息肉状脉络膜血管病变的眼底特征分析

目的 观察中国人息肉状脉络膜血管病变（polypoidal choroidal vasculopathy, PCV）的眼底表现及眼底血管造影特征。 方法 分析经眼底彩色照相、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)检查确诊的PCV患者42例48只患眼的眼底图像资料。 结果 PCV患眼眼底最常见表现为斑片状视网膜下出血，占72.9%；其次是黄白色渗出，占27.1%；仅14.6%的患眼于后极部可见特征性的视网膜下结节样橘红色病灶；54.2%的患眼有出血性或浆液性视网膜色素上皮脱离（pigment epithelium detachment, PED）。75.0%的患眼显示有异常分支的脉络膜血管网及其末梢的息肉状扩张灶；25.0%的患眼见多个息肉状脉络膜血管扩张灶而无明显的分支状脉络膜血管网与之相连。62.5%的息肉状病灶位于黄斑区；12.5%的息肉状病灶在血管弓区；6.3%的息肉状病灶位于视盘旁区；18.8%的息肉状病灶在上述2个部位同时存在。 结论 中国人PCV患眼眼底最常见表现为视网膜下出血，大部分患眼存 在PED。PCV好发部位为斑区及血管弓区，大部分患眼ICGA可见特征性的脉络膜血管网及其末梢的息肉状扩张灶。（中华眼底病杂志，2003，19：269-332）     

渗出型老年性黄斑变性与息肉状脉络膜血管病变眼底形态学的对比分析

目的 观察渗出型老年性黄斑变性（AMD）与息肉状脉络膜血管病变（PCV）眼底表现的异同。 方法 回顾性分析渗出型AMD患者123例137只眼及PCV患者42例48只眼的眼底彩色像、荧光素眼底血管造影（FFA）和吲哚青绿血管造影（ICGA）检查资料。 结果 137只渗出型AMD患眼中，FFA显示16只眼为典型脉络膜新生血管（CNV），占11.7%；隐匿型CNV121只眼，占88.3%。隐匿型CNV患眼中，42只眼ICGA检查可见“热点状”（hot spots）荧光，占34.7%；74只眼表现为后期斑状强荧光，占61.2%；2只眼CNV与PCV共存 ，占1.7%。48只PCV眼中，7只眼的眼底彩色像可见特有的视网膜下橘红色结节样病灶，占14.6%； 2只眼FFA即显示出分 支状脉络膜血管网及息肉状病灶，占4.2%； 36只眼ICGA显示异常分支的脉络膜血管网及其末梢的息肉状扩张灶，占75.0%；12只眼ICGA显示多个息肉状扩张灶而未见伴有分支状脉络膜血管网，占25.0%。息肉状病灶呈葡萄串样外观者16只眼，占33.3%；，呈多个孤立并存者32只眼，占66.7%。造影后期部分息肉状病灶染料渗漏或染色，部分呈息肉状病灶中心为弱荧光，周围环状染色的“冲刷现象”。 结论 渗出型AMD与PCV不同的ICGA表现及PCV眼底特征性的视网膜下橘红色结节样病灶有助于两者的诊断与鉴别诊断.（中华眼底病杂志，2004，20：307-309）     

息肉状脉络膜血管病变的眼底血管造影表现

目的 观察息肉状脉络膜血管病变(PCV )的临床特征及眼底血管造影表现。 方法 回顾分析12例PCV患者12只眼的眼底检查、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)及其5例5只眼的光相干断层扫描(OCT)检查资料。 结果 12只眼均可见深层和(或)浅层出血，黄色脂质渗出。其中6只眼病变处见橘红色病灶，2只眼伴视网膜前出血。FFA检查，静脉期6只眼橘红色病灶内点状荧光，4只眼病变处可见脉络膜血管网。晚期均见息肉状强荧光点荧光素渗漏，2只视网膜前出血眼晚期未见荧光素渗漏。ICGA检查，12只眼晚期见强度不等、簇状或孤立的息肉状扩张灶，4只眼显示明显的脉络膜血管网。OCT检查，4只眼视网膜色素上皮（RPE）和脉络膜毛细血管高反射层呈穹窿状隆起，1只眼无改变。 结论 PCV眼底多见黄斑区出血性和(或)浆液性视网膜色素上皮脱离(RPED)和(或)神经上皮脱离，黄色脂质渗出。FFA及ICGA检查可见分支状脉络膜血管网及末梢膨大息肉状扩张灶。 （中华眼底病杂志，2004，20：310-312）     

息肉状脉络膜血管病变的临床特征分析

目的观察息肉状脉络膜血管病变(PCV)的眼底表现及荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)与相干光断层扫描(OCT)特征。方法分析经眼底检查、FFA、ICGA及OCT确诊的PCV患者16例(16只眼)的眼底图像资料。其中OCT检查资料为8例(8只眼)。结果 16例(16只眼)全部为单眼发病,其中男性10例,占62.5%,女性6例,占37.5%。年龄36～75岁,平均年龄63.4岁。眼底检查14只眼病变部位位于黄斑区,占87.5%,2只眼病变位于视盘颞侧,占12.5%。在黄斑区4只眼见橘红色结节样隆起病灶,13只眼视网膜下有出血,11只眼见脂质沉着。FFA检查16只眼早期均呈强荧光,后期进行性渗漏。其中6只眼表现血液性视网膜色素上皮脱离(PED),1只眼为浆液性PED,2只眼为血液性合并浆液性PED,1只眼呈脉络膜血管网及息肉样结构。ICGA检查16只眼均可见强度不等、簇状或孤立的息肉状扩张灶,其中12只眼可见伞样或树枝样异常扩张的脉络膜血管网。OCT检查8只眼显示7只眼视网膜色素上皮(RPE)和脉络膜毛细血管高反射层呈穹隆状隆起,其下可见结节状改变。1只眼无脉络膜毛细血管高反射层改变。6只眼表现血液性PED,2只眼为浆液性PED合并神经上皮脱离。结论 PCV单眼发病为主,好发部位为黄斑区,最常见表现为视网膜下出血及脂性渗出,部分患眼存在PED。大部分患眼ICGA可见特征性的脉络膜血管网及其末梢的息肉状扩张灶。     

息肉状脉络膜血管病变的临床表现及眼底血管造影

目的 观察息肉状脉络膜血管病变(pol ypiodal choroidal vasculopathy, PCV)的临床表现及眼底血管造影特征。 方法 回顾分析6例PCV患者7只眼的临床资料及荧光素眼底血管造影(fundus fluorescein angiography, FFA)与吲哚青绿血管造影(indocyanine green angiography, ICGA) 检查资料。 结果 PCV患者早期眼底仅可见橘红色病变，随病情进展出现出血 、渗出、水肿、浆液性和(或)出血性视网膜色素上皮(retinal pigment epithelium, RPE) 脱离，病程长者可出现视网膜、脉络膜萎缩。FFA检查1只眼病变处脉络膜血管网扩张，6只眼见密度不均的斑点状强荧光，造影过程中荧光渗漏，晚期呈强度不均的强荧光片；ICGA检查5只眼早期显示分支状脉络膜血管网，末端扩张呈息肉状，晚期脉络膜血管结构不清，息肉状扩张仍然可辨，7只眼均有形态独特的孤立或簇状分布的息肉状强荧光点，晚期仍有染料存留。 结论 PCV患者眼底可见橘红色病变及出血、渗出和RPE脱离，FFA及ICG检查可见分支状脉络膜血管网及末端息肉状扩张。 （中华眼底病杂志，2003，19：269-332）     

息肉状脉络膜血管病变与老年黄斑变性对比分析

目的探讨息肉状脉络膜血管病变(PCV)与湿性老年黄斑变性(AMD)临床特征的区别与联系,以指导临床。方法回顾分析已确诊的PCV及湿性AMD的眼底彩照,荧光素血管造影(FFA),吲哚青绿血管造影(ICGA),光学相干断层扫描(OCT)结果及临床资料。结果PCV15例,年龄48-70岁,平均62.3岁;湿性AMD38例,年龄50-80岁,平均65.8岁。PCV患者眼底视网膜出血、脂质渗出、桔红色结节样病灶分别为11只眼(73.3%)、6只眼(40%)、4只眼(26.7%);AMD患者45只眼中视网膜出血、脂质渗出、青灰色病灶、瘢痕形成分别为25只眼(55.6%)、18只眼(40.0%)、20只眼(44.4%)、3只眼(6.77%)。FFA显示PCV患眼脉络膜息肉状结构、出血性色素上皮脱离(PED)、浆液性PED分别为1只眼(6.7%)、7只眼(46.7%)、2只眼(13.3%),ICGA均可见息肉状扩张病灶(100%);FFA显示AMD患眼典型脉络膜新生血管(CNV)、PED分别为5只眼(11.1%)、14只眼(31.1%),ICGA显示CNV23只眼(51.1%),均未见息肉状结构。PCV的OCT表现为视网膜色素上皮及脉络膜内层呈穹窿状向视网膜神经上皮隆起,其下见结节状改变;AMD则显示视网膜色素上皮和脉络膜毛细血管层呈局部梭形或不规则强反射带。结论PCV与湿性AMD不尽相同,可能是AMD的另一种特殊类型,治疗可能应有所不同,有待于进一步研究。     

息肉状脉络膜血管病变

目的 观察国人息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV) 的眼底和血管造影特征。 方法 对9例PCV患者进行眼底检查、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)检查。 结果 9例患者均为单眼患病。7例患者具有脉络膜分支状血管网及血管末端息肉状膨大；2例患者血管网不明显,但息肉状膨大明显可见。7只眼伴有出血性视网膜色素上皮（retinal pigment epithelium,RPE）脱离,其中4只眼可见血和血浆的分界线。眼底病变部位在黄斑部者8例,视盘旁者1例。 结论 国人PCV患者大部分有脉络膜异常分支血管网, 所有 病例均有血管末端扩张呈息肉样灶；病变部位以黄斑部为主,大多合并有出血性RPE脱离。（中华眼底病杂志，2003，19：269-332）     

息肉样脉络膜血管病变的分类与视力改变

目的 了解不同类型息肉样脉络膜血管病变(PCV)患者视力改变情况.方法 收集经眼底彩色照相、荧光素眼底血管造影、吲哚青绿血管造影(ICGA)以及光相干断层扫描检查确诊的67例PCV患者68只眼的临床资料.根据PCV的活动性与病理特征分为静止性、渗出性和出血性PCV;根据ICGA检查中息肉样病灶的形态特征以及是否合并分支状脉络膜血管网(BVN)分为葡萄状病灶型、单个病灶型和合并BVN的混合病灶型PCV;根据息肉样病灶分布部位分为黄斑区、血管弓区、视盘旁区、中周部和混合区PCV.观察各组的视力情况.结果 静止性、渗出性、少量出血性、多量出血性PCV分别有16、19、19、14只眼,其平均最小分辨角对数(logMAR)视力分别为0.34±0.52、0.70±0.98、0.60±0.50、0.91±0.75.静止性PCV患眼平均视力显著优于渗出性、少量出血性与多量出血性PCV患眼,组间比较,差异有统计学意义(q＝4.75、4.26、5.13,P＜0.05).渗出性PCV与少量出血性PCV患眼平均视力比较,差异没有统计学意义(q=0.98,P＞0.05).葡萄状病灶型、单个病灶或多处单个病灶型、合并BVN的混合病灶型PCV分别有22、38、8只眼,其平均logMAR视力分别为0.52±0.55、0.59±0.43、0.80±0.95.伴有BVN的混合病灶型PCV患眼平均视力显著差于葡萄状病灶型和单个病灶或多处单个病灶型PCV患眼,组间比较,差异有统计学意义(q=3.81、3.02,P＜0.05).黄斑区、血管弓区、视盘旁区、混合区PCV分别有34、1 3、8、13只眼,其平均logMAR视力分别为0.78±0.43、0.57±0.37、0.38±0.27、0.74±0.41.黄斑区PCV患眼平均视力差于血管弓区与视盘旁区PCV患眼,组间比较,差异有统计学意义(q=4.61、5.11,P＜0.05);黄斑区PCV与混合区PCV患眼平均视力比较,差异无统计学意义(q=0.73,P＞0.05).结论 PCV患者视力改变情况不一,且与PCV的活动性与病理特征、息肉样病灶的形态特征和分布部位以及是否合并BVN有关.     

息肉状脉络膜血管病变的吲哚菁绿眼底血管造影分型研究

目的 分析黄斑区息肉状脉络膜血管病变(PCV)在吲哚菁绿眼底血管造影(ICGA)中的不同渗漏亚型及临床特点.方法 对经荧光素眼底血管造影(FFA)及ICGA确诊为PCV的137例144只患眼进行ICGA渗漏状态的分型及各型临床特点的分析.结果 在144只PCV患眼的ICGA中,110只眼出现晚期染料渗漏(渗漏型,76%).渗漏型又可分为三个亚型:息肉灶渗漏型(47只眼,42.7%)、异常分支状脉络膜血管渗漏型(14只眼,12.7%)和混合渗漏型(49只眼,44.5%).其他34只眼显示出晚期病灶的消退和(或)呈冲刷现象(消退型,24%).在渗漏型中,色素上皮脱离(PED)、最佳矫正视力(BCVA)<0.1及陈旧性视网膜下出血的比例分别为56.4%(62只眼),19.1%(21只眼)和4.6%(5只眼);消退型相应比例分别为8.8%(3只眼)、50%(17只眼)和38.2%(13只眼)(P<0.001),同时消退型的病程显著长于渗漏型(P<0.001).结论 在ICGA中可以观察PCV病灶的晚期渗漏及消退现象,其中以渗漏型居多.混合性渗漏是渗漏型中最常见的亚型.渗漏型多表现PED,较好的BCVA以及较短的病程,而消退型则更易表现视网膜下陈旧性出血、较差的BCVA以及较长的病程.这可能提示前者为活动性病灶或处于疾病的早期阶段,而后者则为静止性病灶或处于疾病的晚期阶段.     

息肉状脉络膜血管病变眼底影像检查特征

目的探讨息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)眼底影像特征。方法回顾性分析PCV患者32例(32眼)的眼底检查资料,所有患者均经荧光素眼底血管造影、吲哚青绿血管造影和光学相干断层扫描(optical coherence tomography,OCT)检查确诊。结果 32眼中6眼表现为异常分支状脉络膜血管网,异常血管网造影后期荧光逐渐减弱;21眼表现为不同程度的息肉状脉络膜血管扩张灶,在造影早期呈囊袋样或结节样强荧光,造影后期表现为渗漏、染色、冲刷现象或者消退;5眼表现为PCV与脉络膜新生血管共同存在。表现为异常分支状脉络膜血管网的6眼OCT检查发现视网膜色素上皮及视网膜色素上皮下的两层强反射,即双层征;而表现为息肉状脉络膜血管扩张灶的26眼OCT检查发现脉络膜内层的突兀状结节样隆起,隆起的下面有中等反射存在。结论 PCV在吲哚青绿血管造影和OCT检查中有其特征性眼底影像表现,掌握这些特点有助于与湿性年龄相关性黄斑变性相鉴别,对患者预后的判断和治疗方法的选择都具有重要的临床意义。     

息肉样脉络膜血管病变的频域相干光断层扫描图像特征

目的 研究息肉样脉络膜血管病变(PCV)异常血管网和息肉样病变的频域相干光断层扫描(OCT)图像特征.方法 回顾性病例系列研究.对经吲哚氰绿脉络膜血管造影(ICGA)确诊的54例(63只眼)PCV患者的临床资料进行回顾性分析,观察其脉络膜异常血管网和息肉样病变的频域OCT图像特征.结果 ICGA图像中,有45只眼同时可见脉络膜异常血管网和血管息肉样扩张,8只眼仅见脉络膜异常血管网,10只眼仅见脉络膜血管息肉样扩张.53只眼异常血管网相对应部位均可见视网膜色素上皮层隆起,其中38只眼显示视网膜色素上皮层呈扁平波纹状隆起,视网膜色素上皮层信号与Bruch膜信号之间可见中至高的异常血管网反射信号;15只眼视网膜色素上皮层隆起较高,其下可见中高反射异常血管网和(或)出血信号,Bruch膜信号不完整.55只眼脉络膜息肉样病灶中,有28只眼为孤立性病灶,频域OCT图像显示为局限、轻度隆起的视网膜色素上皮层与Bruch膜之间的中等反射信号;27只眼ICGA图像显示为聚集性息肉样病变,而在频域OCT图像中表现为圆顶形、高度隆起的视网膜色素上皮层脱离,其下可见中等反射信号.结论 PCV异常血管网和息肉样病变大多表现为视网膜色素上皮层和Bruch膜之间的中高反射信号.

Abstract：

Objective To analyze the tomographic features of branching vascular networks and polypoidal lesions in patients with polypoidal choroidal vasculopathy (PCV) by spectral domain optical coherence tomography (SD-OCT). Methods It was a retrospective case series study. Retrospective review of 63 eyes of 54 patients with PCV identified with indocyanine green angiography (ICGA). Tomographic features of branching vascular networks and polypoidal lesions on SD OCT,ICGA and fluorescein angiography were analyzed. Results Both branching vascular network and polypoidal lesions were found in 45 eyes on ICGA,branching vascular network only was found in 8 eyes and polypoidal lesions only in 10 eyes. Retinal pigment epithelial detachment (RPED) was found in all 53 eyes with branching vascular networks on SDOCT. Thirty-eight eyes had areas of moderate reflectivity of branching vascular network between the fluctuating retinal pigment epithelium and Bruch membrane. Fifteen eyes had moderate reflectivity of branching vascular network and/or hemorrhage between high doom-like RPED and incomplete Bruch membrane. Solitary pelypoidal lesions in 28 patients showed local moderate reflectivity between the RPE and Bruch membrane on SDOCT. Other aggregate polypoidal lesions in 27 patients showed moderate reflectivity between high doom-like RPED and incomplete Bruch membrane. Conclusion The vascular abnormalities of PCV identified with ICGA were visualized on SD-OCT images as areas of moderate reflectivity between RPE and Bruch membrane.     

Cross-sectional and en face optical coherence tomographic features of polypoidal choroidal vasculopathy

PURPOSE: To correlate optical coherence tomography (OCT)-ophthalmoscope images with angiographic signs of polypoidal lesions and branching network vessels in eyes with polypoidal choroidal vasculopathy (PCV). METHODS: The authors prospectively examined 50 consecutive eyes with PCV using the OCT-ophthalmoscope and fluorescein and indocyanine green angiography (ICGA). RESULTS: ICGA showed polypoidal lesions in all eyes. In 18 of 22 eyes with a retinal pigment epithelial detachment (PED), OCT-ophthalmoscope cross-sectional B-scan images showed a central dome-shaped PED and a contiguous small PED corresponding to the polypoidal lesions on ICGA. Transverse C-scan images showed an irregularity or protrusion of the highly reflective retinal pigment epithelium (RPE) line of the PED corresponding to the polypoidal lesions on ICGA in all 22 eyes. In 28 eyes without a PED, the B-scan images showed polypoidal lesions as anterior protrusions of a highly reflective RPE line in 26 of 28 eyes; in those 26 eyes, C-scan images showed distinctive rings of a highly reflective RPE line corresponding to the polypoidal lesions on ICGA. ICGA showed an abnormal vascular network in 41 of the 50 eyes that appeared as a highly reflective area on C-scan images in 32 of the 41 eyes. In 20 of the 41 eyes, B-scan images showed two separate highly reflective RPE lines at the area of the abnormal vascular network. CONCLUSIONS: The OCT-ophthalmoscope C-scan images of the irregularity and the protrusion in the PED and the distinctive bright rings in eyes without a PED may be diagnostically important as indicators of polypoidal lesions in eyes with PCV.     

Polypoidal choroidal vasculopathy in elderly Chinese patients

Purpose To investigate the frequency and clinical features of polypoidal choroidal vasculopathy (PCV) in a consecutive series of elderly Chinese patients.Methods A restrospective analysis of 166 consecutive patients 50 years or older with diagnosis of exudative age-related macular degeneration (AMD) was conducted. Color fundus photographs were taken and fluorescein and indocyanine green (ICG) angiography were performed in all patients.Results Of the 166 patients, 37 patients (22.3%) initially suspected of having exudative AMD were ultimately diagnosed as having PCV. Twenty-seven men (73.0%) were affected, 32 patients (86.5%) were unilaterally involved. Of 42 eyes with PCV, 27 eyes (64.3%) demonstrated polypoidal dilations with branching vascular network, and the other 15 eyes (35.7%) showed scattered polypoidal dilations without identifiable continuous branching vascular network on ICG angiography. The predominant location for these lesions was at the macular region in 26 eyes (61.9%), the temporal vascular arcade in 9 eyes (21.4%), the peripapillary area in 6 eyes (14.3%), and the midperiphery in 1 eye (2.4%).Conclusions PCV is a common disease in elderly Chinese patients. In our study group PCV mainly affected men and was mostly unilateral. Most of the lesions were located in the macular region and temporal vascular arcade.     

息肉状脉络膜血管病变的分型研究

目的:依据吲哚菁绿血管造影(indocyanine green angiography,ICGA)显示的息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)的形态进行分型,结合光学相干断层扫描(optical coherence tomography,OCT)及临床特征,探讨各型的特点,为PCV的治疗和预后评价提供依据。方法:回顾性分析在宁夏眼科医院就诊的33例PCV患者。所有病例均经过OCT和荧光素眼底血管造影(fundus fluorescein angiography,FFA)与ICGA等全面检查后确诊。根据ICGA的表现进行分型,同时对各亚型的病变特征进行比较。结果:共收集到33例54眼PCV患者,单眼12例,双眼21例;男20例,女13例;年龄42～86(平均70.63±9.42)岁。45眼病变部位位于黄斑区,占83%。根据ICGA的表现分为:息肉状扩张型(20眼,37%)、异常分支血管网型(16眼,30%)、经典型(18眼,33%)。27眼(50%)出现视网膜色素上皮脱离(pigment epithelial detachment,PED),其中分支血管网型及经典型出现PED的比例相对较高,分别为11眼(68.8%)和12眼(66.7%)。23眼(43%)出现视网膜神经上皮层脱离,其中分支血管网型10眼(62.5%)和经典型9眼(50.0%)易出现神经上皮脱离。31眼(57%)表现为活动型病变,其中分支血管网型和经典型常见,分别为13眼(81.3%)和13眼(72%)。10眼(19%)出现纤维机化膜,其中分支血管网型及经典型多见,分别为7眼(43.8%)和2眼(11.1%)。37眼(69%)有滋养血管的存在,其中分支血管网型和经典型分别为81%和94%。结论:分支血管网型及经典型易出现视网膜色素上皮脱离及视网膜神经上皮层脱离,多表现为活动型病变,存在滋养血管。而息肉型较少出现视网膜色素上皮脱离和神经上皮脱离,多表现为静止型,大多无滋养血管。异常分支血管网型易出现纤维机化膜。     

Photodynamic therapy for polypoidal choroidal vasculopathy: Vaso-occlusive effect on the branching vascular network and origin of recurrence

Purpose To determine whether photodynamic therapy (PDT) has a vaso-occlusive effect on the branching vascular network in polypoidal choroidal vasculopathy (PCV) and whether PDT can prevent future recurrence. Methods We analyzed pre-and post-PDT indocyanine green angiography (ICGA) results of 27 patients (27 eyes) who were diagnosed with PCV and who had shown clinical improvement accompanied by occlusion of polypoidal lesions after PDT. We also investigated the recurrent events in these patients and the origin of the recurrences. Results The branching vascular network persisted, at least in part, in 20 (87%) of 23 eyes undergoing one PDT session and in two (50%) of four eyes undergoing two PDT sessions. In the remaining five eyes, we could not determine definitively whether the branching vessels were occluded completely. Recurrent serous changes occurred in nine eyes (33%) 14–48 months after the last PDT. ICGA revealed that these changes were caused by new polypoidal lesions that originated from further-grown branches of the persistent branching vascular network. Diffuse leakage from undetermined sources seemed to coexist in two eyes. Conclusions PDT cannot induce complete occlusion of the branching vascular network. PDT does not prevent future recurrence, because new active polypoidal lesions may develop from the persistent branching vessels in the network.