三种不同造影方式在糖尿病性视网膜病变诊断中的应用对比

目的：比较分析虹膜荧光血管造影(iris fluorescein angiography,IFA)联合眼底荧光血管造影(fundus fluorescein angiography,FFA)、吲哚菁绿血管造影(indocyanine green angiogrsphy,ICGA)和FFA在早期糖尿病性视网膜病变(diabetic retinitis,DR)中的诊断价值。

方法：选择2015-08/2016-08期间我院收治的DR患者70例136眼,全部患者分别接受ICGA、FFA、IFA+FFA检查,分析三种造影方式的检出结果。

结果：FFA检出病变120眼(88.2%),ICGA检出病变124眼(91.2%),IFA+FFA检出病变130眼(95.6%),三种检查方法病变检出率比较,差异无统计学意义(P>0.05); FFA检出48眼出现新生血管,18眼玻璃体积血,38眼黄斑水肿,16眼无灌注区; ICGA检出49眼新生血管,38眼黄斑水肿,17眼玻璃体积血,20眼无灌注区; IFA+FFA检出17眼增殖性糖尿病性虹膜病变(DI),22眼非增殖性DI,5眼NVG,92眼无DI。

结论：在DR诊断中,IFA+FFA、FFA、ICGA均具有不错的诊断价值,但IFA+FFA可及时发现合并的糖尿病虹膜病变,为及时治疗提供帮助。     

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.     

伴有虹膜新生血管的增殖性糖尿病视网膜病变手术治疗预后观察

目的 探讨伴有虹膜新生血管的增殖性糖尿病视网膜病变玻璃体手术治疗预后.方法 回顾性总结2002～2006年因增殖性糖尿病视网膜病变接受玻璃体手术治疗的住院病例,选择其中随访1月以上的病例入选,对术前伴有虹膜新生血管(INV)的患者记录其临床病程、糖尿病分型、年龄、性别、术前与术后视力、晶体状况、手术方式、PRP情况、以及治疗前后眼压和INV变化情况等并进行总结.结果 其中随访1月以上的病例242例288只眼,最长随访时间60个月.患者年龄(20～76)岁,平均年龄(53.5±10.4)岁.在入选的242例患者288只眼中,有8例8只眼术前发现INV,其中4只眼发展为新生血管性青光眼(NVG).在玻璃体手术联合眼内光凝术后,INV均有不同程度减退,大多发生在术后2周内.其中7例INV消失,1例随访期内未见INV消失.在随访期间,4例NVG患者眼压均药物控制(<21 mmHg).随访期间,5例患者术后视力较术前提高,2例视力不变,1例视力下降,所有病例术后视力均在0.02以上.结论 及时的玻璃体手术联合眼内光凝有可能促进糖尿病性INV的消退,并使NVG的眼压得以控制.     

虹膜荧光血管造影联合眼底荧光血管造影在全视网膜激光光凝术后糖尿病视网膜病变患者中的应用研究

目的　探讨虹膜荧光血管造影（ｉｒｉｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＩＦＡ）联合眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）检查在全视网膜激光光凝术后（ｐａｎｒｅｔｉｎａｌｐｈｏ-ｔｏｃｏａｇｕｌａｔｉｏｎ,ＰＲＰ）增生型糖尿病视网膜病变患者中的临床应用。方法　对ＰＲＰ术后的６５例１２３眼增生型糖尿病视网膜病变患者均行视力、眼压、裂隙灯、ＩＦＡ联合ＦＦＡ检查。采用非参数检验法对比分析裂隙灯和ＩＦＡ检测虹膜新生血管灵敏性的差异。结果　ＦＦＡ显示１２３眼中,２１眼视网膜无灌注区,３９眼视网膜新生血管,１２眼玻璃体积血和３２眼黄斑水肿。ＩＦＡ显示１２３眼中,９７眼无糖尿病虹膜病变,１３眼非增生型虹膜病变,１１眼增生型虹膜病变,２眼新生血管性青光眼。所有非增生型虹膜病变眼不能被裂隙灯发现,能被ＩＦＡ检测。ＩＦＡ检查发现虹膜新生血管眼（１１眼）比裂隙灯检查（５眼）更灵敏（Ｐ＝０．０３）。结论　ＩＦＡ联合ＦＦＡ检查能及早发现ＰＲＰ术后的增生型糖尿病视网膜病变合并糖尿病虹膜病变患者,为及时治疗提供帮助。     

玻璃体内注射Avastin联合睫状体光凝治疗虹膜新生血管性青光眼的疗效分析

目的 观察玻璃体内注射Avastin联合睫状体光凝对虹膜新生血管性青光眼的疗效及安全性.方法 24例(30眼)虹膜新生血管性青光眼患者分别继发于糖尿病视网膜病变(7例12眼)和视网膜中央静脉阻塞(17例18眼),给予玻璃体内注射25 g·L-1 Avastin 0.05 mL,并联合睫状体光凝治疗.术后随访6个月,观察术后眼压、视力、虹膜新生血管及并发症情况.结果 所有术眼虹膜新生血管均在注射Avastin后3 d内消退;1例1眼患者在全视网膜光凝过程中虹膜新生血管复发,再次注入Avastin,完成光凝后加行周边视网膜冷凝,虹膜新生血管消退.光凝后3 d平均眼压为(21.8±5.8)mmHg(1 kPa=7.5mm-Hg).1周为(18.4±2.3)mmHg,6个月眼压为(17.1±1.1)mmHg,与治疗前(51.2±7.3)mmHg相比,差异均有统计学意义(均为P<0.05).治疗前后视力差异无统计学意义.随访期间仅2眼视力有改善,其余视力无明显提高.随访期间未发现玻璃体出血、视网膜脱离和眼内炎、并发性白内障等并发症发生.结论 玻璃体内注射Avastin可明显消退虹膜新生血管,联合睫状体光凝控制眼压.对治疗虹膜新生血管性青光眼是一种安全有效的方法.     

钕-YAG激光晶体后囊切开术后的新生血管性青光眼

新生血管性青光眼是糖尿病的一种严重并发症。有增殖性糖尿病视网膜病变时,晶体摘出术后并发虹膜新生血管(虹膜红变)的发生率增加。一些著者发现:(1)非增殖性糖尿病视网膜病变行白内障囊内摘出术后虹膜新生血管和新生血管性青光眼发生率增高。(2)行白内障囊外摘出术保留完整后囊膜的糖尿病人比行囊内摘出或囊外摘出合并囊膜切开术的病人新生血管性青光     

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。     

超广角眼底荧光血管造影对糖尿病视网膜病变的诊断价值

目的：分析超广角眼底荧光血管造影(UWFA)对糖尿病视网膜病变(DR)的诊断价值。

方法：对2016-10/2018-06在西安市第三医院就诊的DR患者45例90眼进行回顾性分析。其中男25例,女20例,年龄45～76(平均59.52±15.78)岁。所有患者均经直接或间接检眼镜以及UWFA检查。

结果：依据检眼镜检查,在12眼内未见DR,42眼诊断为非增殖性糖尿病视网膜病变(NPDR),36眼诊断为增殖性糖尿病视网膜病变(PDR)。在90眼中,22眼接受视网膜激光光凝治疗,其中8眼接受过广泛视网膜激光光凝(PRP)。依据UWFA检查,12只无DR的眼中有8眼(67%)存在视网膜微动脉瘤,42只诊断为NPDR眼中有4眼(10%)被发现视网膜新生血管(RNV)及血管渗漏,36只诊断为PDR的眼中仍有12眼(33%)存在周边RNV。在诊断为NPDR和PDR的眼中,分别有28眼(67%)和26眼(72%)存在周边视网膜无灌注区。另外,在8只已接受广泛视网膜激光光凝的眼中有4眼(50%)仍有周边RNV及无灌注区。

结论：UWFA能够更全面地对糖尿病患者的周边视网膜进行检查,有助于发现常规影像学检查难于察觉的周边部糖尿病视网膜病变,尤其利于对视网膜激光光凝后的DR患者病情的随访观察。     

不同分期糖尿病视网膜病变患者外周血中AT-Ⅲ、PAI、t-PA变化的研究

目的：寻找糖尿病视网膜病变不同分期与血管内皮功能的相关因子之间的内在联系,从改善血管内皮功能方面为寻找延缓甚至抑制DR的发生或进展的方法提供理论依据。

方法：收集2015-03/12在本院眼科及内分泌科住院的2型糖尿病患者178例及健康对照组62例的血样标本; 根据眼底血管荧光造影(FFA)结果糖尿病组患者可分为无视网膜病变组、非增殖性视网膜病变组、增殖性视网膜病变组; 检测血样标本中抗凝血酶Ⅲ(AT-Ⅲ)、纤溶酶原激活抑制物(PAI)、组织型纤溶酶原激活剂(t-PA)指标与糖尿病视网膜病变分期的相关性。

结果：本研究表明无糖尿病视网膜病变组、非增殖期糖尿病视网膜病变组、增殖期糖尿病视网膜病变组及对照组 AT-Ⅲ比较,差异具有统计学意义(F=5.986,P<0.01); 无糖尿病视网膜病变组、非增殖期糖尿病视网膜病变组、增殖期糖尿病视网膜病变组、对照组PAI 比较,差异具有统计学意义(F=7.434,P<0.01); 无糖尿病视网膜病变组、非增殖期糖尿病视网膜病变组、增殖期糖尿病视网膜病变组及对照组t-PA比较,差异无统计学意义(F=2.556,P>0.05)。糖尿病视网膜病变的程度与AT-Ⅲ、PAI的含量有着密切的关系。

结论：糖尿病视网膜病变发生程度与抗凝血酶Ⅲ、纤溶酶原激活抑制物的含量有着密切的关系,与血管内皮功能也有着密不可分的联系。     

氩激光视网膜光凝治疗增殖型糖尿病视网膜病变的疗效

对增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者270例363眼氩激光视网膜光凝疗效进行分析。光凝后新生血管消退、未再玻璃体出血者占63.6%，其中视网膜新生血管与视盘新生血管、视网膜新生血管合并视盘新生血管间疗效差异均非常显著(P<0.01)；单纯新生血管与新生血管合并玻璃体出血行间疗效差异非常显著(P<0.01)。表明氩激光视网膜光凝治疗增殖性糖尿病视网膜病变的疗效与新生血管的存在部位及是否合并玻璃体出血有关。 （中华眼底病杂志，1995，11：227-228）     

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.     

三联手术治疗伴虹膜新生血管的晚期青光眼临床疗效

目的评价三联手术治疗伴虹膜新生血管的晚期青光眼手术特点、手术时机及效果。方法36例（41眼）晚期青光眼合并虹膜新生血管采用虹膜热凝＋虹膜切开＋小梁切除术,观察视力、眼压、滤过泡、前房、虹膜新生血管、手术并发症和手术成功率。结果36例（41眼）手术成功40眼（97．56％）,术前有视力者术后视力均有提高,术后39眼虹膜血管新生消退,术后前房积血发生率7．31％,2—5d内吸收,无严重并发症发生。结论晚期青光眼合并虹膜新生血管实施局部虹膜热凝＋虹膜切开＋小梁切除术是一种安全有效的方法,晚期青光眼合并新生血管应积极采用手术治疗,以避免视功能的进一步损害。     

Intracameral Avastin dramatically resolves iris neovascularization and reverses neovascular glaucoma

PURPOSE: To report the biologic effect of intracameral bevacizumab in patients with iris neovascularization secondary to proliferative retinal vasculopathies. METHODS: Sixteen eyes of 15 patients with iris neovascularization associated with or without neovascular glaucoma secondary to proliferative retinal vasculopathies received intracameral bevacizumab (1.25 mg). Ophthalmic evaluations included Snellen visual acuity (VA), complete ophthalmic iris angiography, and slit lamp photography. Main outcome measure was change in degree of iris neovascularization. Secondary outcomes included fluorescein iris angiographic leakage, control of intraocular pressure, and changes in VA. RESULTS: All patients with neovascularization demonstrated by slit lamp photography and fluorescein angiography (16/16 eyes) had complete (or at least partial) reduction in leakage of the neovascularization within 3 weeks after the injection. Leakage from iris neovascularization resolved in 12 of 16 (75%) eyes. In two cases recurrent leakage was seen as early as 4 weeks necessitating repeat injection. Intraocular pressure was controlled with maximum medical therapy in eight of nine eyes reducing the need for glaucoma surgery. Visual acuity improved from a median of hand motions to 20/200. CONCLUSIONS: In summary, intracameral bevacizumab was effective in reversing iris neovascularization in the majority of patients. It also facilitated intraocular pressure control in patients with associated glaucoma.     

玻璃体内注射抗血管内皮生长因子单克隆抗体bevacizumab联合超全视网膜激光光凝治疗高危型糖尿病视网膜病变

观察玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab（商品名Avastin）联合超全视网膜激光光凝（E-PRP）治疗高危型增生型糖尿病视网膜病变(PDR）的临床疗效。方法　对临床确诊的高危型PDR患者53例57只眼进行玻璃体腔注射bevacizumab（IVB）联合E-PRP治疗。所有患者治疗前后均常规进行视力、眼压、荧光素虹膜血管造影（IFA）以及荧光素眼底血管造影(FFA)检查、眼底照相。对比观察治疗前及治疗后视力、眼压、虹膜以及视网膜新生血管的消退情况。平均随访时间6个月。结果　IVB 治疗前平均视力（0.143±0.072）,治疗后7 d平均视力（0.218±0.128）,与治疗前相比差异有统计学意义（t=-7.940,P＜0.05）。E-PRP治疗后1、3、6个月平均视力分别（0.228±0.138、0.223±0.125、0.220±0.134）,与IVB前比较,差异均有统计学意义（P＜0.05）;与IVB后比较,差异无统计学意义（P＞0.05）。57只眼中有21只眼瞳孔缘及虹膜有新生血管者,IVB治疗前平均眼压(26.632±2.629) mm Hg(1 mm Hg=0.133 kPa),治疗后7 d平均眼压(19.316±3.092) mm Hg,与治疗前比较,差异均具有统计学意义（t=12.838,P＜0.05）。E-PRP治疗后1、3、6 个月,眼压平均分别［(16.947±2.345)、(16.474±1.611)、(16.421±4.702)］ mm Hg与IVB前、后比较,差异均具有统计学意义(P＜0.05)。IVB治疗后7 d,57只眼视盘及视网膜新生血管部分消退,血管渗漏明显减少或消失。其中瞳孔缘、虹膜表面新生血管者21只眼,新生血管消失,IFA检查结果显示渗漏明显减少。E-PRP 治疗后2个月FFA检查结果显示,一次E-PRP有效率为68.4%,需追加激光者21.1%;其中10.5%未能控制病情行玻璃体手术。结论　IVB辅助E-PRP治疗高危PDR,可促使虹膜、视网膜新生血管迅速消退,减轻血管渗漏,阻止或预防并发症发生,高治疗效果。      

Regression of iris neovascularization after intravitreal injection of bevacizumab in patients with proliferative diabetic retinopathy

PURPOSE: To assess the short-term safety and efficacy of intravitreal injection of bevacizumab for iris neovascularization (INV). DESIGN: Noncomparative, interventional case series. METHODS: Intravitreal bevacizumab was injected in seven eyes of five patients with INV that was associated with proliferative diabetic retinopathy (PDR). The main outcome measurements were visual acuity, intraocular pressure (IOP), and regression of INV by fluorescein angiography before and one week, one month, and two months after injection. RESULTS: Regression of INV was confirmed in all eyes (100%) from one week after injection. Repeated injections stabilized the recurrence (two eyes; 29%) that was observed two months after the initial injection. The visual acuity remained stable or improved, and the intraocular pressure was controlled in six eyes (86%) throughout the follow-up period. No inflammation or complications were observed. CONCLUSIONS: Intravitreal injection of bevacizumab may be an effective and safe alternative for patients with INV that is refractory to conventional treatments.     

虹膜荧光素血管造影对具有棕色虹膜的中国人前葡萄膜炎的诊断价值

背景 前葡萄膜炎的炎症性损伤与血-房水屏障的破坏有关,裂隙灯下对其病情的检查有一定的限制,而荧光素血管造影能客观显示病情的变化.但目前国内对虹膜荧光素血管造影(IFA)的应用研究较少.目的 观察中国人棕色虹膜葡萄膜炎患者IFA图像,探讨IFA在葡萄膜炎诊断和治疗中的临床应用价值.方法 对正常中国人40人40眼和前葡萄膜炎、全葡萄膜炎累及眼前段的患者13例21眼进行裂隙灯、虹膜彩色照相和IFA检查,探讨前葡萄膜炎患眼IFA表现并与正常人进行对照.结果 正常对照眼IFA不显影,呈色素遮蔽荧光,＞60岁正常老年人4例4眼瞳孔缘可见轻微荧光素渗漏.本组葡萄膜炎患眼IFA均有异常荧光素渗漏,按照前葡萄膜炎的严重程度表现为:(1)瞳孔缘和基质层放射状虹膜血管荧光素渗漏.(2)虹膜弥漫性或局限性萎缩,表现为放射状血管透见荧光.(3)虹膜新生血管(NVI),表现为细线状或花团状强荧光,随造影时间延长,有不同程度的荧光素渗漏.结论 IFA可显示裂隙灯检查不能够显示的虹膜炎症性损害病灶并间接反映血-房水屏障和虹膜血管的损害,IFA表现取决于炎症类型、部位以及炎症活动性的严重程度,有助于判断前葡萄膜炎的病情和监测治疗过程.     

Iris indocyanine green angiography in pseudoexfoliation syndrome and capsular glaucoma

PURPOSE: The iris vasculature shows typical changes in pseudoexfoliation syndrome (PXS) revealed by iris fluorescein angiography (IFA), such as hypoperfusion, microneovascularisation, and anastomotic vessels. Iris indocyanine green angiography (IICGA) can visualize more precisely details of the iris vascular pattern, especially as regards hypoperfusion and capillary dilatations. The aim of the present study is to describe the angiographic features of PXS on IFA and IICGA, comparing eyes affected with those not affected by capsular glaucoma. METHODS: In a prospective study 42 consecutive patients affected by PXS underwent a complete ophthalmologic examination including IFA and IICGA. Thirty-two eyes were affected by capsular glaucoma. IICGA was performed using IMAGEnet System H1024. RESULTS: IFA can easily detect the microneovascularisation, whereas IICGA allows a better recognition of iris hypoperfusion and anastomotic vessels, and it can reveal iris pigment epithelium defects. While the degree of hypoperfusion was similar in the two subgroups, eyes affected by capsular glaucoma more frequently showed signs of both microneovascularisation (marked stromal tufts and marked plexi), and of anastomotic vessels (peripheral loop, lesser circle and oblique vessels), with statistically significant difference. A clear correlation between hypoperfusion, microneovascularisation, and anastomotic vessels as regards site and extent was not noticed. CONCLUSIONS: A different angiographic pattern can be detected in PXS eyes with capsular glaucoma in comparison with eyes without it. Further studies are needed to correlate angiographic features revealed by IFA and IICGA, with clinical features.