RPE tears after pegaptanib treatment in age-related macular degeneration

PURPOSE: To describe retinal pigment epithelial (RPE) tears in patients with age-related macular degeneration (AMD) status post pegaptanib (Macugen) injection. METHODS: Six eyes from six patients who developed RPE tears while undergoing treatment with pegaptanib for AMD-related fibrovascular pigment epithelial detachment (PED) and occult choroidal neovascularization (CNV) were identified retrospectively. Diagnosis of pre-pegaptanib fibrovascular PED and post-pegaptanib RPE tears were made by clinical examination, fluorescein angiography (FA), and optical coherence tomography (OCT) imaging of the macula. RESULTS: Four patients developed an RPE tear within 8 weeks after the first pegaptanib injection, while RPE tears were found in two patients following a second injection. Only one of the patients reported acute vision loss, although three of six eyes had a decrease in objective visual acuity in the affected eye to the count fingers level. All six cases displayed the classic clinical and angiographic appearance of RPE tears. In addition, OCT imaging showed an irregular, hyperreflective RPE layer with a focal defect. CONCLUSIONS: RPE tears are known to occur in the setting of PED spontaneously or after laser treatment, but have only recently been described in association with intravitreal pegaptanib. OCT imaging of eyes status post pegaptanib therapy may be helpful in identifying this complication. Patients with AMD, especially those with occult CNV and fibrovascular PED, receiving pegaptanib therapy should be monitored for RPE tears, which may warrant deferral of further injections.     

Optical coherence tomography identification of occult choroidal neovascularization in age-related macular degeneration

PURPOSE: To evaluate and describe the various optical coherence tomography (OCT) features of occult choroidal neovascularization (CNV) in age-related macular degeneration (AMD) at the time of diagnosis. DESIGN: Prospective, consecutive, observational case series. METHODS: One hundred and fifty-three eyes of 130 consecutive patients with subfoveal occult CNV diagnosed on scanning laser ophthalmoscope (SLO) fluorescein angiography (FA) and SLO indocyanine green angiography (ICGA) were evaluated with OCT. The diagnostic criteria for occult CNV on angiography were heterogeneous hyperfluorescence with late leakage in the macular region associated with pigment epithelial detachment (PED), stippled hyperfluorescent dots, and signs of deterioration. OCT findings were evaluated and described. RESULTS: A PED was observed on OCT in 98% (150 eyes) either as a limited retinal pigment epithelium (RPE) elevation (54 eyes [35.3%]) or a complete detachment (96 eyes [62.7%]). Occult CNV corresponded to zones of hyperreflectivity in contact with the RPE band and was detected in 62.7% of eyes. In fibrovascular PED (63 eyes [65.5%]), the elevated RPE was highlighted posteriorly by a moderately reflective band overlying a hyporeflective cavity. In serous PED, the cavity remained optically empty. The RPE in the detached zone showed changes such as fragmentation (137 eyes [89.5%]). OCT also showed intraretinal (122 eyes [79.7%]) and subretinal (64 eyes [41.8%]) fluid. CONCLUSIONS: Analysis of the various OCT features observed in this study confirms the polymorphic nature of occult CNV in AMD, their exudative reactions, the almost constant presence of PED, and the different changes in the RPE band. OCT examination, therefore, provides valuable data to confirm the features of subepithelial occult CNV.     

老年性黄斑变性光学相干断层扫描观察

目的 观察萎缩型，渗出型老年黄斑变性（Age-related macular degeneration AMD）患者的光学相干断层扫描图像特征。比较光学相干断层扫描（Optical Coherence Tomography OCT）和荧光血管造影（Fluorescein angiography FFA）的特点，对脉络膜新生血管（Choroidal neovascularization CNV）进行OCT分型。方法 经FFA确诊的AMD57例76只眼进行OCT检查。结果 AMD患者色素上皮萎缩，软性玻璃膜疣，神经上皮和色素上皮脱离具有特有的OCT特征，OCT图像中视网膜神经上皮增厚、隆起反映视网膜下，视网膜层间积液。神经上皮或色素上皮（Retinal pigment epithelium，RPE）隆起，其下低反射区反映神经上皮或RPE层脱离。CNV的OCT图像分为边界清晰的CNV，边界模糊的CNV，纤维血管性RPE脱离。FFA中的典型性CNV相当于OCT图像中边界清晰CNV，隐匿性CNV相当于OCT图像中边界模糊CNV和纤维血管性RPE脱离。结论 OCT能特征性显示AMD中视网膜神经上皮隆起，视网膜层间积液，出血，神经上皮和RPE的脱离，且显示不同类型CNV的OCT特征。     

Correlation of optical coherence tomography with angiography in retinal pigment epithelial detachment associated with age-related macular degeneration

PURPOSE: To correlate optical coherence tomography (OCT) with angiographic signs of choroidal neovascularization (CNV) in retinal pigment epithelial detachment (PED) associated with age-related macular degeneration (ARMD). METHODS: Prospectively, the authors performed OCT in 35 eyes of 35 patients (30 men and 5 women with a mean age of 71.6 years [range, 56-76 years]) with ARMD. All 35 eyes had CNV in the area of PED or adjacent to it, which was shown by fluorescein or indocyanine green angiography. Cross-sectional images were obtained by the OCT scanning line through the CNV and PED. RESULTS: In 10 (56%) of 18 eyes in which the CNV was at the margin of the PED, a small PED was adjacent to the central, dome-shaped PED. There was a notch between the central and small mounds of PED. In 13 (76%) of 17 eyes in which the CNV was within the PED, a notch was seen in the dome-shaped PED, resulting in a contour with 2 mounds. One of the 2 mounds contained a highly reflective mass immediately beneath the detached retinal pigment epithelium in 8 (62%) of the 13 eyes. CONCLUSION: A tomographic notch in the PED may be diagnostically important as an indication of CNV beneath the detached retinal pigment epithelium in eyes with ARMD.     

Three-dimensional imaging of pigment epithelial detachment in age-related macular degeneration using optical coherence tomography, retinal thickness analysis and topographic angiography

Introduction New diagnostic tools such as the retinal thickness analyzer (RTA), optical coherence tomography (OCT), and topographic angiography (TAG) were introduced into clinical ophthalmology during the last years giving the examiner new insights into anatomical and functional aspects of macular disease. In this study, advantages and disadvantages of the new imaging methods have been evaluated in patients with serous (sPED) and fibrovascular pigment epithelial detachments (fPED) secondary to age-related macular degeneration (AMD).Methods TAG, using fluorescein angiography (FA), provides a three-dimensional profile of the fluorescein pattern based on the analysis of a set of 32 confocal images over a depth of 4 mm. RTA and OCT provide cross-sectional images of the neurosensory retina and the retinal pigment epithelium–choriocapillary complex as well as retinal thickness data encoded in a false color map. We compared and evaluated these modalities in 15 patients with fPED and 15 patients with sPED secondary to AMD.Results In patients with classic fPED, TAG detected neovascular structures and delineated their configuration. In sPEDs, pooling of extravascular fluid was detected in a dome-shaped configuration. OCT provided detailed information on the neurosensory retina’s structures but failed to detect the neovascular membrane in fPED. Mapping the retinal thickness, RTA and OCT both failed to detect the PED and showed typical algorithm error-based patterns.Conclusion TAG OCT and RTA are useful imaging modalities in the evaluation of AMD cases. TAG visualizes the vascular configuration, dynamic perfusion, and leakage changes. OCT and RTA are able to complementarily document intra-, subretinal, and sub-RPE fluid accumulation secondary to CNV. However, OCT seems to be more efficient in imaging AMD-related pathologies than RTA, as this modality is often compromised by intra- or subretinal structural abnormalities. Nevertheless, all modalities may provide further valuable insight into AMD pathogenesis, enhance diagnostic quality, and improve the assessment of therapeutic effects.     

病理性近视黄斑部脉络膜新生血管的OCT和FFA表现

目的分析病理性近视（PM）黄斑部脉络膜新生血管（CNV）的光学相干断层扫描（OCT）和眼底荧光素血管造影（FFA）的图像特征。设计临床病例研究。研究对象23例（25眼）伴有黄斑部CNV的PM患者。方法对上述患眼行OCT和FFA检查，对比分析结果。主要指标黄斑部CNV的OCT和FFA图像。结果OCT检查，18眼（72％）CNV呈纺锤形或类圆形团块状，呈强或中等强度反射，自视网膜色素上皮层向上突出，位于视网膜神经上皮层下；7眼（28％）CNV呈不规则增强紊乱的反射信号，位于视网膜色素上皮层平面。9眼伴视网膜色素上皮出血性脱离，6眼伴视网膜前膜形成，2眼伴黄斑裂孔形成，15眼伴不同程度的视网膜增厚和水肿。FFA检查中有19眼显示造影早期黄斑部的盘状或不规则荧光渗漏，6眼仅显示病灶处荧光遮蔽和／或透见荧光。结论PM黄斑部CNV的OCT图像以在色素上皮层增生的类圆形和纺锤形纤维血管膜为特征，其范围较局限，常伴有色素上皮层出血性脱离。     

老年色素上皮脱离的随访观察

目的 探讨老年色素上皮脱离的最终结局及其影响因素。方法 用眼底荧光血管造影和／或吲哚青绿血管造影对１０例ＰＥＤ进行了追踪随访，平均随访时间３４个月。结果 ７例老年ＰＥＤ在随访过程中并发了脉络膜新生血管，ＰＥＤ范围均≥１ＰＤ，其中６例年龄〉５５岁，ＩＣＧＡ能比ＦＦＡ更清晰的并发ＣＮＶ；３例ＰＥＤ变平伏，其中３眼ＰＥＤ范围〈１ＰＤ。     

Alterations of retinal pigment epithelium in central serous chorioretinopathy

BACKGROUND: To examine with en face optical coherence tomography (OCT) the alterations of retinal pigment epithelium (RPE) in central serous chorioretinopathy (CSC) and their role in the pathophysiology of CSC. METHODS: We examined retrospectively 30 consecutive eyes of 30 patients with various phases of CSC. All patients underwent fluorescein angiography, indocyanine green angiography, and en face and longitudinal OCT examinations. RESULTS: Of 25 eyes with acute CSC, en face OCT showed RPE abnormalities in 22 eyes (88%) with pigment epithelial detachment (PED) in nine eyes (36%) and a small bulge of RPE in the posterior pole in 15 eyes (60%). Of four eyes with chronic CSC, OCT showed PED in one eye (25%) and a small bulge of RPE in other three eyes (75%). Of 29 eyes with acute or chronic CSC, fluorescein angiography showed characteristic pinpoint leakage in 20 eyes (69%). Of these 20 eyes, a leaking point was located within PEDs in five eyes (25%) and was consistent with the bulge of RPE in nine eyes (45%). With indocyanine green angiography, 28 (97%) eyes showed choroidal vascular hyperpermeability. Ten of the 11 eyes with PED (91%) showed PED within the areas of choroidal vascular hyperpermeability. Sixteen of the 18 eyes with a bulge of RPE (89%) showed the bulge within areas of choroidal vascular hyperpermeability. The one eye in the quiescent CSC exhibited multiple small PEDs within the areas of choroidal vascular hyperpermeability by en face OCT. CONCLUSIONS: En face OCT enables us to detect alterations of RPE in eyes with CSC. Most alterations of RPE were associated with choroidal abnormalities.     

Clinical features of drusenoid pigment epithelial detachment in age related macular degeneration

AIM: To analyse clinical features of drusenoid pigment epithelium detachment (PED) in age related macular degeneration. METHODS: 61 eyes of 32 patients with untreated drusenoid PED were followed for an average of 4.6 years (range 1-17 years). Drusenoid PED was defined as (1/2) disc diameter (DD) of confluent soft drusen under the centre of the macula. All patients underwent visual acuity measurement, biomicroscopic fundus examination, stereoscopic colour photograph, and fluorescein and indocyanine green angiography. Optical coherence tomography was performed in selected cases at the last examination. Kaplan Meier survival analysis was performed to estimate the probability of complications. RESULTS: Three different natural outcomes were identified: persistence of drusenoid PED (38%), development of geographic atrophy (49%), and choroidal neovascularisation (CNV) (13%). Based on Kaplan Meier survival analysis, drusenoid PED had a 50% of chance of developing geographic atrophy after 7 years. If the drusenoid PED was greater than 2 DD or was associated with metamorphopsia at initial presentation, progression to atrophy or ingrowth of CNV occurred after 2 years (p<0.01). Indocyanine green angiography confirmed fluorescein angiographic features or ascertained the presence of CNV when fluorescein angiography was equivocal. Optical coherence tomography was helpful in distinguishing coalescent soft drusen from drusenoid PED and disclosed the accumulation of sub or intraretinal fluid in eyes with CNV. CONCLUSION: Drusenoid PED size greater than 2 DD and metamorphopsia were risk factors identified at presentation which affected prognosis. The evaluation of the eyes at risk requires the use of all imaging means in order to ascertain the diagnosis of CNV. At long term (over 10 years), geographic atrophy and CNV had occurred in 75% and 25% respectively, with a poor visual outcome.     

Evolution of retinal pigment epithelium detachment after photodynamic therapy for choroidal neovascularization in age-related macular degeneration

PURPOSE: To report a case of pigment epithelium detachment (PED) which appeared after photodynamic therapy (PDT) and was followed up for 50 months. METHODS: Case report. RESULTS: A 71-year-old woman with occult choroidal neovascular membrane due to age-related macular degeneration (ARMD) developed PED 48 hours after PDT. The patient was studied with fluorescein angiography (FA) and optical coherence tomography (OCT). Fluorescein angiographic evidence of PED remained essentially unchanged during the follow-up period of 50 months. Although OCT initially gave clear evidence of PED, in the last 12 months of follow-up the PED appears to have resolved. CONCLUSIONS: Photodynamic treatment could be involved in the occurrence of PED in occult choroidal neovascular membrane due to ARMD. In this particular case OCT could be considered since it offers useful information in the pretreatment and the post-treatment follow-up period.     

Optical coherence tomography in the assessment of retinal pigment epithelial tear

PURPOSE: To study the findings of optical coherence tomography (OCT) in retinal pigment epithelial (RPE) tears. METHODS: Sixteen eyes of 16 consecutive patients with age-related macular degeneration complicated by RPE tear were studied using OCT. Fluorescein angiography also was performed. Thirteen eyes were at the acute stage and three eyes were at the scarring stage, still with a recognizable tear. RESULTS: Optical coherence tomography identified an RPE detachment (PED) with focal interruption of the RPE in all cases. Optical coherence tomography always highlighted a peculiar non-dome-shaped profile of the serous PED, as opposed to that of the PED not complicated by an RPE tear. A very intense hyperreflectivity was observed in the OCT scans performed through the retracted RPE. A deep hyperreflectivity under the line corresponding to the RPE was evident in the area of the bare choroid. No choroidal neovascularization could be visualized using OCT, either at the acute or at the scarring stages. CONCLUSIONS: Optical coherence tomography, a noncontact, noninvasive imaging technique, may be a useful tool, complementary to fluorescein angiography, in the clinical assessment of RPE tears.     

Evaluation of cases of polypoidal choroidal vasculopathy showing classic choroidal neovascularization in their natural course

BACKGROUND: Some cases of polypoidal choroidal vasculopathy (PCV) in their natural course develop into classic choroidal neovascularization(CNV) as shown by fluorescein angiography (FA) findings. SUBJECTS AND METHOD: We evaluated 8 eyes of 8 PCV patients showing classic CNV by FA findings, using indocyanine green angiography (IA) and optical coherence tomography(OCT). RESULT: All patients showed subretinal grayish exudates, which were considered fibrinous. Five cases were recognized as true subretinal CNV according to IA and OCT findings. The other 3 patients showed polypoidal dilatation with vascular networks by IA, and a moderately reflective mass considered fibrinous over the polypoidal elevation of retinal pigment epithelium (RPE) by OCT. CONCLUSION: Both true CNV and PCV with fibrin are present in PCV patients showing classic CNV. It requires care to determine proper treatment.     

The nature and frequency of neovascular age-related macular degeneration

PURPOSE: This study was designed to evaluate the frequency and nature of neovascularization in age-related macular degeneration (ARMD) utilizing the combination of digital imaging techniques, fluorescein angiography (FA), indocyanine green (ICG) angiography, and optical coherence tomography (OCT). METHODS: A complete clinical examination was performed on 100 eyes of 93 consecutive newly diagnosed patients with neovascular ARMD. Digital fluorescein angiography, ICG angiography, and OCT were also used in evaluating those patients. Comparison of the imaging techniques to determine their value in studying the nature of the lesions. RESULTS: On the basis of existing fluorescein standards, 15 eyes were diagnosed with classic choroidal neovascularization (CNV), 15 with minimally classic CNV, and 70 with occult CNV. ICG angiography was superior for detecting the active vascular component in polypoidal CNV (16 eyes) and retinal angiomatous proliferation (14 eyes). OCT was more sensitive than FA for determining the presence of cystoid macular edema evident in the vast majority of eyes with retinal angiomatous proliferation (RAP). CONCLUSIONS: These results suggest that FA, ICG angiography, and OCT, when used in combination, will assist clinicians in best determining the precise nature of the neovascular process in ARMD.     

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。     

Detachment of subfoveal choroidal neovascularization in age-related macular degeneration

PURPOSE: To report the entity of partial detachment and folding of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). DESIGN: Interventional case reports. METHODS: Review of the features of CNV detachment in two patients with CNV due to ARMD by contact lens slit-lamp biomicroscopy, fluorescein angiography, optical coherence tomography, and three-dimensional confocal scanning laser indocyanine green (ICG) angiography. RESULTS: One patient out of approximately 300 (0.5%) ARMD patients treated by photodynamic therapy (PDT) developed partial CNV detachment and folding 6 weeks after the second PDT treatment. Another patient out of approximately 100 (1.0%) ARMD patients treated by transpupillary thermotherapy (TTT) developed partial CNV detachment and folding 6 weeks after the second TTT treatment. The CNVs were large (2,500 microm to 4,500 microm) and located between the retina and the retinal pigment epithelium. In each, these findings were clearly visualized by slit-lamp biomicroscopy. Fluorescein angiography demonstrated an associated retinal pigment epithelium tear in one patient. Optical coherence tomography showed distinctive features and confocal scanning laser ICG further delineated the detached folded CNV. The best-corrected visual acuity improved in one patient from 20/80 to 20/40 and in the other from counting fingers at 6 feet to 20/200 after the CNV detachment. CONCLUSIONS: Partial CNV detachment and folding represent a unique, not previously reported, and possibly favorable outcome of PDT and TTT. The low energy and selectivity of these treatments may explain this phenomenon.     

引起黄斑下脉络膜新生血管的几种常见疾病的 光相干断层扫描图像特征分析

目的观察引起黄斑下脉络膜新生血管(CNV)的几种常见疾病的光相干断层扫描（OCT）图像特征并对其分类，为CNV的鉴别诊断和治疗提供依据。方法回顾分析经常规眼底检查以及荧光素眼底血管造影（FFA）检查确诊的老年性黄斑变性(AMD)、病理性近视、中心性渗出性脉络膜视网膜炎(CEC)和特发性脉络膜新生血管(ICNV)患者165例187只眼的OCT检查资料，结合FFA检查结果对OCT图像进行分类并总结分析各类图像特征。结果可确定边界的CNV 60只眼，表现为边界清楚的视网膜色素上皮(RPE)层和脉络膜毛细血管层的梭形增厚；不易确定边界的CNV 101只眼，表现为弥散的脉络膜反向散射增强；浆液性RPE脱离19只眼，表现为RPE下的光学暗区；出血性RPE脱离11只眼，表现为RPE下的高反向散射区域，迅速衰减；纤维血管性RPE脱离10只眼，表现为RPE和脉络膜之间的轻至中度无反向散射区；神经上皮脱离45只眼，表现为神经上皮层与RPE分离，其间为光学暗区。结论引起黄斑下CNV的几种常见疾病的OCT图像可以分为6类，分析OCT的图像特征有助于CNV的鉴别诊断与治疗。(中华眼底病杂志,2005,21:69-73)      

渗出性老年黄斑变性的光学相干断层扫描

目的 观察渗出性老年黄斑变性黄斑部新生血管膜的形态改变。方法 对42例49眼渗出性老年黄斑变性的黄斑部进行光学相干断层扫描和荧光造影检查,并对二者的结果进行比较。结果 渗出性老年黄斑变性黄斑部光学相干断层扫描图像显示黄斑部新生血管膜有4种表现,即边界清晰的新生血管膜21眼（42.8％）。边界不清的新生血管膜15眼（30.6％）。纤维血管性色素上皮脱离6眼（12.3％）和出血性色素上皮脱离7眼（14.4％）;与荧光造影比较显示边界清晰的新生血管膜和纤维色素上皮脱离多表现为典型的新生血管膜,边界不清的新牛血管膜和出血性色素上皮脱离多表现为隐匿性新生血管膜。结论 光学相干断层扫描能够确定脉络膜新生血管膜的形态,并对脉络膜新生血管膜的层次和边界进行定位。     

Neovascular ingrowth site photothrombosis in choroidal neovascularization associated with retinal pigment epithelial detachment

PURPOSE: To describe the clinical, angiographic and optical coherence tomography (OCT) findings of patients with choroidal neovascularization (CNV) associated with retinal pigment epithelial detachment (PED) who were treated by neovascular ingrowth site photothrombosis. METHODS: Interventional case reports. After identification of the CNV feeder vessels, two patients had focal photothrombosis of the neovascular ingrowth site using continuous 810-nm laser application after intravenous indocyanine green (ICG) injection and were prospectively followed with fluorescein and ICG angiography as well as OCT. RESULTS: Both patients presented an increase of 3 or more ETDRS lines in visual acuity by 12 months of follow-up. Fluorescein and ICG angiography demonstrated reduced lesion perfusion and regression of the PEDs; accordingly, OCT disclosed decrease in retinal thickness and elevation caused by rapid fluid resolution. There were no significant complications related to the procedure. CONCLUSION: Photothrombosis using 810-nm light to direct laser energy continuously at the neovascular ingrowth site after intravenous ICG infusion is effective in restoring macular architecture and improving vision in patients with CNV complicated by PEDs by means of substantial decrease in the lesion perfusion and resolution of exudative manifestations.     

眼底血管造影和OCT结合对CEC脉络膜新生血管分型的评估

目的应用荧光素眼底血管造影（FFA）、吲哚青绿血管造影（ICGA）和光学相干断层扫描（OCT）3种影像检查评估中心性渗出性脉络膜视网膜病变（CEC）脉络膜新生血管（CNV）的分型和性质。方法采用FFA、ICGA和Strastus-TM型OCT仪3种检查观察并相互印证53例（56眼）CEC患者的CNV的形态及类型。结果FFA图像显示,典型性CNV25眼（44.64%）,部分典型性CNV11眼（19.64%）;隐匿性CNV2眼（3.57%）,其中纤维血管性色素上皮脱离型（F-PED）1眼,晚期无源性渗漏1眼,CNV瘢痕化13眼（23.21%）。ICGA图像显示,19眼（33.93%）在ICGA与FFA早期同时显示CNV,7眼（12.5%）FFA为非典型性CNV,ICGA表现为焦点状或边界清晰的斑状,1眼ICGA早期显示病灶周围及后极部伴有限局性脉络膜血管扩张,10眼（17.85%）在ICGA晚期显示弱荧光环;CNV瘢痕化9眼（16.07%）。OCT显示,21眼（37.5%）CNV呈类圆形团块位于视网膜神经上皮下间隙;22眼（39.29%）的CNV呈纺锤形或不规则形位于色素上皮层平面;1眼（4.76%）为不规则、松散、边界不清的中等或高光反射组织;9眼（19.64%）色素上皮完整、连续,其下中等强度反射,局部视网膜隆起或不隆起。33眼伴有浆液性神经上皮脱离;2眼伴有出血性色素上皮脱离。结论采用眼底血管造影和OCT相结合评判CNV的状况可以明确病情,提供治疗的依据。     

蝶形视网膜色素上皮营养不良患者的多模式眼底影像学特征

目的:探讨蝶形视网膜色素上皮营养不良(BPD)患者的多模式眼底影像特征。方法:回顾分析2016-01/2019-07经多模式影像检查确诊BPD的患者18例36眼的眼底彩照、红外照相、自发荧光、荧光造影、脉络膜造影、光学相干断层扫描(OCT)及眼底血流成像OCT(OCTA)等多模式眼底影像检查。结果:典型的眼底彩色照相可显示色素异常沉着而呈现的蝶翅样病变外观,病变进展后蝶形外观不明显,而相应区域萎缩;红外照相显示BPD患者的眼底黄色病灶,表现为白色高亮影像;自发荧光可有斑片状、点状所勾勒的蝶翅表现,也可有以上特征重叠的表现,当病变进展萎缩明显时,自发荧光不能显示典型的蝶形改变,但可以反映出色素上皮细胞的破坏程度范围;眼底荧光血管造影和脉络膜造影除了显示蝶形病变外,能更为精准地显示血管病变情况,尤其是脉络膜新生血管(CNV)的检查;OCT显示病变位于视网膜色素上皮(RPE)之上与光感受器之间。随病变进展,色素上皮表现相应扩大的损伤,继发CNV者可见突破RPE的高反射信号;OCTA显示病变对视网膜深层和浅层损伤不明显,但脉络膜血流信号不同程度丢失,可敏感检出CNV的血流影像。结论:多模式眼底...