特发性水螅状脉络膜血管病变的临床分析

目的：探讨特发性水螅状脉络膜血管病变（idiopathic polypoidal choroidal vasculopathy,IPCV)的临床特征。方法：回顾分析161例（202只眼）在1995年11月－2001年4月期间诊断为湿性型老年黄斑变性（age-related macular degeneration,AMD)患者的临床资料，并对其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)进行了重新分析。结果：14例（8．7％）17只眼原诊断为湿性型AMD的患者重新诊断为IPCV。国人IPCV多发生于男性（78．6％），且单眼受累状主（78．6％）。发病年龄48－78岁，平均61．5岁。ICGA显示IPCV病变呈一异常分支的脉络膜血管网，血管网的末梢有水螅状扩张、膨隆；病变位于黄斑区及颞上、下血管弓周围者12只眼（70．6％），视乳头旁5只眼（29．4％）。结论：IPCV易误诊为湿性型AMD，但其ICGA显示的分支状脉络膜血管网及末梢的水螅状血管扩张有助于两者的诊断与鉴别 诊断。     

Recurrent Metastatic Breast Carcinoma Presenting with Pansinusitis and Choroidal Metastases and Subsequent Bilateral Simultaneous Orbital Cellulitis

A case report and literature review of a unique presentation of metastatic breast cancer is provided. A 46-year-old patient with a history of breast carcinoma presented with a choroidal mass. Three days later she went on to develop bilateral simultaneous orbital cellulitis, investigation of which revealed underlying bony metastases from a breast primary. In order to diagnose underlying neoplasia, full history and examination is necessary when assessing patients with orbital inflammation.     

Amelanotic Choroidal Nevi

A review of 373 patients with presumed choroidal nevi revealed 19 (5.1%) to have largely or totally amelanotic nevi. All patients but one with amelanotic nevi were white, and all were 48 years of age or older. Each lesion was located posterior to the equator, had a mean diameter of 3.2 mm, and was less than or equal to 1 mm in elevation. Intravenous fluorescein angiography most often disclosed early and late hyperfluorescence, corresponding to the amelanotic areas of the nevus. No lesions were observed to grow during a mean 14-month follow-up period. The differential diagnosis of amelanotic nevi of the choroid is discussed and includes amelanotic malignant melanoma, cavernous hemangioma of the choroid, metastatic cancer to the choroid, posterior scleritis, choroidal osteoma, and hypopigmented congenital hypertrophy of the retinal pigment epithelium.     

脉络膜黑色素瘤与脉络膜脱离的超声鉴别诊断

分析了25例脉络膜黑色素瘤与75例(76眼)脉络膜脱离的超声显象特点。脉络膜黑色素瘤表现为半圆形或圆形、蘑菇形的实质性光团,肿瘤内有挖空现象,近半数有脉络膜凹陷,部分病例有声影。脉络膜脱离表现为1个至数个半球形光带或分叶的环形光带,多位于锯齿缘至赤道部之间,内部无回声,无脉络膜凹陷及声影。     

局灶性脉络膜凹陷临床特征

目的：观察局灶性脉络膜凹陷（FCE）的临床特征。方法：回顾性系列病例研究。收集2016年10月至2017年11月在金华眼科医院就诊的FCE患者12例（22眼）。所有患者行最佳矫正视力、裂隙灯显微镜、间接眼底镜、光学相干断层扫描（OCT）及超广角激光扫描检眼镜等检查，部分患者行荧光素钠眼底血管造影检查。结果：12例患者中，双眼FCE 10例，单眼FCE 2例。22眼中，正视10眼，近视12眼。患眼初诊BCVA（LogMAR）为0～0.5（0.18±0.11）。眼底检查FCE处17 眼表现为大致正常，2眼有不同程度脱色素或黄白色病灶，2 眼黄斑区见盘状水肿，1 眼黄斑区见出血、渗出灶。OCT检查示22 眼均呈单一FCE；16眼（16/22）为偏中心凹型FCE，6眼（6/22）为中心凹下型FCE。2眼（2/22）合并中心性浆液性脉络膜视网膜病变，经治疗后神经上皮层下积液吸收，FCE处无明显改变。1眼（1/22）合并脉络膜新生血管，经多次抗血管内皮生长因子治疗后病情反复。结论：FCE多双眼发病，也可单眼发病；可合并中心性浆液性脉络膜视网膜病变，也可合并脉络膜新生血管，与屈光状态有一定的相关性；视力可正常或不同程度下降；FCE处眼底表现大部分完全正常，当出现合并症时可出现相对应症状。     

Transpupillary Thermotherapy in the Treatment of Choroidal Metastasis from Breast Carcinoma

BACKGROUND: Most patients who develop metastatic carcinoma to the choroid are managed by local radiation or chemotherapy. Since transpupillary thermotherapy (TTT) is currently gaining attention as an optional treatment for choroidal melanomas and hemangiomas, we sought to determine whether TTT is suitable for treatment of solitary choroidal metastasis at the posterior pole. METHOD: We report on a patient with decreased vision due to a serous macular detachment in a eye with a solitary choroidal metastasis from breast carcinoma, who was managed by TTT. RESULTS: After two months of follow up, total re-absorption of the serous macular detachment was achieved and the patient recovered full visual acuity in the treated eye. The choroidal mass became atrophic and hyperpigmentation of the retinal pigment epithelium and retinal folds in the macular region were observed. After six months of TTT, the ocular picture remained unchanged. CONCLUSION: TTT can be considered an acceptable therapeutic option for solitary choroidal metastasis associated with serous retinal detachment.     

Choroidal neovascular membrane in radiation retinopathy

Radiation retinopathy can occur years after the initial radiotherapy of the cancers of head and neck. It generally has a fulminant course, and can cause a variety of severe retinal abnormalities. Choroidal neovascularization has been rarely reported in radiation retinopathy. In this case report, a 21-year-old boy is presented who developed fulminant radiation retinopathy and choroidal neovascular membrane 4 years after receiving radiotherapy for his nasopharyngeal carcinoma.     

视网膜脱离伴脉络膜脱离的临床分析

伴脉络膜脱离的视网膜脱离发病占同期视网膜脱离的４．１５％。分析住院手术１３５眼，总痊愈率为６５．９３％与同期不含脉络脱离的视网膜脱离成功率相比，复位率低且明显差异（Ｐ〈０．０１），将１３５例脉络膜脱离分为花边，半月，球形三型，花边型组手术成功率较高，放视网膜下液有很高的意外率，封闭了裂孔，可以完成环扎术，不放水更有利。对注气要慎重，术前术后要早用、用足激素，同足激素，同时尽早手术以提高成功率。     

Choroidal Analysis of Polypoidal Choroidal Vasculopathy by Spectral Domain Optical Coherence Tomography

 Purpose: This study was designed to measure the changes in the subfoveal choroidal thickness (SFCT) and choroidal maximal vessel diameter (MVD) of the affected and unaffected fellow eyes in patients with polypoidal choroidal vasculopathy (PCV) and compare them to healthy controls. Methods: In this cross-sectional observational clinical study, SFCT and MVD were measured in both eyes of 53 patients with unilateral PCV. PCV eyes were subgrouped into group A and unaffected fellow eyes into group B. All patients were diagnosed with PCV by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). Sixty age- and gender-matched healthy subjects were enrolled in the control group (group C). Results: No statistical difference was observed among groups in age and gender. Overall, SFCT was correlated with MVD in all subjects (P< 0.001; correlation coefficient: 0.759). P values were < 0.001 with a correlation coefficient of 0.686, 0.801, and 0.808 in groups A, B, and C, respectively. No statistical significance was noted in SFCT among groups A (266.45 ± 99.51μm), B (269.57 ± 105.10 μm), and C (243.83± 99.68 μm) (P=0.335). However, the MVD in group A was (202.55 ± 72.45 μm), significantly larger than that in group C (166.45 ± 56.18 μm, P=0.008), while the MVD in group B (194.75 ± 85.27 μm) was equally significantly greater than that in group C (166.45 ± 56.18μm) (P=0.038). Conclusion: For both PCV patients and healthy subjects, SFCT was positively correlated with MVD. No statistical significance was noted in SFCT between PCV eyes and unaffected fellow/ normal eyes. However, MVD was significantly larger in the PCV affected eyes than in unaffected fellow or normal control eyes, suggesting that MVD could be considered as a sensitive indicator to evaluate choroidal perfusion in PCV patients.     

Choroidal Detachment: Clinical Manifestation,Therapy and Mechanism of Formation

One hundred and twelve eyes of 103 patients were analyzed during a 9½-year period after surgical drainage of a choroidal (ciliochoroidal) detachment (CD). Choroidal detachment in five groups of postoperative patients was studied. CD after surgery for cataract, for cataract and glaucoma, and for glaucoma alone had different time courses, but in all of these, there were similar amounts of protein (67% of plasma protein concentration) in the suprachoroidal fluid (SCF). In marked contrast was a group of patients with intraoperative choroidal effusions and very little protein (18% of plasma concentration) in the SCF. Identified also was a chronic recurrent form of CD that usually persisted for more than three months. Three distinct mechanisms by which choroidal effusion is formed were recognized, (1) one with evidence for the effusion occurring through an intact isoporous membrane (groups 1–3) ; (2) a second in which hemorrhagic SCF appeared acutely or subacutely (groups 1 and 2) through a disrupted isoporous membrane; and (3) a third form, an intraoperative choroidal effusion in patients with elevated episcleral venous pressure. Increased filtration rate of serum through an intact choriocapillary membrane caused molecular sieving of serum proteins. Inflammation, infection, cataract formation, and corneal edema were uncommonly encountered. Indications for surgery and recommended surgical technique are outlined in detail.     

原发性房角关闭性疾病患者脉络膜厚度的临床研究

目的:应用频域光学相干断层扫描深度增强成像技术(EDI-OCT)测量并探讨原发性房角关闭性疾病(PACD)患者黄斑区及视盘周围脉络膜厚度的特点及规律,分析脉络膜厚度在PACD发病机制中的作用。方法:前瞻性研究。收集2015-01/2019-12于我院就诊的PACD患者82例155眼,其中可疑原发性房角关闭(PACS)组24例24眼;急性原发性房角关闭(APAC)组28例35眼;慢性原发性房角关闭(CPAC)组30例38眼;原发性闭角型青光眼(PACG)组38例58眼。另收集健康志愿者87例87眼纳入正常对照组。所有研究对象均应用EDI-OCT测量黄斑区及视盘周围脉络膜厚度。结果:PACD各组黄斑区脉络膜厚度均高于正常对照组(P<0.05)。在PACD患者中,除距黄斑中心凹3mm处鼻侧,PACG组黄斑区其余各点位脉络膜厚度均低于PACS组、APAC组、CPAC组(P<0.05)。APAC组黄斑中心凹下脉络膜(357.17±61.49μm)最厚,PACS组(318.04±56.52μm)次之,PACG组最薄(263.55±67.87μm)。除CPAC组,其余各组黄斑中心凹旁1mm处脉络膜厚度均较黄斑中心凹下脉络膜厚度降低(P<0.05)。各组受检者黄斑中心凹旁3mm处脉络膜厚度均低于黄斑中心凹下和黄斑中心凹旁1mm处(P<0.05)。各组受检者视盘周围脉络膜厚度无差异(P>0.05)。结论:PACD患者及正常人黄斑中心凹下脉络膜最厚,离黄斑中心凹越远,脉络膜越薄。黄斑区脉络膜增厚是PACD患者又一特征性解剖结构,可能是诱发青光眼急性发作的重要因素。PACD患者视盘周围脉络膜厚度与正常人相比并无特征性改变。     

Clinical Characteristics of Inflammatory Choroidal Neovascularization in a Chinese Population

Purpose: To describe demographic features and clinical and imaging characteristics of inflammatory choroidal neovascularization (CNV) in a Chinese population.

Methods: A retrospective case review of patients with CNV secondary to uveitis from 2002 to 2013.

Results: A total of 125 patients (150 eyes, 166 CNVs; bifocal CNVs in 16 eyes), 64% of whom were women, were reviewed. The mean age was 35.86 years. The proportions of patients with punctate inner choroidopathy (PIC), multifocal choroiditis (MFC), and Vogt-Koyanagi-Harada (VKH) were 50.4, 22.4, and 8%. All of the cases were classic CNV in fluorocein angiography and type 2 CNV in OCT. The proportion of subfoveal lesions in active CNV (30.09%) was less than that in inactive CNV (60.38%).

Conclusions: PIC, MFC, and VKH were the three primary specific types of uveitis with inflammatory CNV in this study. Inflammatory CNV tended to break though the retinal pigment epithelium and beneath the neurosensory retina. Moreover, inflammatory CNV was usually nonsubfoveal when it occurred.     

Iodine-125 Irradiation of Choroidal Melanoma: Clinical Experience

Twenty-nine patients with choroidal melanomas were treated with iodine-125 seeds in gold scleral plaques. Iodine-125 emits low energy 25 KeV photons which are attenuated by the side and back of the plaques so that the radiation is "directed" towards the choroidal tumor. The anticipated therapeutic benefits of using a low energy isotope and directional applicators have been realized. There has been a marked reduction in ocular complications in the nine medium and 20 large melanomas so treated. Our complication rate was 34% with a mean follow-up of 38 months. This is a lower complication rate, with longer follow-up, and in larger tumors than that reported with the use of cobalt-60, ruthenium-106 or ion beam. Three patients with large tumors and two patients with medium tumors died of metastasis. This compares favorably to results of similarly sized melanomas treated by enucleation.     

Choroidal metastases and choroidal melanomas: comparison of ultrasonographic findings

AIMS—The purpose of the study was to analyse, whether the shape and the height to base ratio in B-scan ultrasonography are appropriate to differentiate choroidal melanomas from metastases.
METHODS—Between 1991 and 1996 16 eyes of 16 patients with choroidal metastases from breast carcinomas and 66 eyes of 66 patients with choroidal melanomas were evaluated ultrasonographically. The diagnosis of choroidal melanoma has been confirmed histologically in all eyes. Irradiated tumours were excluded from the study. Fisher's exact test and χ² test were used for statistical analysis.
RESULTS—Choroidal metastases demonstrated a significantly lower height to base ratio in B-scan (mean 0.18, SD 0.08) than melanomas (mean 0.6 (0.16); p < 0.001). A polygonal tumour surface was significantly more frequent in metastases (13 out of 16 metastases and in six out of 66 melanomas, p < 0.001). A choroidal excavation could be demonstrated in 38 melanomas and in no metastatic tumour (p < 0.001). The reflectivity was significantly higher in metastases than in melanomas.
CONCLUSION—The combined use of height to base ratio and reflectivity enables a highly significant discrimination between choroidal melanomas and metastases from the breast, thus probably constituting appropriate variables for the clinical differentiation.

Keywords: choroidal melanoma; choroidal metastasis; ultrasonography     

脈络膜肿瘤的临床分析

目的 探討脉絡膜腫瘤的診斷及治療方法。方法 回顧分析9例10眼脉絡膜腫瘤的臨床治療及6月-10年随訪资料。結果 脉絡膜轉移癌預后差;黑色素瘤手術治療后随訪5年,無眼外蔓延,視力穩定;血管瘤激光光凝后,視力穩定及增進者占50％。結論 脉絡膜腫瘤的治療方法與腫瘤的性質、部位、大小密切相關。     

Vision Loss from Choroidal and Pituitary Metastases Secondary to Renal Cell Carcinoma: A Case Report

A 62-year-old male with a history of metastatic clear cell renal cell carcinoma (ccRCC) presented with decreased vision to 20/50 in the left eye. Fundus examination revealed an elevated, amelanotic mass lesion in the superotemporal macula, without involvement of the central macula by subretinal fluid or tumour. Given incongruity between the fundus findings and the degree of visual impairment, visual field testing was obtained, revealing a bitemporal hemianopia. Magnetic resonance imaging demonstrated optic chiasm compression by a pituitary mass, which had previously been overlooked on computed tomography imaging. Biopsy confirmed metastatic ccRCC to the pituitary, which presented simultaneously with the presumed choroidal metastasis.     

息肉样脉络膜血管病变的光相干断层扫描

目的 :观察息肉样脉络膜血管病变 (polypoidalchoroidalvasculopathy ,PCV )的光相干断层扫描 (opticalcoherencetomography ,OCT)图像特征。方法 :对比分析常规眼底检查、荧光素眼底血管造影 (fundusfluoresceinangiography ,FFA )及吲哚青绿血管造影 (indocyaninegreenangiography ,ICGA)检查确诊的PCV患者 9例 9眼 (PCV组 )、渗出型老年性黄斑变性 (exudativeage -relatedmaclarde generation ,AMD)引起的浆液性视网膜色素上皮脱离 (retinalpigmentepithelialdetachments ,RPED) 11例 11眼、中心性渗出性脉络膜视网膜病变 (centralexudativechoroidoretinopathy ,CEC)引起RPED 2例 2眼 (浆液性RPED组 )的OCT检查图像资料 ,观察PCV患眼视网膜下结节样病灶特征、RPED隆起高度和基底宽度的相关性。结果 :PCV眼OCT图像表现为RPE和脉络膜毛细血管高反射层呈穹隆状隆起 ,表面不规则 ,边缘陡峭。其下或视网膜色素上皮 (retinalpigmentepithelial ,RPE)光带水平可见结节样改变。 3眼有RPED ,5眼RPED合并神经上皮脱离。RPE隆起高度和基底宽度比率 :PCV组 (0 14 5 1± 0 0 40 0 )较浆液性RPED组 (0 0 876± 0 0 3 2 5 )高 (t =-3 3 2 4,P =0 0 0 4) ,高度和基底宽度呈线形关系 ,且PCV组直线较浆液性PED组