Vogt-小柳-原田综合征的眼底荧光血管造影表现

目的：探讨Vogt-小柳-原田综合征（VKH）的眼底荧光血管造影（FFA）表现。方法：对20例（40只眼）患者的眼部表现及FFA等临床资料进行回顾性分析。结果：全部患者均有双眼视网膜色素上皮（RPE）的多发性渗漏，36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，多有囊样荧光素积存的特征性外观。     

前部缺血性视神经病变的发生因素及诊断

目的 探讨前部缺血性视神经病变的发生因素及诊断。方法 回顾性分析前部缺血性视神经病变９５例（１０３只眼）的发病特点,以及视野和眼底荧光素血管造影的表现。结果 平均发病年龄５２．４岁。８例（１０只眼）无原发病,８７例（９３只眼）伴有糖尿病、高血压和（或）眼底动脉硬化。眼底荧光素血管造影早期视盘全部或荧光充盈延缓或缺损,伴有相应的视野缺损。造影晚期视盘荧光形态有多种表现形式,缺血区呈强荧光者７６只眼（     

急性视网膜坏死综合征眼底血管造影表现特征

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）图像特征及在临床诊断中的应用价值。方法经临床及造影确诊为ARNS患者14例20只眼,分析总结其临床及FFA表现。结果FFA图像中视盘边界不清,晚期强荧光者17只眼;周边部病灶区视网膜动静脉血管广泛闭塞16只眼;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,病灶区与正常视网膜交界处较多的荧光素渗漏点者15只眼;视网膜脱离者8只眼。结论ARNS的FFA表现主要是视盘强荧光和视网膜血管闭塞及病灶区脉络膜荧光不清晰散在的点片状强弱荧光不均匀区。FFA检查可进一步了解病变损害的程度,对ARNS的诊断有重要的参考价值。     

眼球钝挫伤眼底荧光血管造影分析

目的眼球钝挫伤眼底荧光血管造影的分析。方法对38例(48只眼)眼球钝挫伤行眼底荧光血管造影。结果视神经挫伤(8只眼),视盘水肿、出血、FFA示视盘毛细血管扩张及渗漏晚期呈强荧光;视网膜震荡(22只眼),眼底表现为后极部视网膜水肿,黄斑中心凹反射消失。FFA:视网膜静脉早期后极部视网膜可见数片遮蔽荧光,小静脉管壁不均匀轻度荧光着染;视网膜出血(8只眼),FFA表现出血区荧光遮蔽;脉络膜裂伤(7只眼),视盘颞侧可见一条或数条黄白色弧形或条纹样,凹面朝向视盘。FFA:血管下方弱荧光造影,晚期呈高荧光;黄斑裂孔(3只眼):其中板层裂孔1只眼,FFA未见异常荧光;全层裂孔(2只眼),FFA显示为黄斑区圆形透见荧光。结论眼底荧光血管造影能及时准确了解眼球钝挫伤的部位和程度,同时结合病史、临床表现,综合分析做出准确诊断。     

特殊类型葡萄膜炎患者荧光素眼底血管造影特征分析

目的 探讨特殊类型葡萄膜炎患者的眼底图像特征及荧光素眼底血管造影的特征. 方法 回顾性分析我院眼科门诊行FFA检查并确诊为葡萄膜炎的患者36例51眼的眼底和FFA图像及相关临床资料. 结果 36例51眼葡萄膜炎患者中,双眼发病的有15例30眼,单眼发病的有21眼.其中以Beheet's病最多,15例19眼;Vogt-小柳-原田病8例15眼;急性视网膜坏死综合征7例10眼;系统性红斑狼疮伴葡萄膜炎6例7眼.多数患者FFA主要表现为:视盘荧光着染且在中后期可见荧光渗漏,黄斑囊样荧光积存,视网膜血管轻到中度荧光染色伴渗漏,视网膜深层平面片状荧光渗漏. 结论 不同病因可引起不同类型的葡萄膜炎,其荧光素眼底血管造影表现有其共性,也有其各自的特征.通过FFA检查可确诊特殊类型的葡萄膜炎,而且会对其治疗起到重要的指导意义.     

原田病的眼底荧光血管造影分析

目的分析原田病的眼底荧光血管造影特点。方法对23例（40眼）原田病患者进行详细眼部检查,并行眼底彩色照相和眼底荧光血管造影（fundus fluorescein angiography,FFA）等检查。结果23例（40眼）原田病患者中,急性期患者FFA：造影早期32眼视盘表面放射状毛细血管扩张、染料渗漏至后期呈强荧光;22眼后极部及中周部背景荧光呈斑点状充盈缺损或/及迟缓,7眼放射状条形低荧光;35眼眼底后极部及中周部表现为多发性强荧光斑点,如墨汁样扩散并彼此融合。结论VKH（原田病）具有选择性损害视网膜色素上皮的特点,FFA的特征性表现对该病早期具有重要诊断意义。     

息肉状脉络膜血管病变

目的 观察息肉状脉络膜血管病变（polypoidal choroidal vasculopathy，PCV）的发病率及其临床特征。方法 回顾性分析1997～2003年诊断为渗出型AMD163例157眼脉络膜新生血管（choroidal neovascu larization，CNV）的眼底血管造影资料。结果 54例55眼符合PCV，分别占本组CNV患者163例157眼的33％和35％。除1例为双眼发病外，其余均为单眼。男性36例36眼、女性18例19眼，经统计学分析男女发病率无明显差别（t=1．847，P〉0．05）。年龄47～75岁，平均61．8岁。网膜下出血部位主要位于后极部，39眼可见橘红色病灶，其中34眼合并黄白色脂质渗出，13眼合并玻璃体积血。荧光素眼底血管造影（fundus fluorescein angiographv，FFA）显示：22眼出血性色素上皮脱离，12眼网膜下出血联合浆液性色素上皮脱离，9眼出血性色素上皮脱离联合浆液性神经上皮脱离。2眼浆液性色素上皮脱离。8眼仅表现为网膜下出血遮蔽伴息肉状斑点样高荧光而无色素上皮和或神经上皮脱离；息肉状斑点样高荧光位置：黄斑区32眼，混合区（黄斑区＋血管弓区、黄斑＋乳头旁、视盘旁＋血管弓区）7眼，血管弓区5眼，视盘旁区3眼，中周区1眼，7眼未显现斑点样高荧光。结论 PCV多见于老年病人，大部分为单眼发病，男女发病率差异不明显，通过临床上见到的后极部大片网膜下出血性合并橘红色病灶和（或）黄白色脂质渗出以及FFA所显示的脉络膜斑点状或花簇状高荧光及其位置，可作出初步诊断。     

Vogt-小柳-原田氏病13例荧光素眼底血管造影与治疗分析

目的探讨Vogt-小柳原田病的眼底荧光血管遣影特征和糖皮质激素治疗效果。方法回顾性分析13例（25眼）Vogt-小柳原田病的临床表现．眼底荧光血管造影的特点和糖皮质激素治疗的效果。结果所有Vogt-小柳原田病的患者均表现为：视盘充血,边界不清,黄斑呈囊样水肿,静脉迂曲扩张,动脉变细,后极部视网膜弥漫性水肿。FFA主要表现为：FFA表现为特征性后极部早期多发性荧光渗漏点,晚期视同膜呈多囊样视网膜下荧光素积存。复发1例眼底呈晚霞状,无赤光下可见赤道部Dalen—Fuchs结节,糖皮质激素治疗后25只眼底炎症基本得到控制,显效者17只眼（66．7％）,好转者8只眼（33．3％）。所有病例出院时视力均高于0．5（P〈0．05）。结论眼底荧光血管造影检查和糖皮质激素的早期合理应用对Vogt-小柳原田病的诊断及预后具有很重要的作用。     

41例糖尿病视网膜病变合并视网膜静脉阻塞的临床及眼底病变分析

目的 分析糖尿病视网膜病变（DR）合并视网膜静脉阻塞（RVO）的眼底特征和荧光素眼底血管造影（FFA）的图像特征。方法 回顾分析眼科门诊行FFA检查的DR合并RVO患者41例45眼的眼底图像特征及相关临床资料。结果 41例DR合并RVO的患者中．双眼同时发病有4例8只眼．其余皆为单眼，其中以视网膜中央静脉阻塞（CRVO）最多，有29只眼．其次为颞上分支静脉阻塞．有7只眼．其它分吏静脉阻塞有9只眼。FFA表现为：静脉阻塞区网膜有大量神经纤维层出血．相应黄斑区荧光渗漏．掩盖了此眼DR的改变．对侧眼可见DR不同级别的改变或无DR改变。所观察病例中有1只眼同时合并动、静脉阻塞．FFA表现为：静脉阻塞区网膜有大量出血．动脉阻塞区网膜苍白，动脉充盈延迟。结论 DR合并RVO的临床及眼底改变有其特殊性．应与单发的DR或RVO鉴别。     

30例视网膜静脉阻塞的荧光眼底血管造影分析

目的:观察视网膜静脉阻塞的荧光眼底血管造影(FFA)图像特征探讨其对临床诊疗的意义.方法:对30例患者作了荧光眼底血管造影.结果:30例视网膜静脉阻塞患者中,非缺血型7例,FFA表现为静脉管壁轻度荧光素渗漏,少量微血管瘤形成.缺血型23例,FFA表现为视盘毛细血管扩张,静脉迂曲扩张,大片出血遮盖毛细血管床,黄斑有弥漫荧光素渗漏.结论:视网膜静脉阻塞分为缺血型和非缺血型,FFA可更好的显示这两种分型并作为选择治疗和观察疗效的依据.     

埋藏性视乳头玻璃膜疣临床误诊分析

目的:分析误诊为其他疾病的埋藏性视乳头玻璃膜疣的原因和临床特点。方法:回顾性分析8例(10眼)误诊为视乳头水肿和缺血性视神经病变的埋藏性视乳头玻璃膜疣患者的一般情况及视力、眼底、视野、视觉诱发电位、眼底荧光血管造影、眼部B超和头颅CT检查情况等资料。结果:就诊时的视力:0.1-1.0。眼底检查显示所有病例均表现视乳头水肿,边界不清,部分病例可有视乳头或其边缘出血。8例患者中,6例视野正常,2例表现为生理盲点扩大及与视乳头相连的弓形暗点;眼底荧光血管造影均显示视盘部分荧光逐渐增强,后期呈斑块状、结节样或不均匀强荧光,持续时间长,其形态、大小无变化,无荧光素渗漏。视觉诱发电位未见明显异常。B超检查可见视乳头隆起,有结节样强回声。结论:埋藏性视乳头玻璃膜疣临床上较少见,常被误诊为视乳头水肿和缺血性视神经病变,眼底荧光血管造影及眼部B超检查具有诊断意义。     

多波长激光联合玻璃体腔内注射曲安奈德治疗视网膜静脉阻塞的疗效观察

目的：观察多波长激光光凝视网膜联合玻璃体腔内注射曲安奈德（TA）治疗视网膜静脉阻塞（RVO）的临床疗效。方法：45例患者中,眼底荧光血管造影（FFA）检查有明确的无灌注区（NP区）且≥5PD及（或）有视盘、视网膜、虹膜新生血管者,立即给予多波长激光光凝治疗;光学相干断层扫描（OCT）显示黄斑水肿≥450μm,或视网膜出血较多,FFA检查显示大面积遮蔽荧光者,行玻璃体腔内注射TA4mg治疗,术后定期观察视力、眼压、虹膜、瞳孔、黄斑水肿、视网膜新生血管及无灌注区情况,随访3～21个月。结果：多波长激光光凝治疗视网膜静脉阻塞患者17例（包括玻璃体腔内注射TA后随访过程中出现视盘、视网膜、虹膜新生血管者8例）,视力均有不同程度提高,黄斑水肿明显改善,NP区及视盘、视网膜、虹膜新生血管消退,血管渗漏消失;玻璃体腔内注射曲安奈德36例,视力均有不同程度提高,OCT检查视网膜厚度改变,黄斑部厚度在注药后逐渐下降,早期改变明显,黄斑部厚度2.5～3个月时接近正常并逐渐稳定,FFA检查提示血管渗漏减轻。结论：多波长激光光凝视网膜联合玻璃体腔内注射TA是治疗RVO的一种行之有效的治疗手段,部分患者可出现高眼压、黄斑水肿复发等并发症。     

视盘血管袢的临床特征

目的：了解视盘血管袢的临床特征。方法：回顾分析我院自开展荧光素眼底血管造影以来的诊断为视盘血管袢的14例(16眼)临床资料。结果：视盘血管袢62．5％的分布于视盘上方；动脉袢10眼，静脉袢6眼；合并玻璃体积血8眼；视力在0．5以下者占78．5％。结论：视盘血管袢动脉居多，多于视盘上方，影响视力的主要原因为合并症。     

糖尿病视网膜病变合并前部缺血性视神经病变的眼底及临床特征

目的　观察糖尿病视网膜病变 (DR)合并前部缺血性视神经病变 (AION)的眼底血管造影 (FFA)和临床特征。方法　回顾分析 16 18例DR合并AION 17例患者的FFA检查结果、视力、视野、VEP等相关的临床资料。结果　 17例患者中双眼同时出现AION 1例 ,双眼先后出现AION 1例 ,其余为单眼 ,其中右 11眼 ,左 4眼。FFA表现为 :患眼视盘始终低荧光或早期出现区域性低荧光或充盈迟缓 ,后期荧光素渗漏。单眼发病 15例中 ,有 6例患者双眼底DR的分级一致 ,另外 9例患者DR的改变为 :合并AION眼的DR分级低于无AION的眼。双眼先后发病的 1例患者 ,先发病眼的DR分级低于后发病眼。所有病人均有不同程度视力损害 ,但视野出现损害者仅有 10人 ,表现为与生理盲点相连的束状或扇形视野缺损 ,视觉诱发电位(VEP)出现异常者有 11人。结论　DR合并AION的患眼 ,其眼底DR改变常轻于无AION的患眼 ,说明眼底血流量的减少可能对DR的发展起保护或抑制性作用。     

正常眼压性青光眼患者单侧视盘出血眼的特点分析

目的 观察单侧视盘出血(DH)的正常眼压性青光眼(NTG)患者出血眼的临床特征.方法 回顾性分析37例单侧DH的NTG患者双眼间差异,观察指标包括眼压,屈光度,中央角膜厚度,视盘的面积、横径、纵径、横径/纵径,视盘的整体参数和DH所在区域的分区参数,视盘旁脉络膜萎缩灶β区(PPA)的发生率、面积、范围、最大宽度等.视盘面积及其他整体和分区参数通过应用海德堡视网膜断层扫描仪Ⅱ型(HRT-Ⅱ)测量获得,视盘的横径、纵径及PPA系列参数则通过使用计算机Image-pro plus 6专业图像分析软件对视盘的HRT-Ⅱ图像进行分析获得.所得结果进行单因素及多因素回归分析.结果 DH组视盘的纵径较对侧组长(P＜0.01),横径/纵径较对侧小(P=0.017),PPA的发生率较对侧高(P=0.031),差异均有统计学意义.DH组视盘整体参数的视网膜神经纤维层平均厚度(G-MRNFLT)、轮廓线高度变异(G-HVC)较对侧小(P值分别为0.028、0.047),视杯形态测量(G-CSM)较对侧组大(P=0.047),盘沿面积(G-RA)、盘沿体积(G-RV)与对侧组无明显差异;分区参数的S-RA、S-RV、S-MRNFLT较对侧组小(P值分别为0.033、0.01、0.008),S-CSM较对侧大(P=0.021),S-HVC与对侧无明显差别.两组在角膜厚度、屈光度、眼压、PPA的面积、范围、最大宽度方面无明显差异.将视盘面积、屈光度、G-RA、G-MRNFLT、G-CSM、横径/纵径、β区弧度范围进行多因素回归分析,横径/纵径为与视盘出血相关的独立因素(P=0.032,OR＜0.001:＜0.001～0.35);将视盘面积、屈光度、S-RA、S-MRNFLT、S-CSM、横径/纵径、β区弧度范围进行回归分析,横径/纵径及S-MRNFLT是与视盘出血相关的因素(S-MRNFLT:P=0.019,OR＜0.001:＜0.001～0.154;横径/纵径:P=0.02,OR＜0.001:＜0.001～0.124).结论 NTG单侧DH眼出血所在区域的视网膜神经纤维层较薄,横径/纵径值较小,前者表明NTG单眼DH患者出血所在区域的视网膜神经纤维层损害较重,后者则提示DH眼的视盘较长,这一形态特点可能与其发生出血之间有一定的内在关系.

Abstract：

Objective To investigate the clinical characteristics of the eyes with unilateral disc hemorrhage (DH) in normal tension glaucoma (NTG) patients. Methods 37 normal-tension glaucoma patients with unilateral DH were studied. Extensive parameters were analyzed to evaluate which parameters differ significantly between the DH eyes and the companion eyes. These parameters are:(1) intraocular pressure (IOP), (2) dioptres of refractive errors, (3) central corneal thickness (CCT), (4) disc area, (5)disc shape including horizontal diameter, vertical diameter and horizontal diameter/vertical diameter, (6)global parameters of optic disc, including rim area(G-RA), rim volume(G-RV) , mean retinal never fiber layer thickness( G-MRNFLT), cup shape measure ( G-CSM) and height variation contour ( G-HVC), (7)sectorial parameters of DH located area, including S-RA, S-RV, S-MRNFLT, S-CSM and S-HVC, (8)parameters of the peripapillary atrophy (PPA) beta zone including the incidence rate, area, extent and maximum width. The global and sectorial parameters of the optic disc were obtained directly from HRT-Ⅱ.The other parameters, such as optic disc horizontal diameter, vertical diameter and PPA, were obtained by processing the raw optic disc images acquired from HRT-Ⅱ using computer software Image-pro plus version 6.Univariate and multivariate regression analyses were performed on the acquired parameters. Results The disc vertical diameter ( P＜0.01) and incidence rate ( P = 0. 031 ) of zone beta appeared to be significantly larger in the DH eyes than the ones in the contra-lateral eyes, while horizontal diameter/vertical diameter was significantly smaller in the DH eyes. As for the optic disc global parameters, the G-MRNFLT (P=0. 028), G-HVC (P = 0.047) were significantly lower in the DH eyes than in the contra-lateral eyes while the G-CSM was significantly higher in DH eyes (P =0. 047). The differences of G-RA, G-RV between two eyes were not significant. As for the regional parameters, S-RA, S-RV, S-MRNFLT were significantly smaller in the DH eyes than in the contra-lateral eyes with P-values 0. 033, 0. 01 and 0. 008 respectively. SCSM was significantly larger in DH eyes (P =0. 021 ). S-HVC did not display significant difference between two groups. There were also no significant differences in CCT, dioptres of refractive errors, IOP, PPA parameters (including area, extent and maximum width) between DH eyes and companion eyes.Multivariate regression analysis demonstrated that contained disc area, dioptres of refractive errors, G-RA,G-MRNFLT, G-CSM, horizontal diameter/vertical diameter and zone beta extent, the horizontal diameter/vertical diameter were the significant factors independently associated with disc hemorrhage ( P = 0.032,OR ＜ 0.001: ＜ 0.001 -0.35). Logistic regression analysis also showed that contained disc area, dioptres of refractive errors, S-RA, S-MRNFLT, S-CSM, horizontal diameter/vertical diameter and zone beta extent,the horizontal diameter/vertical diameter and S-MRNFLT were the significant factors independently associated with disc hemorrhage ( S-MRNFLT: P = 0. 019, OR ＜ 0. 001: ＜ 0. 001 - 0. 154; horizontal diameter/vertical diameter: P = 0.02, OR ＜ 0. 001: ＜ 0. 001 - 0. 124). Conclusion Our study indicates that horizontal diameter/vertical diameter is significantly smaller in NTG patients with unilateral optic disc hemorrhages. The DH located area also appears to have thinner RNFL thickness. Unilateral optic disc hemorrhages tend to have severe RNFL damage in DH located area and their optic disc shape tend to be longer, therefore we hypothesis that the elongation of the optic disc may be associated with the occurrence of DH.     

Longitudinal Measurement of Hemodynamic Changes within the Posterior Optic Nerve Head in Rodent Nonarteritic Anterior Ischemic Optic Neuropathy

Objective To assess the in vivo dynamic blood flow features of posterior optic nerve head (ONH) in rat model of nonarteritic anterior ischemic optic neuropathy (rNAION). Methods rNAION was established with Rose Bengal and argon green laser in Sprague-Dawley rats. Fundus photography and fundus fluorescein angiography (FFA) were performed to assess the dynamic changes of optic disc in morphology in 90 days and in blood perfusion in 3 hours after the induction of disease. Histological examinations were performed to evaluate the success of modeling. The dynamic blood flow kinetics of posterior ONH in rNAION were measured by Laser Doppler Flowmetry (LDF) on the day 3, 7, 14, 21, and 40 after the disease induction. One-way ANOVA, Student’s t-test and Bonferroni adjustment were used for multiple comparisons of kinetic measurements of blood flow. Results Optic disc edema and subsequent resolution associated with the development of optic disc pallor were observed in rNAION. FFA showed that the optic disc was hypofluorescence in the early phase and hyperfluorescence in the late phase. Histological studies suggested edema and loosened tissues of ONH, loss of retinal ganglion cells (RGCs), optic nerve substance and gliosis. Compared to the naive rats, the blood flow kinetics of posterior ONH in rNAION significant reduced at each time point after modeling (F=175.06, P<0.0001). The reductions were specifically remarkable in 14 days after the disease induction (All P<0.01). Conclusions Continuous blood perfusion reduction was found in rNAION, with significant alteration in 14 days after disease induction. Our results provided important information for understanding the hemodynamic changes in rNAION.