吲哚青绿脉络膜血管造影对激光光凝治疗年龄相关性黄斑变性应用价值

目的：探讨吲哚青绿脉络膜血管造影对指导激光光凝治疗年龄相关性黄斑变性(AMD)的应用价值。方法：采用激光扫描检眼镜(SLO)对55例(60眼)渗出型AMD进行眼底荧光血管造影术(FFA)和吲哚青绿脉络膜血管造影术(ICGA)检测，对比分析FFA和ICGA图像，发现黄斑区视网膜下脉络膜新生血管(CNV)的位置、范围、大小和数目，观察CNV的供养血管(FV)。在FFA和ICGA图像的指导下，对不同类型CNV分别半导体近红外激光(810nm)和Fd—Nd：YAG激光(532nm)波长激光进行光凝治疗。治疗后根据病人视力、眼底变化、FFA和ICGA复查结果综合评价疗效。结果：60眼渗出型从AMD中，FFA发现典型CNV24眼，占40％，隐匿性CNV36眼，占60％；ICGA检查60眼中，典型CNV45眼，占75％；典型CNC伴有明显供养血管(FV)18眼；显示CNV的热点10眼，占16．7％；盘状高荧光5眼，8．3％。IC—GA典型CNV发现率明显高于FFA，P＜0．001。激光光凝治疗渗出AMD60眼中，显效21眼，占35．0％；有效16眼，占26．7％；无效23眼，占38．3％；复发12眼，占20．0％。疗效明显高于对照组，P＜0．01。结论：ICGA可提高隐匿型CNV发现率，在ICGA指导下，采用不同波长激光治疗可取得更好效果，并可客观评价疗效。     

老年黄斑变性黄斑出血的吲哚青绿血管造影

目的；用吲哚青绿血管造影(indocyanme green angiography，ICGA)观察老年黄斑变性(age-related macular degeneration，AMD)黄斑出血掩盖的脉络膜新生血管(choroidal neovascularization，CNV)。 方法：对22例24只眼AMD黄斑出血患者作眼底彩色照相、眼底荧光血管造影(fundus fluoresceln angiography,FFA)及ICGA检查，并对两种不同的眼底血管造影图像进行比较和分析。 结果：ICGA检查在本组AMD黄斑出血病例显示了CNV的如下特点：①ICGA发现了FFA未能发现的CNV，②ICGA较准确地判断了CNV的位置；③ICGA发现CNV的数量比FFA多，更全面地显示CNV；④ICGA较准确地显示了CNV的范围大小。 结论：ICGA能较全面、准确地揭示AMD黄斑出血所掩盖的CNV，并能扩大适于激光光凝的CNV范围及提高激光光凝的成功率。 （中华眼底病杂志，1997，13:146-149）     

吲哚青绿在眼科的应用新进展行

吲哚青绿染料(indocyanin green,ICG)在眼科的应用逐渐受到关注,它主要应用在ICG血管造影、超声乳化白内障连续环形撕囊、黄斑裂孔手术中视网膜内界膜的撕除、ICG介导的激光治疗。我们对ICG的发展历史及应用现状进行了综述。     

年龄相关性黄斑变性中易于确诊的斑状脉络膜新生血管吲哚青绿造影术

目的：利用吲青绿造影对易于确诊的斑状脉络膜新生血管（CNV）的自然病程进行评定。方法：2位从事黄斑疾病和吲青绿造影的眼科医生使用眼底镜观察、荧光造影、吲哚青绿造影的方法,对患有渗出性年龄相关性黄斑变性和易于确诊的斑状CNV的40只眼进行检查。用多变量分析方法对斑块的增加量和视力损害的相关性进行分析,并用年龄、性别和随访时间诸因素进行校正。结果：平均随访时间为13．5个月（中位数为11个月）。初始和最终的平均视力分别为20／46（中位数为20／50）和20／65（中位数为20／100）。初始荧光斑的大小平均为6．62mm^2,（中位数为20／100）。初始荧光斑的大小平均为6．62mm^2,（中位数为6．20mm^2)最终范围为10．40mm^2（中位数为9．76mm^2)。斑块的扩大有统计学上的显著差异（P＜0．001）。结论：研究发现斑状CNV随时间变化有增大的趋势,随访1年内增大约40％。然而造成的视力下降并无显著性,并与病损的扩展程度轻度相关;并未显示出与性别有直接的关系。     

吲哚青绿血管造影在老年黄斑变性脉络膜新生血管诊治中的应用

由于吲哚青绿血管造影（ＩＣＧＡ）弥补了眼底荧光血管造影（ＦＦＡ）的不足,医生能更清晰地观察到脉络膜血液循环情况。本文就ＩＣＧＡ在诊断老年黄斑变性（ＡＭＤ）患者脉络膜新生血管（ＣＮＶ）病变中的应用,并在ＩＣＧＡ指导下进行激光,放射等疗法方面作一综述。     

吲哚青绿介导的光栓塞治疗黄斑中心凹下脉络膜新生血管

目的　探讨吲哚青绿介导的光栓塞（ｉｎｄｏｃｙａｎｉｎｅｇｒｅｅｎ-ｍｅｄｉａｔｅｄｐｈｏｔｏｔｈｒｏｍｂｏｓｉｓ,ＩＭＰ）治疗黄斑中心凹下脉络膜新生血管（ｃｈｏｒｏｉｄａｌｎｅｏｖａｓｃｕｌａｒｉｚａｔｉｏｎ,ＣＮＶ）的疗效。方法　选择特发性ＣＮＶ（ｉｄｉｏｐａｔｈｉｃＣＮＶ,Ｉ-ＣＮＶ）和年龄相关性黄斑变性（ａｇｅ-ｒｅｌａｔｅｄｍａｃｕｌａｒｄｅｇｅｎｅｒａｔｉｏｎ,ＡＭＤ）伴黄斑中心凹下ＣＮＶ（ＡＭＤｗｉｔｈｓｕｂｆｏｖｅａｌＣＮＶ,Ａ-ＣＮＶ）患者共３６０例（４３２眼）,分成光动力疗法（ｐｈｏｔｏｄｙｎａｍｉｃｔｈｅｒａｐｙ,ＰＤＴ）治疗组（ＰＤＴ组）、经瞳孔温热疗法（ｔｒａｎｓｐｕｐｉｌｌａｒｙｔｈｅｒｍｏｔｈｅｒａ-ｐｙ,ＴＴＴ）组、ＩＭＰ组、ＩＭＰ＋玻璃体内注射曲安奈德（ｉｎｔｒａｖｉｔｒｅａｌｔｒｉａｍｃｉｎｏｌｏｎｅａｃｅｔｏｎｉｄｅ,ＩＶＴＡ）组及对照组。通过眼底照相、光学相干断层扫描、荧光素眼底血管造影、吲哚青绿血管造影等检查观察ＣＮＶ的消退情况,观察视力的变化,比较各种治疗效果。结果　各组Ａ-ＣＮＶ患者治疗次数差异有统计学意义（Ｐ＜０．０５）。对于Ｉ-ＣＮＶ,ＰＤＴ组、ＴＴＴ组、ＩＭＰ组、ＩＭＰ＋ＩＶＴＡ组、对照组治疗前后具体的视力变化分别为０．１３±０．１１、０．０９±０．１２、０．１２±０．１４、０．１９±０．１５、０．１０±０．１２,各组之间视力差异无统计学意义（Ｐ＞０．０５）。对于Ａ-ＣＮＶ,各组治疗前后具体的视力变化分别为０．２３±０．１４、０．１３±０．１０、０．１８±０．０９、０．１９±０．１１、０．０３±０．０３,各组间差异有统计学意义（Ｐ＜０．０５）。ＰＤＴ治疗组较其余各组可获得最好的视力效果;ＩＭＰ联合或不联合ＩＶＴＡ的疗效其次,不如ＰＤＴ组;ＴＴＴ治疗组与其余各组比较,治疗效果最差;组间两两比较差异均有统计学意义（均为Ｐ＜０．０５）。结论　ＩＭＰ是一种治疗ＣＮＶ的更为经济有效的替代方法,适合推广应用,特别是在基层医院。     

年龄相关性黄斑变性治疗新进展

年龄相关性黄斑变性是发达国家中老年人群主要致盲眼病,其患病率逐年上升。近年来其治疗方面取得很大进展。预防性治疗以抗氧化剂为代表,近来也出现了一些新的治疗方法,如他汀类药物等。抗CNV的治疗重心由激光治疗转为从转录及表达水平针对VEGF及其受体的治疗。联合治疗是研究CNV治疗新的发展方向,多项试验验证了PDT联合抗VEGF治疗的有效性。但是手术治疗CNV作为一项补充的治疗措施,其疗效需要更多的随机对照临床试验验证。     

年龄相关性黄斑变性的基因治疗

年龄相关性黄斑变性（AMD）是老年人主要的致盲眼病之一,湿性型AMD危害较大,主要表现为脉络膜新生血管（CNV）的形成,目前尚无理想有效的治疗方法。随着分子生物学技术的发展,基因治疗为AMD的治疗提供了新思路。现已发现许多启动和抑制CNV的基因,以及可能导致AMD发生的基因位点,其中补体因子H（CFH）被认为是引发AMD的关键基因。就目前AMD基因治疗的载体、靶基因的选择以及引发AMD的关键基因进行综述。     

吲哚青绿眼底血管造影在常见眼底病诊断中的应用

吲哚青绿眼底血管造影（ICGA）在1970年用于眼底造影。相较于传统的荧光素钠造影（FFA）能更好的反应脉络膜层血液循环的状况,可作为诊断脉络膜病变的重要辅助手段。通过动态观察ICGA可以明确病变部位、分类,指导治疗,评估预后等。本文就吲哚青绿目前在眼科临床上的应用作一综述。     

年龄相关性黄斑变性的治疗研究新进展

年龄相关性黄斑变性是一种随年龄增长而发病率逐渐上升的黄斑部疾病。主要由视网膜色素上皮细胞和视网膜退行性变而引起的不可逆性的中心视力下降或丧失。近年来,对多种类型年龄相关性黄斑变性尤其是新生血管型(age-related macular degeneration,ARMD)的治疗已经进行了大量的多中心的临床实验观察,涌现出光动力疗法、药物治疗、放射治疗、激光光凝、黄斑下手术、经瞳孔温热治疗、中医药治疗等方法,本文就ARMD目前有关的治疗方法及其进展做一综述。     

Indocyanine green angiographic features prognostic of visual outcome in the natural course of patients with age related macular degeneration.

AIMS: To determine indocyanine green (ICG) angiographic features prognostic of visual acuity loss in eyes following a natural course of exudative age related macular degeneration (AMD). METHODS: 89 eyes of 72 patients (48 men, 24 women) aged between 50 and 87 years old (mean 69.5 (SD 8.8) years) with classic and/or occult choroidal neovascularisation (CNV) were reviewed. ICG angiographic features were classified as follows: type 1, well demarcated hyperfluorescence with late ICG leakage; type 2, well demarcated hyperfluorescence with no late dye leakage; type 3, poorly demarcated hyperfluorescence; type 4, no hyperfluorescence. Follow up ranged from 6 to 67 months (mean 19.2 (11.5) months). Logistic regression analyses were performed using change of visual acuity (worse or not) as the dependent variable, and patient age, sex, characteristics of fluorescein angiography (classic or occult CNV), location of CNV, and each ICG type as the independent variables. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Type 1 CNV was associated with the highest risk for visual acuity loss (OR: 7.50, CI: 1.42-39.55, p = 0.018) among the present variables. In contrast, CNV having no ICG leakage (type 2, 3, and 4), represented no significantly increased risk. CONCLUSION: Well demarcated hyperfluorescence with late ICG leakage appears to be predictive of visual acuity loss in eyes with CNV. Thus, ICG angiography may offer a useful means of predicting visual outcomes in AMD.     

老年黄斑变性玻璃膜疣的吲哚菁绿血管造影

目的：探讨老年黄斑变性（AMD）玻璃膜疣的吲哚菁绿血管造影（ICGA）特征及其临床意义。方法：对10例16眼早期AMD患者进行眼底荧光血管造影（FFA）及ICGA。结果：⑴FFA早期玻璃膜疣为透见荧光,后期部分呈现着色现象。⑵ICGA早期可见脉络膜充盈迟缓或不规则,后期可见脉络膜渗漏高荧光区、点状强荧光及斑状强荧光团。玻璃膜疠为遮蔽荧光。此外可见涡状静脉异常。结论：AMD早期即有明显的脉络膜循环紊乱及可疑非活动性新生血管生成。对AMD患者进行FFA和ICGA眼底血管对照检查,对了解AMD的发病机理,及早发现潜在的脉络膜新生血管,以尽早给予适当的预防性治疗均有重要意义。     

光动力治疗年龄相关性黄斑变性的疗效观察

目的:评价维替泊芬(商品名:维速达尔)光动力疗法(photodynamic therapy,PDT)治疗继发于年龄相关性黄斑变性的脉络膜新生血管疾病的有效性和安全性。方法:回顾性分析接受维速达尔光动力治疗的86例102眼,评价指标包括视力,荧光血管造影和吲哚青绿血管造影。所有患者共接受154次治疗,平均1.51次。结果:在86例患者102眼中,随访时间3mo～2a。其中接受1次治疗60例,31例经过两次治疗,3次治疗9例,5次治疗1例。共治疗154次,平均1.51次。PDT治疗1a后,接受治疗眼视力基本保持稳定。其中,视力提高1行和/或1行以上者22眼(21.6%);视力稳定者72眼(70.6%)。结论:维速达尔PDT治疗年龄相关性黄斑变性安全有效。     

Grid laser treatment of occult choroidal neovascularization in age related macular degeneration

Laser photocoagulation treatment of occult choroidal neovascularization (CNV) in age related macular degeneration has been up to now discouraging. We report a randomized clinical trial comparing grid laser treatment versus the natural course in 24 eyes with this kind of neovascularization. In 12 eyes a low energy scatter photocoagulation was applied to the areas of presumed CNV and abnormal retinal pigment epithelium, sparing the fovea. The follow-up ranged from 1 to 3 years. At the three months follow-up visit, the subretinal exudation appeared reduced in 40% of the treated eyes and in none of the control eyes. During the period of follow-up the occult CNV turned to classic CNV in 4 treated and in 4 untreated eyes. At the last examination (average follow-up 18 months), anatomical and functional conditions were not significantly different in the two groups. Our data fail to show a beneficial long-term effect of grid laser treatment for occult CNV; no iatrogenic complications were seen in our series.Presented at the 3rd International Symposium on Ocular Circulation and Neovascularization, Paris, May 21–23, 1992.     

Indocyanine green angiographic findings in fellow eyes of patients with unilateral occult neovascular age-related macular degeneration

Purpose: To determine the role of indocyanine green angiogaphy (ICGA) in the prediction of the development of choroidal neovascularization (CNV). Methods: We reviewed the ICG angiograms of 124 patients with newly diagnosed unilateral occult CNV secondary to age-related macular degeneration (AMD) in whom the fellow eye had only drusen by biomicroscopy and fluorescein angiography. Follow-up data of at least 12 months were obtained in all eyes. Results: 113 fellow eyes had a normal ICG study, while 11 fellow eyes revealed plaque-like late hyperfluorescence. During an average follow-up time of 18.2 months exudative AMD developed in 7 of 11 eyes with late hyperfluorescence on ICGA and in 6 of 113 with a normal ICGA study. Conclusion: ICGA may help to predict which fellow eyes are at higher risk of developing future exudative changes. This revised version was published online in September 2006 with corrections to the Cover Date.     

渗出型老年黄斑变性的吲哚青绿血管造影特征

目的 观察渗出型老年黄斑变性(age-related macular degeneration,AMD)的吲哚青绿血管造影(indocyanine green angiography,ICGA)特征。 方法 诊断为渗出型AMD的患者31例(39只眼)，年龄50～82岁，视力范围：指数/30cm～0.7,全部完成了眼部检查、眼底彩色照相、眼底荧光素血管造影(fundus fluorescein angiography,FFA)和吲哚青绿血管造影(indocyanine green angiography,ICGA)，分析和比较FFA和ICGA图像特征。 结果 FFA诊断为隐匿性脉络膜新生血管(choroidal neovascularization,CNV)的26只眼中，ICGA诊断为典型CNV有15眼，占57.7%。FFA诊断为浆液性色素上皮脱离(不伴CNV)4只眼中，有1只眼ICGA诊断为浆液性色素上皮脱离伴典型CNV。FFA和ICGA对瘢痕组织诊断的眼数及特性相近。 结论 与FFA相比，ICGA可提高对AMD典型性CNV的诊断率，扩大对AMD的治疗范围。(中华眼底病杂志,1998,14:76-80)     

经瞳孔温热疗法治疗年龄相关性黄斑变性

年龄相关性黄斑变性（AMD）是老年人致盲的常见原因。根据其临床表现可分为干性和湿性。湿性AMD以视网膜色素上皮（RPE）下有活跃的脉络膜新生血管（CNV）为主要特征，而引起视力下降的主要原因是CNV引起的黄斑区反复出血、渗出、瘢痕改变，视力预后极差。经瞳孔温热疗法（TTT）是一种治疗继发于AMD的CNV的较新方法，采用直径可调节的大光斑，穿透深的激光连续照射，使靶组织缓慢升温，在消除CNV病灶的同时又相对保存病变表面视网膜的结构和功能。就TTT治疗AMD的应用发展、特点、临床疗效、治疗方法以及可能出现的并发症等作一综述。     

年龄相关性黄斑变性眼底血管荧光造影分析

目的:探讨眼底荧光造影(fundus fluorescein angiography,FFA)在老年黄斑变性诊断中的应用价值。方法:用Topocon TRC-NW7SF型眼底照相机对老年黄斑变性(age related macular degeneration,AMD)患者进行FFA检查,并结合临床其他检查进行分析。结果:AMD患者40例62眼中,萎缩型49眼(79%),渗出型13眼(21%)。萎缩型表现均为点状或斑驳样透见荧光,未见荧光素渗漏。渗出型早期可见脉络膜新生血管(choroidal neovascularization,CNV)形态,晚期大量荧光素渗漏,周围有出血者则表现为荧光遮蔽。结论:对AMD患者早期应用FFA检查有助于分析CNV,并显示其范围和部位,为治疗提供依据。     

Development of polypoidal lesions in age-related macular degeneration

Purpose

To investigate the development of polypoidal lesions using indocyanine green angiography (IA) in eyes with typical age-related macular degeneration (AMD).

Methods

We retrospectively reviewed the medical records of 47 consecutive patients (47 eyes) with typical AMD who had been followed up with IA for at least 2 years.

Results

At the initial visit, although all eyes showed classic and/or occult choroidal neovascularization (CNV) associated with AMD, no eyes showed polypoidal lesions by IA. However, during follow-up, 13 (27.7%) of the 47 eyes did show polypoidal lesions. All polypoidal lesions developed at the edge of persistent CNV or, more often, at the terminus of recently progressed CNV. Of 12 eyes with a final lesion area >8 disc area, 7 (58.3%) showed newly developed polypoidal lesions. In the eyes with these newly developed polypoidal lesions, the mean area of the vascular lesion had extended significantly from 10.50±7.88 mm² to 20.87±10.21 mm² during follow-up (P=0.0018).

Conclusion

The current observation suggests that IA of active AMD sometimes reveals polypoidal lesions if there is progression of the CNV in the subretinal pigment epithelium space.     

Clinicopathological correlation of primary and recurrent choroidal neovascularisation following surgical excision in age related macular degeneration

AIMS/BACKGROUND—Fluorescein angiography and histopathological findings were correlated in two patients with recurrent choroidal neovascular membranes (CNVs) in an attempt to gain insight into the possible causes of recurrent CNVs and into the healing response after CNV excision.
METHODS—Two patients with recurrent CNVs underwent repeat excision, and the excised tissue was studied with light and electron microscopy.
RESULTS—Incomplete CNV excision probably led to the recurrences. The portion initially excised appears to have been anterior to the RPE in case 1. In both cases, recurrent CNVs contained RPE-like cells suggesting that native RPE can repopulate the dissection bed. The tissue excised at the second operation contained areas with hyperplastic RPE and fragments of Bruch's membrane (external to the RPE basement membrane) in a matrix of fibrillar collagen and fibrocytes, suggesting that initial removal of the CNV can be followed by an abnormal anatomical arrangement of RPE and scarring of Bruch's membrane.
CONCLUSIONS—Abnormal resurfacing of the dissection bed by RPE and fibroblasts may underlie, in part, the limited visual outcome often seen after surgical excision of CNVs in age related macular degeneration.

Keywords: age related macular degeneration; choriocapillaris atrophy; choroidal neovascularisation; fluorescein angiography