荧光血管造影用于国人棕色虹膜新生血管诊断的初步观察

目的观察国人虹膜新生血管（NVI）患者的虹膜荧光血管造影（IFA）表现,与裂隙灯检查对比,探讨IFA在NVI诊断上的临床应用价值。方法对国人40例（40眼）正常者和27例（28眼）各种病因继发NVI患者及24例（27眼）可疑NVI患者,进行了裂隙灯、虹膜彩照和IFA检查。结果正常对照组IFA不显影,呈色素遮蔽荧光,部分（22.2%）大于60岁正常老年人瞳孔缘可见轻微荧光素渗漏。所有NVI患者（100%）IFA显示瞳孔缘和虹膜表面出现小团状、细线状或不规则交叉网状强荧光,充盈迅速,伴有不同程度的荧光素渗漏。对于部分（11.1%）严重眼底缺血患者,IFA可提前于裂隙灯发现NVI。结论IFA在国人棕色虹膜病变特别是NVI的诊断中有应用价值,能够更敏感地显示NVI的形态和位置,并判断其活动性,为NVI的诊断及疗效判断提供了客观依据。     

荧光素虹膜血管造影联合眼底血管造影在DR合并新生血管性青光眼中的应用

背景 新生血管性青光眼(NVG)是由视网膜缺血缺氧继发的眼病.荧光素虹膜血管造影(IFA)可早期诊断NVG,但其不能全面反映眼底血管情况.IFA联合荧光素眼底血管造影(FFA)可全面检测视网膜及虹膜新生血管情况,但目前国内关于糖尿病视网膜病变(DR)合并NVG患者中此方法的应用研究较少. 目的 探讨IFA联合FFA检查在增生性糖尿病视网膜病变(PDR)患者合并新生血管性青光眼的临床应用.方法 采用回顾性研究方法.纳入2013年2月至2016年1月在河南省立眼科医院接受IFA和FFA联合检查的PDR患者79例133眼,其中无虹膜病变100眼,I期青光眼红变期21眼,Ⅱ期开角型NVG 12眼.所有患眼均行视力、眼压、裂隙灯显微镜、IFA联合FFA检查.采用McNemar非参数检验法对比分析裂隙灯显微镜和IFA检查在I期青光眼红变期患眼检出率的差异. 结果 IFA检查显示100眼无虹膜病变患者无异常虹膜荧光素渗漏,FFA检查显示接受全视网膜激光光凝术(PRP)治疗的32眼未发现视网膜新生血管,68患眼存在视网膜新生血管;早期IFA检查显示,21眼I期青光眼红变期患者瞳孔缘或虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管;早期IFA检查显示12眼NVG患者虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管.I期青光眼红变期患眼中IFA检查的检出率为100％(21/21),明显高于裂隙灯显微镜检查的71.43％(15/21),2种检测方法检出率的比较差异有统计学意义(P=0.03). 结论 IFA联合FFA检查可以及早发现PDR合并青光眼红变期,有助于及时指导治疗.     

急性低眼压白化兔荧光素虹膜血管造影的研究

目的观察白化兔急性低眼压荧光素虹膜血管造影(IFA)特点,探讨白化兔清醒状态行IFA的可行性。设计实验性研究。研究对象新西兰兔12只(12眼)。方法穿刺抽吸玻璃体制作急性低眼压兔眼模型,随机分为4组,即低眼压0h、2h、4h、8h组(每组各3只3眼),分别在造模前及各自低眼压时间点行裂隙灯、眼前节照相及IFA,之后再从中随机选3只(3眼)作为低眼压1~4d组于低眼压1、2、4d行以上检查。兔捆绑固定后用眼杯撑开受试眼睑裂,耳缘静脉注射荧光素钠注射液行IFA。主要指标虹膜及房水中荧光素渗漏程度及时间。结果兔急性低眼压造成虹膜基质和前房内大量荧光素渗漏,0h渗漏最重,2h渗漏开始减轻,8h以后除虹膜血管网略多外,其余基本接近正常。捆绑固定配合眼杯可使清醒状态兔顺利完成IFA。结论兔IFA证实,急性低眼压会造成血-房水屏障破坏,低眼压早期破坏程度最重,破坏程度随低眼压持续时间延长而逐渐减轻。     

糖尿病虹膜红变的发展和分级

糖尿病人虹膜的异常血管称为“虹膜红变”(rubeosis iridis),本文描绘了糖尿病人眼血管变化的特征,并将“虹膜红变”分级。共对33只眼各种程度糖尿病性虹膜睫状体病变的虹膜作荧光血管造影,大多数病人,在病程中每隔数月作一次。荧光血管造影显示的异常虹膜血管有下列类型:(1)围绕瞳孔有扩张的渗漏的血管。(2)不规则或迟缓充盈荧光素的放射状动脉。(3)表层分枝状新生血管形成,通常起自房角。(4)放射状血管,尤其是动脉呈现扩张与渗漏。根据血管造影所见,作者将糖尿病虹膜的血管病变分成4个等级。一级:瞳孔周围血管扩张及渗漏,这是最早的发现,可单眼出现亦更常见     

兔眼前段缺血诱发虹膜新生血管的研究

目的 建立兔虹膜新生血管(NVI)模型,检测房水中血管内皮生长因子(VEGF)的质量浓度.方法 5只有色家兔任一眼切断上下内外4条直肌,另一眼作为对照,术后每日在裂隙灯显微镜下观察眼前段炎症反应及新生血管形成情况;术后7 d眼前段血管荧光造影观察荧光素渗漏情况.ELISA法测定术前对照眼和术眼术后4、7、11、14 d房水中VEGF的质量浓度.结果 术后1 d实验眼全结膜充血,房水略混浊;术后3 d房水混浊,可见尘样KP,虹膜表面开始出现新生血管;第7 d所有实验眼虹膜表面均可见新生血管,耳缘静脉注射10%荧光素钠后实验眼房水变绿,30 s后荧光激发眼前段血管荧光造影显示明显的高荧光素渗漏,术后第4 d,房水中的VEGF质量浓度升高,第7 d达高峰,第14 d时较对照眼低.结论 切断兔上下内外4条直肌引起眼前段缺血综合征,能够有效地诱发NVI的形成;房水中VEGF质量浓度随着新生血管的形成先增高后降低,2周时低于正常水平.     

虹膜荧光素血管造影在新生血管性青光眼随访中的应用

目的　观察虹膜荧光素血管造影（iris fluorescein angiography，IFA）在新生血管性青光眼（neovascular glaucoma，NVG）随访中的作用。方法　收集2015年2月至2017年2月在北京大学第三医院随访过程中发现眼压再次升高的NVG患者17例（17眼），其中男10例（10眼），女7例（7眼），年龄（52.2±14.2）岁。视网膜中央静脉阻塞7眼，糖尿病视网膜病变7眼，视网膜分支静脉阻塞2眼，视网膜中央静脉合并动脉阻塞1眼。记录患者的最佳矫正视力、眼压、裂隙灯显微镜检查等资料。行IFA评估患者虹膜新生血管复发的情况，包括新生血管范围、荧光素渗漏程度，并与裂隙灯显微镜检查结果进行对比。结果　本研究发现，通过IFA观察到17例（17眼）患者均存在虹膜新生血管，其阳性率为100.0%；依据荧光素渗漏的情况对患者的病变进行分级，其中轻度12例12眼，中度4例4眼，重度1例1眼。裂隙灯显微镜检查结果显示12例（12眼）患者存在明显的虹膜新生血管，5例（5眼）患者未观察到明显的新生血管，其阳性率为70.6%。两种检查方法的阳性率比较差异具有统计学意义（P=0.022）。IFA所显示的新生血管范围大于裂隙灯下观察的结果。结论　IFA有助于NVG患者新生血管复发的早期诊断，在NVG随访中有十分重要的作用。     

虹膜血管造影的临床应用研究

虹膜血管造影(IA)主要包括虹膜荧光素血管造影和虹膜吲哚青绿血管造影,对于阐释虹膜病变是一项有价值的技术。IA的临床应用国外较为广泛,主要涉及监测眼底缺血性病变继发的虹膜新生血管、葡萄膜炎患者手术前后血-房水屏障功能的评价、新生血管性青光眼早期诊断及判定虹膜肿瘤和虹膜发育异常等。     

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.     

“首诊于眼科的急性淋巴细胞白血病”病例评析

刘雪莲等医师给我们提供了一个很好的病例.我们想对本病例的诊断、鉴别诊断,白血病致视网膜病变的发病因素进行一些讨论,以提高大家的兴趣与认识.患者初诊为双眼葡萄膜炎,是何种葡萄膜炎？作者未提及.让我们首先讨论一下葡萄膜炎这一话题：本病例如真患葡萄膜炎,最可能是哪种葡萄膜炎？据检查：患者双眼前节角膜后无KP,房水闪辉阴性,虹膜无异常,瞳孔直径3 mm,对光反应灵敏.眼后节玻璃体未见炎症细胞,视网膜黄斑区见晕轮,相干光断层扫描（optical coherence tomography,OCT）显示为神经上皮脱离,除右眼视网膜见小片出血外,无视网膜或脉络膜炎症如渗出、水肿等.荧光素眼底血管造影（fundus fluorescein angiography,FFA）显示双眼视盘颞侧及鼻侧有较多脉络膜点状强荧光点,随造影时间延长,渐有荧光渗漏,晚期荧光积存.右眼下方视网膜有小片状出血呈遮蔽荧光.双眼视盘晚期荧光增强,视盘边界模糊.视网膜血管无异常荧光.     

全葡萄膜炎的荧光素眼底血管造影及吲哚菁绿血管造影特征

目的 观察全葡萄膜炎的荧光素眼底血管造影(FFA)及吲哚菁绿血管造影(ICGA)特征.方法 对22例(22只眼)全葡萄膜炎患者的28只眼按常规方法 做FFA检查.其中4例(8只眼)做ICGA检查.结果 16例活动性病变的FFA均出现视盘及附近视网膜高荧渗漏,其中4例(6只眼)视网膜血管充盈延迟,狭窄或闭塞,管壁染色渗漏为主,6例(9只眼)毛细血管荧光素渗漏,7只眼视网膜色素上皮荧光素渗漏;6只眼黄斑点状荧光素渗漏,4例(6只眼)黄斑囊样水肿,3例(4只眼)伴视网膜出血及棉绒斑.6例(6只眼)陈旧性全葡萄膜炎见视网膜弥漫斑驳样荧光部分合并小的遮蔽荧光.4例吲哚菁绿造影中1例特发性全葡萄膜炎表现为脉络膜毛细血管扩张及高荧光,1例VKH早期脉络膜血管无异常,后期脉络膜不均匀的荧光渗漏.1例白塞病2只眼表现为脉络膜毛细血管充盈不良、低荧光遮蔽,1例白塞病患者双眼脉络膜及血管未见异常.结论 全葡萄膜炎的FFA特征为视盘、视网膜色素上皮、视网膜血管和黄斑出现不同程度的荧光素渗漏.ICGA以脉络膜的低荧光和(或)高荧光表现为主、早期脉络膜血管可以无变化.FFA及ICCG能客观地反映葡萄膜炎对视网膜组织的损害,对确定葡萄膜炎的类型及病程提供诊断和治疗依据.     

Effects of aging on fluorescein leakage in the iris and angle in normal subjects.

PURPOSE: To determine the presence of fluorescein leakage from the iris and angle in normal subjects, and how it is affected by aging. METHODS: The subjects were 92 normal volunteers and patients with senile cataract who ranged in age from 20 to 93 years and were free from any systemic or ocular diseases. Fluorescein iris and angle photography and color iris and angle photography were performed using a goniolens and a photo slit lamp. RESULTS: Radial ciliary body vessels were found in 22 eyes (24%), radial iris vessels or trabecular vessels in 7 eyes (8%), and circular ciliary band vessels were seen in 4 eyes (4%). Goniovessels were found in 8 of 30 eyes (27%) of those under 50 years of age. No significant difference in the incidence of goniovessels was found between those over and under age 50 (P < .01). In the pupillary margin, fluorescein leakage was seen in 1 of 30 eyes (3%) in the age group under 50 years, whereas leakage was found in 30 of 62 eyes (48%) in the age group over 50 years. In the anterior chamber angle, leakage was seen in 4 of 30 eyes (13%) under age 50 years, and in 38 of 62 eyes (61%) over age 50 years (P < .05). CONCLUSIONS: These findings suggested that the incidence of leakage of fluorescein from the pupillary margin and anterior chamber angle tends to increase with age. Thus, when leakage of fluorescein in angle and iris is observed, it is important to consider the physiological changes resulting from aging.     

Fluorescein iris angiography and anterior segment fluorophotometry in patients with Beh?et's disease

Fluorescein iris angiography and anterior segment fluorophotometry were performed in 63 eyes of 34 patients with Beh?et's disease during its remission stage. Thirty normal eyes were studied as the control. A variety of leakage patterns comprising posterior chamber leakage and paravascular leakage were detected in 32 eyes with Beh?et's disease by means of fluorescein iris angiography, while no leakage was detected in the control eyes. These leakage patterns were frequently seen in the posterior type uveitis group of Beh?et's patients, but were scarce in the anterior type uveitis group. By anterior segment fluorophotometry, the levels of fluorescein concentration in the anterior chamber were significantly higher in the posterior type uveitis eyes of Beh?et's patients than those in either the anterior type uveitis eyes or the controls (P less than 0.05-P less than 0.01). The results indicated that the damage to the vascular system still existed in the remission stage of the disease, and that this abnormality occurred more markedly in the posterior type group than in the anterior type group of Beh?et's disease eyes.     

The complex study of the iris in transformed light

Complex investigations of the iris in a transformed light by methods of iridochromoscopy, iridochromophotography, examination in a polarized light, transillumination in red light and fluorescence angiography was conducted in 25 eyes of patients with open-angle glaucoma, 10 eyes of patients with anterior flaccid uveitis and in 23 healthy eyes (a control group). It was found that in patients with open-angle glaucoma and anterior flaccid uveitis trophic and vascular changes in the iris predominated, as compared with control. The most typical for open-angle glaucoma changes in the iris were atrophy of the stroma with predominant involvement of the pupillary zone, exogenic pigmentation of the pupillary and ciliary zones, destruction of the pigment margin of the pupil, thickening of the anterior border layer, pseudoexfoliation of the pupillary margin, defects in the posterior pigment layer, being more extensive in the pupillary zone, as well as disturbances in permeability of the iris in a combination with hypoperfusion and rare bundles of microneovascularization in the area of a lesser arterial circle and the ciliary zone. In case of flaccid uveitis, the most frequent changes were diffuse atrophy of the iris, efflorescence of the pupillary margin, destruction of the pigment rim of the pupil, multiple defects in the posterior pigment layer along its whole length, increased permeability of vessel, microneovascularization of the iris stroma in a form of a thin vascular network.     

Effects of aging on fluorescein iris and angle photography in normal subjects]

In the present study we took the fluorescein iris and angle photography of normal eyes and studied them according to different age groups. The range of age in 108 eyes of 92 subjects was from 20 to 93 years. They were free from any systemic diseases or ophthalmic diseases which would cause iris rubeosis. Fluorography was carried out using a Mizuno Trabeculens to determine the leakage points of fluorescence from the iris and the angle. In the angle there were gonio vessels which revealed no leakage of fluorescein. They were observed in 8 of 30 eyes (27%) for subjects in the fifth decade of life or less and in 24 of 78 eyes (31%) for subjects aged 50-90. No significant difference was seen between the two age groups. As to variations of gonio vessels, radial ciliary body vessel was found in 23 eyes, radial iris vessel or trabecular vessel in 10 eyes, and circular ciliary band vessel in 7 eyes. In the pupillary margin no leakage was seen in 30 eyes of 30 cases in the fifth decade of life or less, while leakage was found in 33 of 78 eyes, 42 of 62 cases over the fifth decade of life. In the angle leakage was seen in 4 of 30 eyes, 13 of 30 cases in the fifth decade of life or less, while leakage was observed in 43 of 78 eyes over the fifth decade of life. These results suggested that leakage of fluorescence from the pupillary margin, the angle or both increases with age.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fuchs''s heterochromic cyclitis: a simultaneous bilateral fluorescein angiographic study of the iris.

Twelve patients with Fuchs's heterochromic cyclitis (FHC) were studied with simultaneous bilateral flucrescein angiography of the iris. The flow began a little earlier in the contralateral iris in 4 cases, and simultaneously in both irides in 8 cases. The radial iris vessels were narrow in 7 eyes with FHC and in the contralateral eyes of 2 elderly patients and 1 patient with pigmentary retinal dystrophy and FHC. An ischaemic sector of the iris was seen in 6 eyes with FHC, neovascularisation of the iris in 8 eyes, and fluorescein leakage of the iris vessels was seen in all eyes with FHC. No neovascularisation of the iris occurred in the contralateral eyes, and only minimal fluorescein leakage was seen at the pupillary border of 5 contralateral eyes. The results support the hypothesis of vascular pathomechanism in FHC.     

The site of breakdown of the blood-aqueous barrier under the influence of vaso-dilator drugs

The techniques of fluorescein angiography and vascular labelling with carbon suspension were used in an attempt to identify the site of breakdown in the blood-aqueous barrier in rabbits following intracameral administration of bradykinin, prostaglandin-E₂, acetyl choline and histamine.Fluorescein photography of the anterior segment after injecting fluorescein intravenously indicated that the breakdown of the barrier was located primarily in the posterior chamber and that comparatively little of the dye entered across the anterior surface of the iris.Carbon labelling experiments showed that the drugs caused a marked increase of endothelial permeability of the vessels in the ciliary processes and their iridial extensions whilst the iris vessels themselves remained unaffected.It is pointed out that leakage into the posterior chamber also entails some breakdown in the epithelial component of the barrier in this region and possible mechanisms are discussed     

Fluorescein iris angiography in nodular sarcoid iritis

The value of fluorescein iris angiography in the diagnosis and follow-up of nodular sarcoid iritis was studied in five patients with nodular iritis and histologically verified generalized sarcoidosis. On the angiograms the sarcoid nodules appeared as hyperfluorescent patches which always exceeded the number of nodules seen by biomicroscopy. Fresh iris nodules were characterized by mild diffuse fluorescence and dilatation and leakage of the adjacent vessels whereas old granulomas were covered by tortuous neovascular vessels which in the active stage of the disease leaked fluorescein profusely. After recovery or between recurrent attacks the amount of leakage decreased or stopped although the neovascular network did not disappear. At recurrences new areas of fluorescence due to fresh nodules were observed in addition to intense leakage from some of the previous lesions. Most of the small nodules were situated in the pupillary part of the iris resulting in dilatation and abnormal permeability of all the peripupillary vessels. The weakness of absence or diffuse leakage from the radial vessels of the iris agrees with the proliferative nature of sarcoid nodular iritis and explains the low-grade symptoms of the patients.     

Integrity of the blood-ocular barrier after intravitreal gas injection

The authors studied the effect of various intravitreal gases on the integrity of the blood-ocular barrier using a fluorophotometric technique. The gas (0.3 ml) was injected into the vitreous cavity of a pigment rabbit after paracentesis. Air and two long-acting gases, sulfur hexafluoride and perfluoropropane, were studied. The eyes that received only paracentesis served as controls. Fluorescein concentrations in the anterior chamber were determined by slit-lamp fluorophotometer 30 minutes following intravenous fluorescein administration. Fluorophotometry was repeated on days 1, 3, 7, and 14 after the gas injections. The eyes that received sulfur hexafluoride and perfluoropropane showed increased aqueous fluorescein concentrations in comparison with the control eyes and the air-injected eyes, although conventional slit-lamp biomicroscopic examination detected no anterior chamber inflammatory signs in these eyes. The aqueous fluorescein leakage decreased to the normal level after the intravitreal gas bubble was absorbed. These results suggest that intravitreal gas bubbles induce subclinical breakdown of the blood-aqueous barrier, which becomes re-established soon after the gas is absorbed.