急性视网膜坏死综合征的荧光素眼底血管造影分析

目的：了解急性多膜坏死综合征荧光素眼底血管造影图像的特征。方法：用荧光素眼底血管造影方法检查16例（21只眼）急性视网膜坏死综合征患者,分析其图像特征。结果：造影结果显示,视乳头均呈高荧光,视网膜主分枝动脉变细、有白鞘,但均显荧光,充盈可迟缓,仅1例主分枝动脉部分闭塞,静脉迂曲、着染、渗漏。视网膜坏死灶多见于周边部,造影早期显不均匀弱荧光,晚期显强荧光,退行萎缩区呈斑驳样荧光,均伴周边小血管闭塞及无灌注区,后极部可见散在脉络膜炎性病变。结论：FFA有助于了解病变的性质和范围,有助于诊断。但应注意与巨细胞病毒性视网膜炎相鉴别。     

玻璃体切除术中全视网膜光凝治疗晚期增生性糖尿病视网膜病变

目的 探讨玻璃体手术结合眼内激光一次性全视网膜光凝术治疗晚期增生性糖尿病视网膜病变(PDR)的疗效。方法 晚期PDR患者56例(56只眼),其中牵引性视网膜脱离者32例(32只眼)。所有患者均行玻璃体切除术和全视网膜光凝,约光凝800～1000个光斑。观察患者术前后视力、房水、晶状体、玻璃体、视网膜改变情况,分析患者术后荧光素眼底血管造影结果和并发症。结果 术后随访时间≥3个月,52只眼玻璃体腔和眼底均清晰,视网膜保持复位,未见新鲜出血、渗出灶及新生血管等。32只眼术后行荧光素眼底血管造影检查,其中28只眼未见无灌注区。术后视力提高者52只眼。结论 眼内全视网膜光凝具有所需能量小、有效率高、并发症少、术后反复出血发生率低等优点。对于晚期PDR患者,在玻璃体切除术中行一次性全视网膜光凝,疗效满意,手术安全。     

有髓神经纤维合并视网膜血管异常的临床观察

目的探讨先天性有髓神经纤维合并视网膜血管异常的临床特征。方法回顾分析我院诊治随访的合并视网膜血管异常的有髓神经纤维患者6例,总结其眼底表现及眼底荧光素血管造影特征,进而分析血管异常原因。结果 6例患者均可见有髓神经纤维沿视网膜神经纤维分布,视网膜血管异常发生于有髓神经纤维的视网膜区域:4例患者视盘旁有髓神经纤维附近可见火焰状的出血、视网膜血管走行迂曲,2例患者为视盘毛细血管扩张。眼底荧光素血管造影显示:有髓神经纤维较薄弱时常表现为正常荧光,较浓厚可表现为遮蔽荧光;合并视盘旁出血时表现为出血区域遮蔽荧光,毛细血管扩张的患者荧光造影显示血管扩张、荧光素渗漏,晚期呈片状强荧光。结论认识并关注由有髓神经纤维所引发的视网膜血管异常有着重要的临床意义,避免误诊为其他视网膜血管性疾病。对于合并新生血管和玻璃体出血的患者,要明确病因,早期给予激光或手术等及时正确的治疗。     

眼部注射庆大霉素致中毒性视网膜病变

目的 探讨眼部注射庆大霉素所引起的中毒性网膜病变。方法 观察７例玻璃体内结膜下注射庆大霉素后表现后极部视网膜水肿、出血、动静脉阻塞,晚期视神经萎缩。５例做了荧光素眼底血管造影检查。结果 荧光素造影显示,病变区视网膜血管中断呈大片无灌注区。因管壁染色并渗漏,晚期视盘呈强荧光。视力预后极差。结论 庆大霉素玻璃体内注射用量应低于２００μｇ或更换其它有效抗生素。     

初发期Vogt-小柳原田病的眼部表现及其荧光素眼底血管造影和频域光学相干断层扫描影像特征分析

目的探讨初发期Vogt-小柳原田病(VKH)的眼部表现及其影像特征。方法收集山西省临汾市尧都区眼科医院2010年1月至2013年4月就诊的17例(34只眼)初发期Vogt-小柳原田病患者的临床资料,对所有患者进行常规眼底检查和荧光素眼底血管造影(FFA),其中8例(8只眼)同时行频域光学相干断层扫描(OCT),结合患者病史进行综合回顾性分析。结果眼底检查和FFA检查显示所有患者均为双眼发病。FFA显示17例(33只眼)视乳头周围及后极部多发针尖样荧光素渗漏,晚期荧光素渗漏增强呈多湖状荧光素积存。其中视乳头周围毛细血管扩张、荧光素渗漏及视乳头边界不清者7例(14只眼);视乳头边界清及晚期荧光素着色者10例(20只眼)。1例(1只眼)仅表现为视乳头周围毛细血管扩张、荧光素渗漏及视乳头边界不清,但视网膜和脉络膜无荧光素渗漏。1例(1只眼)可见视乳头向周边部发散的放射状及条纹状低荧光。对8例(8只眼)分别进行视乳头周围及黄斑区、中周部频域OCT,显示视乳头周围视网膜神经上皮脱离,黄斑区和中周部视网膜神经上皮呈多发浅脱离及神经上皮内囊腔。结论眼底检查发现视乳头充血、视网膜水肿皱褶及视网膜浅脱离的患者,荧光素眼底血管造影检查多可见视乳头周围及后极部、中周部呈多发强荧光斑点,晚期荧光素渗漏增强且扩散融合呈多湖状荧光素积存;OCT检查可见视乳头周围视网膜神经上皮脱离、后极部及中周部视网膜神经上皮多发浅脱离及神经上皮内囊腔。     

视网膜分支静脉阻塞并视盘新生血管

患者男, 50岁。因右眼视力突然下降, 伴眼前"红影"飘动, 视远近物均不清9 d, 就诊于湖北省宜昌华厦眼科医院。既往无高血压、糖尿病等全身疾病史。眼部检查:右眼、左眼裸眼视力分别为0.6、0.8。右眼、左眼眼压分别为12.0、10.5 mm Hg (1 mm Hg=0.133 kPa )。双眼眼前节未见异常。散瞳后眼底检查, 右眼玻璃体血性混浊, 视网膜分支静脉纡曲扩张, 颞上支静脉完全闭塞, 呈白线状, 上方动脉血管纤细, 颞上视网膜散在出血, 视盘前增生膜伴大量新生血管。共焦激光扫描红外眼底照相检查, 右眼视盘前新生血管呈"鸡冠样", 黄斑颞侧见小片状新生血管, 下方玻璃体可见带状出血, 视网膜静脉纡曲扩张, 颞上支静脉扭曲, 粗细不均(图1A)。荧光素眼底血管造影检查, 38 s可见视盘前及黄斑颞侧新生血管荧光素渗漏均呈强荧光, 下方带状出血遮蔽荧光, 颞上分支静脉血管局部未显影, 视网膜颞上方、上方以及黄斑颞侧可见大片无灌注区(图1B);59 s可见视盘前及黄斑颞侧新生血管荧光素渗漏增强、范围扩大, 颞上分支静脉局部显影明显延迟, 部分静脉管壁荧光染色(图1C);9 min...     

应用共聚焦激光扫描血管造影技术诊断孤立性脉络膜血管瘤

目的评价激光扫描血管造影技术在诊断孤立性脉络膜血管瘤中的应用价值。设计回顾性病例系列。研究对象临床诊断为疑似脉络膜血管瘤35例患者。方法对临床疑似为脉络膜血管瘤患者35例,彩色眼底照相后,行30°及150°视野共聚焦激光扫描血管造影检查。主要指标共聚焦激光扫描血管造影的成像特征。结果荧光素眼底血管造影(FFA)特征为所有35例患者动脉前期或动脉期即显荧光,至动静脉期荧光增强、融合,荧光素渗漏,其间夹杂斑点状弱荧光;静脉早期瘤体呈多湖状,可见血管网形态,晚期荧光素渗漏呈强荧光区。吲哚氰绿血管造影(ICGA)早期可清晰显现瘤体由脉络膜血管团组成,随后染料渗漏,荧光增强,融合呈强荧光灶。150°广角视野共聚焦激光扫描眼底成像提供了瘤体的整体形态。结论激光扫描血管造影技术中FFA和ICGA同步造影及全景造影为孤立性脉络膜血管瘤诊断提供更多的信息。     

早期不完全性视网膜中央静脉阻塞荧光造影观察

目的 探讨早期不完全性视网膜中央静脉阻塞的荧光造影特征。方法 对20例临床诊断为不完全性视网膜中央静脉阻塞早期患者行眼底荧光造影，治疗后随访观察。结果 视网膜循环时间延长，血流呈涨潮式，血管缓慢充盈，血管内荧光素呈颗粒状，管腔未完全闭塞。结论 静脉阻塞早期造影诊断，及时用药，可避免视力不可逆损害。     

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)     

家族性渗出性玻璃体视网膜病变的荧光素眼底血管造影分析

目的分析家族性渗出性玻璃体视网膜病变的眼底表现及荧光素眼底血管造影(FFA)特征。方法收集我院诊治的家族性渗出性玻璃体视网膜病变患者,进行眼底照相及FFA检查,进行对比分析。结果眼底特征性表现为,视盘颞侧一条索样皱襞,该部分视网膜血管分支密集、数目较多,终止与周边视网膜。周边视网膜检查可见一边界清晰的片状灰白色病灶,此处视网膜血管迂曲扩张。FFA特征为:周边视网膜FFA显示血管分支增多、迂曲扩张,呈"树枝样"改变,走行平直。血管末端发生吻合、呈扇形终止,此部分血管渗漏。结论眼底检查、FFA结合患者病史、家族史可明确诊断家族性渗出性玻璃体视网膜病变。     

多发性一过性白点综合征的临床和眼底血管造影特征

目的 观察多发性一过性白点综合征(MEWDS)的临床表现和眼底血管造影特征.方法 经荧光素眼底血管造影(FFA)和吲哚青绿血管造影(ICGA)检查确诊的40例MEWDS患者40只眼的临床资料纳入研究.分析其临床特征、FFA和ICGA改变.结果 40例患者均为单眼发病,其中,男性12例,女性28例;年龄16～64岁,平均年龄29.4岁.初诊时最佳矫正视力0.1～1.0,平均最佳矫正视力0.82.眼底检查均可见多个灰白色圆形斑点状病灶,直径约100～500 μm,边界欠清晰;位于视网膜深层或视网膜色素上皮层.部分患者伴有轻度玻璃体混浊.FFA检查早期发现所有患者在白点状病灶对应部位可见有圆形或环形强荧光斑,晚期着染;18例患者出现视盘强荧光,并伴有视盘周围静脉渗漏;7例患者出现黄斑区强荧光斑.ICGA造影早期可见到视网膜后极部及周边部弱荧光斑,晚期持续存在,无明显渗漏;与FFA 检查比较,其弱荧光斑数目多且明显.所有患者的主诉症状均在6～8周内消失.结论 MEWDS患者眼底表现为多发性灰白色点状病灶;FFA早期表现为圆形强荧光和视网膜血管异常;ICGA检查可清晰显示视网膜后极部及中周部弱荧光斑,病灶数目明显多于FFA检查和检眼镜检查所见.

Abstract：

Objective To observe the clinical and fundus angiography characteristics of multiple evanescent white dot syndrome (MEWDS). Methods Forty eyes of 40 patients (12 males/28 females) with MEWDS, diagnosed by fundus fluorescein angiography (FFA) or indocyanine green angiography (ICGA)were enrolled. All cases were unilateral. The age was ranged from 16 to 64 years old, with a mean of 29.4years. The initial average corrected vision was ranged from 0.1 to 1.0, with a mean of 0.82. The characteristics of clinical manifestations, the features of FFA and ICGA were analyzed. Results Multiple gray-white dots (100-500 μm) were found throughout the posterior pole and the mid-periphery areas. The lesions were at the depth of outer retina and retinal pigment epithelium layers. Some patients presented with mild vitreous opacity. FFA showed round or ring hyper-fluorescence spots at the early stage and tissue staining at the late stage, corresponding to the gray-white dots. Hyper-fluorescence spots and leakages at the retinal veins near optic disk were seen in 18 patients. The hyper-fluorescence spots near macular area were found in 7 patients. ICGA showed that numerous dark hypo-fluorescent dots in the mid-periphery and posterior pole at the early stage and no leakage at the late stage. ICGA detected more lesions than FFA. All of the patients were recovered without any visual complications within 6-8 weeks. Conclusions MEWDS patients have multiple fundus gray-white dots, and hyper-fluorescence and the abnormal retinal vessels by FFA, and multiple weak hypo-fluorescent spots throughout the posterior pole and the mid-periphery areas clearly on ICGA. The ICGA showed more lesions than the ophthalmoscope and FFA examination.     

A clinical approach to the diagnosis of retinal vasculitis

Retinal vasculitis is a sight-threatening inflammatory eye condition that involves the retinal vessels. Detection of retinal vasculitis is made clinically, and is confirmed with the help of fundus fluorescein angiography. Active vascular disease is characterized by exudates around retinal vessels resulting in white sheathing or cuffing of the affected vessels. In this review, a practical approach to the diagnosis of retinal vasculitis is discussed based on ophthalmoscopic and fundus fluorescein angiographic findings.     

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。     

Oral fluorescein angiography with the confocal scanning laser ophthalmoscope.

OBJECTIVE: To evaluate the efficacy of oral fluorescein angiography with a confocal scanning laser ophthalmoscope (SLO) system. DESIGN: Comparative case series. PARTICIPANTS: The authors used a confocal SLO (Heidelberg Retina Angiograph [HRA]) to perform oral fluorescein angiography in 47 patients, 13 of whom were without any retinal disease and 34 with a variety of retinal diseases including macular holes and pucker, inflammatory diseases, retinal vascular diseases, and age-related macular degeneration. The images were also compared to images taken with a fundus camera after intravenous fluorescein injections in patients on whom both studies were done. INTERVENTION: Color fundus photographs were taken of each eye (30 degrees fundus camera) before drinking 4 ml of 25% sodium fluorescein mixed with 60 ml of orange juice. After oral fluorescein ingestion, images of each eye were taken with a fundus camera (TriX film) and the HRA (using 512- x 512-pixel resolution). The images were repeated at 0-, 2.5-, 5-, 7.5-, 10-, 12.5-, 15-, 20-, 25-, and 30-minute intervals. Twenty of the 47 patients underwent intravenous fluorescein angiography performed with the fundus camera. MAIN OUTCOME MEASURE: Images were analyzed by a masked reader, and foveal avascular zone visualization, branch retinal vessel identification, and image quality were scored. Statistical analysis was performed with a t test for paired data with a two-tailed test of significance (alpha = 0.05). RESULTS: Foveal avascular zone was 100% as seen in 16 eyes (47%) in the HRA machine versus 1 eye (2%) in the conventional fundus camera (P < 0.0001). The third-order branch retinal vessels were identified in 59% of eyes in the HRA versus 26% in the fundus camera group (P < 0.0001), and the image quality was considered comparable to an intravenous angiogram in 47% with the HRA versus 9% with the conventional fundus camera (P < 0.0001). CONCLUSIONS: Oral fluorescein angiography using the HRA produces sufficiently detailed images to diagnose, treat, and follow many types of retinal pathology.     

成人型卵黄样黄斑营养不良光相干断层扫描血管成像影像特征

目的观察成人型卵黄样黄斑营养不良(AFVD)的OCT血管成像(OCTA)影像特征。方法回顾性临床观察性研究。2018年3月至2019年5月在云南省第二人民医院眼科经眼底彩色照相、FFA、FAF及OCT等多模式影像检查手段诊断为AFVD的12例患者22只眼纳入研究。其中,男性8例16只眼,女性4例6只眼;年龄33~62岁,平均年龄(48.7±8.9)岁。双眼发病10例,单眼发病2例。视力0.08~0.6.22只眼中,卵黄样物质较为完整8只眼,卵黄样物质内出现不同程度破裂14只眼;继发脉络膜新生血管(CNV)10只眼。所有患者采用海德堡OCTA仪行OCTA检查。中心波长840 nm,采集速度85000次A扫描/s,获得3 mm×3 mm的扫描,在扫描过程中采用Eye-Tracking动眼追踪技术,选择图像质量与位置较佳的像进行标记保存。总结分析卵黄样物质、眼底血管变化及继发CNV在OCTA中的影像特征。结果卵黄样物质较为完整的8只眼,B-scan影像可见视网膜神经上皮层下致密卵黄样物质,位于RPE层与椭圆体带之间,密度较均匀;en-face影像可见卵黄样物质处血流信号,为卵黄样物质反射上方血管的伪迹。卵黄样物质内出现不同程度破裂的14只眼,B-scan影像中视网膜椭圆体带与RPE层之间的卵黄样物质信号不均匀,可见部分弱反射信号的腔隙;en-face影像可见卵黄样物质较为完整的区域仍呈现反射上方血管的伪迹,而卵黄样物质破裂处无血流信号。22只眼中,视网膜浅层、深层毛细血管拱环区视网膜小血管形态发生异常10只眼,可见部分小血管分支走形改变,未能吻合呈完整的拱环结构;未见视网膜毛细血管造成明显结构改变12只眼。继发CNV的10只眼中,8只眼表现为粗大如"枯枝状"的非活动性CNV,2只眼表现为密集、细小血管支构成的活动性CNV。结论AFVD在OCTA中可表现为由于卵黄样物质推挤所致的视网膜血管走形异常、卵黄样物质本身反射的血管伪迹以及卵黄样物质下方CNV的存在等影像特征。     

色素失禁症患者的眼底表现及治疗

目的:探讨色素失禁症(IP)患者的眼底荧光素血管造影特征及其辅助治疗的意义。方法:回顾性研究,收集2019-03/08确诊的IP患儿10例18眼的临床资料纳入研究,均为女性患儿,就诊年龄2周~42月龄,详细记录患儿的病史及家族史,均行眼底彩色照相及眼底荧光素血管造影检查。结果:纳入患儿眼底检查结果提示:1期病变1例1眼,FFA提示视网膜散在异常血管,晚期无渗漏,定期随访。2期病变4例6眼,FFA提示视网膜可见异常血管吻合,无明显新生血管生成,均行视网膜光凝。3期病变7例9眼,FFA提示视网膜新生血管荧光渗漏、视网膜前出血性荧光遮蔽,均行玻璃体腔注药(雷珠单抗注射液2mg∶0.2mL,注射量每眼0.25mg/0.025mL)联合视网膜光凝;其中2例为单眼发病,对侧眼正常。4期病变2例2眼,4a期病变1眼,FFA显示视盘、黄斑向颞侧牵拉连至周边部视网膜、局部浅脱离,行玻璃体切割手术;4b期病变1眼,眼前节照相提示晶状体后白色机化膜,眼部B超提示视网膜脱离,行玻璃体切割手术。结论:初步证实了眼底荧光素血管造影可辅助IP相关性视网膜病变的分期及治疗,对其治疗随访有指导意义,但对于各期病变的治疗目前尚无统一标准,有待更多临床资料。     

The clinical study of congenital looped/coiled peripapillary retinal vessels

PURPOSE: To present clinical manifestations of eyes with peculiar looped/coiled peripapillary retinal vessels. METHODS: Seven patients with looped/coiled retinal vessels on or near the optic disc were enrolled. All patients went through detailed ophthalmologic examinations and fluorescein angiography (FAG). RESULTS: There were two men and five women. Patients' age ranged from 15 to 71 years (mean: 39 years). The follow-up period ranged from 3 to 74 months (average: 27 months). One patient had bilateral involvement. Five of the seven patients noticed sudden onset of floaters in one eye. The colour fundus photography revealed looped/coiled retinal vessels on or near the optic disc, and most of the vessels were arteries. Accompanied retinal, preretinal, or vitreous haemorrhage was noted in all five patients who had sudden onset of floaters. Fluorescein angiography showed no leakage from the looped/coiled retinal vessels. No specific underlying diseases were noted in any patients. Follow-up examination revealed reabsorption of haemorrhage, and no change of the abnormal vessel patterns in any eyes. CONCLUSIONS: The peculiar fundus lesion of looped/coiled peripapillary retinal vessels is likely a benign congenital retinal vascular anomaly that does not progress. Floaters secondary to preretinal or vitreous haemorrhage is the most frequent complaint. The prognosis is excellent.     

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...     

Acute choroidal ischemia associated with toxoplasmic retinochoroiditis

PURPOSE: To describe eight patients with active toxoplasmic retinochoroiditis (RC) who had features suggestive of acute choroidal ischemia. METHODS: A retrospective review of the clinical records of 23 consecutive patients with acute toxoplasmic RC was performed. All patients underwent detailed ophthalmic examination at presentation and throughout follow-up, including dilated biomicroscopic fundus examination, fundus photography, fluorescein angiography, and indocyanine green (ICG) angiography. RESULTS: Of 23 patients, 8 (34.8%) had a large area of retinal whitening surrounding a small focus of RC. Fluorescein as well as ICG angiography showed a well demarcated geographic area of early choroidal hypofluorescence that extended beyond the clinical borders of the white retinal lesion, particularly by ICG angiography. Associated findings for these 8 patients included old retinochoroidal scars (7 [87.5%]), serous retinal detachment (3 [37.5%]), retinal hemorrhages (1 [12.5%]), and multiple satellite dark dots by ICG angiography (6 [75%]). Seven of eight patients were treated using a combination of antitoxoplasmic drugs and corticosteroids. All findings seen at the acute stage resolved in 2 weeks to 6 weeks. A small atrophic retinochoroidal scar replaced the active toxoplasmic lesion and was surrounded with mild or moderate retinal pigment epithelium changes that were associated with decreased final visual acuity in 2 patients (25%). CONCLUSION: Patients with toxoplasmic RC may develop features suggestive of choroidal ischemia that can result in a transient or permanent decrease in vision. Choroidal ischemia can only be suspected clinically, and fluorescein angiography and ICG angiography are required to establish the definitive diagnosis.