图像以突出于色素上皮层的类圆形团块为特征,其形态和大小可因治疗和观察时间而变化。     

50岁以上患者视网膜色素上皮脱离的眼底特征分析

目的 探讨50岁以上患者视网膜色素上皮脱离（PED）的眼底改变特征。 方法 回顾分析2001年10月至2004年8月经荧光素眼底血管造影（FFA）确诊为PED的31例（34只眼）50岁以上连续性病例，眼底改变的特征，患者均进行眼底彩色照相、FFA及吲哚青绿血管造影（ICGA）检查。 结果 31例34只PED患眼中，FFA显示浆液性PED18只眼，占52.9%，血液性PED8只眼，占23.5%，浆液血液性PED 8只眼，占23.5%。ICGA结果显示，12只眼（35.3%）伴发脉络膜新生血管（CNV）,17只眼（50.0%）伴发息肉状脉络膜血管病变（PCV），1只眼（2.9%）同时伴发CNV及PCV，4只眼（11.8%）不伴有脉络膜血管性病变。 结论 50岁以上患者PED可发生于CNV、PCV及无脉络膜血管性病变患眼，其中PCV患眼最常见。 (中华眼底病杂志, 2006, 22:224-227)     

色素失禁症患者的眼底表现及治疗

目的:探讨色素失禁症(IP)患者的眼底荧光素血管造影特征及其辅助治疗的意义。方法:回顾性研究,收集2019-03/08确诊的IP患儿10例18眼的临床资料纳入研究,均为女性患儿,就诊年龄2周~42月龄,详细记录患儿的病史及家族史,均行眼底彩色照相及眼底荧光素血管造影检查。结果:纳入患儿眼底检查结果提示:1期病变1例1眼,FFA提示视网膜散在异常血管,晚期无渗漏,定期随访。2期病变4例6眼,FFA提示视网膜可见异常血管吻合,无明显新生血管生成,均行视网膜光凝。3期病变7例9眼,FFA提示视网膜新生血管荧光渗漏、视网膜前出血性荧光遮蔽,均行玻璃体腔注药(雷珠单抗注射液2mg∶0.2mL,注射量每眼0.25mg/0.025mL)联合视网膜光凝;其中2例为单眼发病,对侧眼正常。4期病变2例2眼,4a期病变1眼,FFA显示视盘、黄斑向颞侧牵拉连至周边部视网膜、局部浅脱离,行玻璃体切割手术;4b期病变1眼,眼前节照相提示晶状体后白色机化膜,眼部B超提示视网膜脱离,行玻璃体切割手术。结论:初步证实了眼底荧光素血管造影可辅助IP相关性视网膜病变的分期及治疗,对其治疗随访有指导意义,但对于各期病变的治疗目前尚无统一标准,有待更多临床资料。     

病理性近视的相干光断层扫描

目的研究病理性近视的相干光断层扫描(OCT)的图像特征。方法对100例(195只眼)高度近视患者行OCT检查。患者年龄16～76岁。屈光度数-6．00～-36．00D。结果OCT检查正常者7只眼(3．6％),视网膜色素上皮及脉络膜毛细血管光带不均匀和薄变者161只眼(82．6％),黄斑全层裂孔21只眼(10．8％),其中合并视网膜脱离10只眼(5．1％),黄斑限局性视网膜浅脱离24只眼(12．3％),其中合并视网膜劈裂7只眼(3．6％),黄斑脉络膜新生血管膜19只眼(9．7％),Fuchs斑9只眼(4．6％),厚的黄斑出血3只眼,黄斑前膜18只眼(9．2％),常合并有视网膜水肿。黄斑视网膜神经上皮薄变5只眼(2．6％),漆裂纹3只眼(1．5％)。结论与裂隙灯全视网膜显微镜检查比较,OCT在观察视网膜色素上皮和脉络膜毛细血管改变,确诊黄斑裂孔,发现小的神经上皮脱离和劈裂,诊断黄斑前膜,神经上皮薄变等方面均有优越性。但对薄的黄斑出血及小色素点不能分辨,对厚出血与色素难以分辨,因而也有其局限性。     

渗出型老年性黄斑变性和中心性渗出性脉 络膜视网膜病变脉络膜新生血管的 光学相干断层扫描

目的观察渗出型老年性黄斑变性(exudative age-related macular degeneration, AMD)和中心性渗出性脉络膜视网膜病变(central exudative chorioretinopathy, CEC)脉络膜新生血管 (choroidal neovascularization, CNV) 的光学相干断层扫描 (optical coherence tomography, OCT) 图像特征并比较两者之间的差异。方法对渗出型AMD 患者22例23只眼,CEC患者19例20只眼进行OCT检测,应用OCT软件进行CNV大小及黄斑中心凹视网膜神经上皮层厚度测量并分析两者与视力的关系。结果CNV的OCT 图像主要表现有：单纯性CNV、CNV伴浆液性神经上皮层脱离和CNV伴脉络膜视网膜渗出(可伴有浆液性神经上皮层脱离及浆液性或出血性色素上皮脱离)。渗出型AMD的CNV以CNV伴脉络膜视网膜渗出为主,有13只眼,占56.52%,其CNV累及范围较大;CEC的CNV以单纯性CNV为主,有18只眼,占90.00 %,其CNV累及范围相对较小。两组患者视力与黄斑中心凹视网膜神经上皮层厚度呈负相关( γ=-0.521,P=0.001)。结论渗出型AMD与CEC其CNV具有不同的OCT 形态特征,CNV累及范围也有差异。(中华眼底病杂志,2001,17:299-302)     

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。