白血病所致视神经浸润的临床观察

目的　探讨白血病所致视神经浸润的临床特点。方法　收集２００６年１月至２０１４年６月于云南省第二人民医院眼科确诊为白血病视神经浸润的２３例患者,排除高血压、糖尿病、颅内高压等造成视神经损伤的全身及局部疾病。根据眼底病变的特征分为两种类型:（１）单纯视盘水肿;（２）视盘水肿合并出血渗出性病变。结果　２３例患者中９例１８眼表现为单纯视盘水肿,眼底彩色照相可见患者视盘水肿,呈不同程度隆起,边界不清楚,严重者高达３～４个屈光度,视盘表面小毛细血管扩张、充血明显。眼底荧光血管造影显示:荧光造影早期视盘表面血管扩张,通透性增加,出现荧光素渗漏,晚期视盘着染呈强荧光。２３例患者中１４例２８眼表现为视盘水肿出血合并视网膜血管异常,眼底彩色照相极似急性视网膜坏死样改变,可见视盘肿胀、苍白,边界模糊,视盘表面及周围视网膜散在点片状出血点;视盘周围视网膜苍白水肿,视网膜动脉呈白线样浸润,静脉迂曲扩张;后极部散在不同程度出血及白色浸润灶,并累及黄斑区。眼底荧光血管造影:视盘表面血管扩张,通透性增加,出现荧光素渗漏,晚期视盘着染呈强荧光,视网膜静脉迂曲扩张、出血区域遮蔽荧光。结论　单纯视盘水肿和视盘水肿合并出血渗出性病变是白血病所致视神经浸润的两种主要表现。眼科临床医师应加强对该病的认识,积极寻求有效的治疗手段。     

感染性眼内炎玻璃体切除术后眼底继发损害的临床观察及病理学分析

目的探讨眼内炎玻璃体切除术后继发性的眼底损害。方法回顾分析2005年-2008年我院眼内炎玻璃体切除术后眼底图像和眼底荧光素造影结果。结果35例（35眼）中19例可见后极部、血管旁黄白色渗出;部分视网膜血管呈白鞘,小血管闭塞呈白线状;视网膜散在小出血点。3例可见增生性玻璃体视网膜病变,荧光素眼底血管造影显示血管迂曲扩张,晚期荧光素渗漏。出血及渗出物较多处呈荧光遮蔽,2例视盘晚期荧光渗漏。视网膜部分血管闭塞,毛细血管结构破坏,荧光素充盈缺损。可见大小不等的无灌注区。结论重视眼内炎术后的继发损害,最大限度保护患者视功能。     

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.     

荧光素眼底血管造影在眼挫伤诊断中的应用

目的分析眼挫伤后荧光素眼底血管造影（FFA）的临床表现。方法对68例（78眼）眼球挫伤行眼底血管荧光造影检查。结果视网膜震荡43眼中33眼FFA表现为视网膜动脉静脉稍迂曲、黄斑区点状透见荧光。10眼FFA表现为低荧光，无荧光渗漏。视网膜出血8眼FFA表现出血区荧光遮蔽。脉络膜裂伤9眼FFA表现为血管下方弧形弱荧光、造影晚期呈高荧光。黄斑孔6眼：其中板层孔4眼，FFA未见异常荧光；全层孔2眼FFA显示为黄斑区圆形透见荧光。视神经挫伤12眼FFA表现视盘毛细血管扩张及渗漏，晚期呈强荧光；其中1眼视盘灌注时间晚于视网膜中央动脉灌注。结论眼底血管荧光造影能及时准确地了解眼球挫伤后损伤部位和程度，为指导临床诊疗提供依据，应作为眼球挫伤的常规检查。     

急性前部葡萄膜炎的眼底荧光血管造影改变

目的探讨急性前部葡萄膜炎患者眼底的变化。方法对急性前部葡萄膜炎患者５４例６１只眼进行眼底荧光血管造影。结果６１只眼中发现６０只眼视盘周围毛细血管扩张，晚期强荧光。其中伴有黄斑区周围毛细血管扩张１８只眼，伴有黄斑区囊样水肿４只眼，伴有视盘边缘血管旁条状出血２只眼。结论９８．３％急性前部葡萄膜炎患者，眼底荧光血管造影均有视网膜和视乳头周围血管的改变。     

视网膜血管炎

患者男,31岁,因双眼视力下降到西安市第四医院眼科就诊。否认全身疾病及家族遗传疾病。眼科检查：双眼矫正视力0.5。眼底检查可见视盘边界欠清,颜色淡红,视网膜血管纡曲扩张。采用200TX欧堡超广角荧光造影仪行荧光素眼底血管造影检查,双眼早期动静脉充盈尚可,视盘毛细血管扩张;中晚期视盘强荧光,视网膜静脉纡曲呈节段样扩张,管...     

Vogt-小柳-原田综合征的眼底荧光血管造影检查

目的：探讨Vogt－小柳－原因综合征（VKH）的荧光素眼底血管造影（FFA）特征。方法：对26例（52只眼），患者的眼部表现及FFA等资料作回顾性分析。结果；全部患者均有双眼视网膜色素上皮（RPE）的多发性渗漏，46只眼形成多囊样荧光素积存的特征性外观，8只眼视盘表面辐射状毛细血管扩张渗漏，6只眼视盘及周围有条状出血遮蔽荧光，视网膜中央血管系统未见受累。结论：VKH的FFA特征为RPE的多发性渗漏，多有囊性荧光素积存的特征性外观。     

埋藏性视盘玻璃膜疣的临床分析

目的 探讨埋藏性视盘玻璃膜疣的临床表现、眼底荧光血管造影(fundus fluores-cein angiography,FFA)和B超特征.方法 回顾性分析2003年3月至2006年7月确诊为埋藏性视盘玻璃膜疣的32例(32眼)患者的临床资料,对其眼底表现、FFA及B超检查结果进行分析讨论,结果眼底表现:3例未见异常,26例可见视盘周围视网膜前或视网膜下出血.3例出现玻璃体腔出血.FFA:26例视盘周围可见视网膜下出血遮蔽荧光;12例早期视盘可见局限性强荧光,晚期边界呈结节状强荧光,余20例未见特异性结节状着色.32例患者B超检查均可见视盘处的不规则扁平隆起病灶,呈类圆形强回声.结论 对于伴有近视合并视盘周围出血的青年患者,采用FFA结合B超检查可提高埋藏性视盘玻璃膜疣的检出率     

成人Coats病一例

患者男,64岁.因左眼渐进性视物不清1年于2012年3月19日来我院就诊.既往体健.家族中无类似疾病者.眼部检查:右眼视力0.8,矫正1.0;左眼视力0.04,不能矫正.裂隙灯显微镜检查双眼眼前节未见异常.直接检眼镜眼底检查结果显示,左眼视盘颜色正常,边界清晰,黄斑部可见环形硬性渗出和水肿,拱环下半毛细血管异常扩张,黄斑中心凹正下方0.5、3.5个视盘直径(DD)处分别可见小动脉瘤样扩张(图1,2);视盘颞上方视网膜下黄白色不规则隆起渗出,约2.0 DD大小,高达2个屈光度,其上及视盘正上方周边部视网膜小血管不规则局部扩张,并可见出血和红色动脉瘤样病灶,部分血管闭塞(图3);其它部位视网膜未见明显异常.右眼眼底未见异常.荧光素眼底血管造影检查结果显示,静脉早期病灶区视网膜毛细血管扩张,不同大小血管瘤呈强荧光,出血及硬性渗出遮蔽荧光;周边部可见约4.0 DD大小毛细血管无灌注区;晚期瘤体及异常血管荧光渗漏着染.视盘颞上方病灶区大片强荧光渗漏(图4～6),黄斑区弥漫性水肿.实验室检查,血胆固醇正常.临床诊断:成人Coats病.建议行激光光凝治疗,但因患者依从性差而未执行.     

眼底无可见视网膜病变糖尿病患者的荧光血管造影

目的探讨糖尿病患者检眼镜下未见到视网膜病变的荧光血管造影表现。方法对常规眼底检查未见到视网膜病变的糖尿病患者进行眼底荧光血管造影。结果荧光血管造影正常44只眼,与眼底所见符合率为35.48%;异常表现共80只眼占64.52%,其表现主要为微血管瘤,视网膜毛细血管扩张和毛细血管无灌注等。结论眼底镜下未发现视网膜病变的糖尿病患者,眼底荧光造影出现了微血管瘤,视网膜毛细血管扩张等改变。     

Venous vascular anomalies within the myelinated retinal nerve fiber area]

We report the case of a 25 year old caucasian female who was presented to our clinic with a four year history of recurrent vitreous hemorrhages, myelinated retinal nerve fibers and ipsilateral anisometropic myopia, astigmatism and amblyopia of her right eye. On fluorescein angiography small, postcapillary venous malformations in the area of myelinization were diagnosed. Vascular anomalies within regions of myelinated retinal nerve fibers have not been described so far. Even if actual leakage itself from the anomalous vessels could not be documented, vitreous hemorrhaging did not recur after successful lasercoagulation and obliteration of the vascular anomalies.     

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)     

Bilateral large peripapillary venous and arterial loops

BACKGROUND: Peripapillary loops of venous origin are extremely rare. CASE: A 55-year-old woman was referred to us for further examination of peripapillary vascular abnormalities. OBSERVATIONS: Fundus examination and fluorescein angiography clearly showed a venous and an arterial peripapillary loop in both her right and left fundi. The venous loop in the right eye was in a large hairpin configuration, extending into the retina about 1 disc diameter from the optic disc. Fluorescein angiography in the left eye revealed slow and irregular filling of dye into a venous loop that showed stasis of the bloodstream through the loop. Various retinal vascular abnormalities, including cilioretinal artery and triple branching of the retinal vein were also observed. CONCLUSION: The findings in this case of bilateral peripapillary venous and arterial loops and unilateral trifurcation of retinal vein suggest that there could be an association in the other retinal abnormalities. Periodic follow-up examinations seem necessary.     

Indocyanine green angiographic findings in acute retinal necrosis

PURPOSE: To clarify indocyanine green (IA) angiographic features in patients with acute retinal necrosis (ARN). METHODS: Two patients with ARN were examined by fluorescein angiography (FA) and IA, and findings from both were compared. RESULTS: Fundus examination revealed widespread retinal hemorrhages and yellowish-white patches in the periphery, characteristic of ARN. In both cases, FA showed diffuse dye leakage from all retinal veins and the optic disc, and vascular obstruction in the peripheral fundus. In IA, dye leakage was localized, and extravasation of dye was evident only from the lower temporal retinal vein and the lower half of the optic disc. This pattern of indocyanine green dye leakage appeared to be continuous from the optic disc toward the lower temporal retinal vein. Also, IA clearly demonstrated choroidal vascular filling delay in one case in the early phase of the angiogram. CONCLUSIONS: While FA showed diffuse dye leakage from all retinal veins, IA identified only the retinal vessels with the most prominent vascular damage. IA also identified choroidal vascular lesions in these patients with ARN. The information obtained by IA might be useful to detect retinal vasculitis with prominent inflammation and to determine the extent of choroidal inflammation in patients with ARN.     

Wide-spread myelinated nerve fibers of the optic disc: do they influence the development of myopia?

Purpose: To find correlations between the extent of myelinated nerve fibers with refraction anomalies. Method: Searching for myelinated nerve fibers in the slide collection of the University Eye Hospital Freiburg we found 13 patients. We distinguished between eyes with wide-spread myelinated nerve fibers located on and around the optic disc which extended to the midperiphery of the retina (6 patients; Group A) and eyes with circumscribed myelinated nerve fibers, localized merely around the optic disc (7 patients, Group B). In Group A myelinated nerve fibers spared the macula area, but were localized very close to the macula. Color fundus photographs were taken by the Zeiss Fundus camera SK50 (30 ° and 50 ° picture size) and by the Olympus Fundus camera GRC-W (same picture size). Results: The myelinated nerve fibers were found to be unilateral in all 13 patients. In all 6 patients of Group A, a strabismus was present. The affected eye had a severe amblyopia and a unilateral myopia (- 5.75 to - 25.0 D.). The nonaffected fellow eye showed a normal visual acuity with no or only a slight refractive error. In the 7 patients of the Group B, no strabismus was present and a normal or a slightly decreased visual acuity of the affected eye was found. No distinct refractive error was present in the affected and non-affected eyes of this group. Conclusions: Myopia only occurred in eyes with wide-spread myelinated nerve fibers but not in eyes with circumscribed myelinated nerve fibers. We assume that myelinated nerve fibers, if wide-spread, cause myopia.     

Parry-Romberg syndrome studied by optical coherence tomography.

A case of Parry-Romberg syndrome that was studied by fluorescein angiography and optical coherence tomography (OCT) is described. OCT revealed the existence of retinal nerve fiber layer edema and abnormalities of the vitreoretinal interface. The presence of diffused retinal edema throughout the papillomacular area and the formation of thick retinal folds with intraretinal diffuse macular edema were also evident. Fluorescein angiography demonstrated optic disc swelling, engorgement of the retinal vessels, and mottling of the pigment epithelium. The retinal nerve fiber layer edema and the hyperreflectivity of the retinal surface indicate abnormalities and thickening of the vitreoretinal interface, as shown on OCT, and may further contribute to the retinal involvement in Parry-Romberg syndrome.     

Vascular shunt of the optic disc resembling neovascularization in a diabetic patient with optic disc drusen

PURPOSE: To report an insulin-dependent diabetic patient who was referred by the diabetic screening clinic as having proliferative diabetic retinopathy who was found to have bilateral optic disc drusen with optociliary shunt resembling neovascularization on the disc. METHODS: Complete ocular evaluation including a fluorescein angiography was performed. RESULTS: Fundus examination showed signs of mild nonproliferative diabetic retinopathy in the right eye and the presence of well-defined optic disc drusen in both eyes with a peculiar vascular abnormality resembling neovascularization on the right disc. The central retinal vein pulsation was normal on digital examination. Autofluorescence confirmed the presence of the optic disc drusen in both eyes. Fluorescein angiography showed no leakage from the optociliary shunt. The vascular abnormality has remained stable for 2 years. CONCLUSIONS: This case highlights the correlation of optic disc drusen and optociliary shunts which in diabetic patients can be misdiagnosed as neovascularization.     

Linear pattern of West Nile virus-associated chorioretinitis is related to retinal nerve fibres organization

PURPOSE: To clarify the reason for the linear pattern of West Nile virus (WNV)-associated chorioretinitis. METHODS: The study included 12 patients (24 eyes) with WNV-associated chorioretinitis. All the patients underwent a complete ophthalmic evaluation, including dilated fundus examination, fundus photography, fluorescein angiography, and indocyanine green angiography. Characteristics of linear streaks, particularly their relationship to the course of retinal and choroidal vessels, and pattern of retinal nerve fibres, were analysed. RESULTS: All patients had bilateral multifocal chorioretinitis with linear clustering of chorioretinal lesions associated with a variable number of scattered lesions. Linear streaks, variable in number and length, originated from the optic disc or its vicinity in most cases. Their course in all cases appeared to closely follow the course of retinal nerve fibres, rather than that of retinal or choroidal vessels. CONCLUSIONS: Results of our study show that the linear pattern of WNV-associated chorioretinitis is related to retinal nerve fibres organization, suggesting a contiguous spread of WNV virus from central nerve system via the optic nerve fibres to the outer retina, retinal pigment epithelium, and choroid.