不明原因黄斑出血的吲哚青绿脉络膜血管造影

目的:探讨眼底荧光血管造影不能确定出血原因的黄斑出血的原发病灶。方法:对18例(20眼)不明原因黄斑出血作了吲哚青绿脉络脉络膜血管造影检查及分析。结果:本文结果表明导致不明原因黄斑出血的原发病灶有三类:脉络膜新生血管形成、视网膜血管异常和黄斑区偶发性出血。其中脉络膜新生血管导致的不明原因黄斑出血占多数(14眼),而由视网膜血管异常(3眼)和黄斑区偶发性出血(3眼)所致的不明原因黄斑出血比率较少。结论:吲哚青绿脉络膜血管造影对揭示不明原因黄斑出血的原发病灶有非常重要的价值。眼科学报 1997;13:62～66。     

Amelanotic Choroidal Nevi

A review of 373 patients with presumed choroidal nevi revealed 19 (5.1%) to have largely or totally amelanotic nevi. All patients but one with amelanotic nevi were white, and all were 48 years of age or older. Each lesion was located posterior to the equator, had a mean diameter of 3.2 mm, and was less than or equal to 1 mm in elevation. Intravenous fluorescein angiography most often disclosed early and late hyperfluorescence, corresponding to the amelanotic areas of the nevus. No lesions were observed to grow during a mean 14-month follow-up period. The differential diagnosis of amelanotic nevi of the choroid is discussed and includes amelanotic malignant melanoma, cavernous hemangioma of the choroid, metastatic cancer to the choroid, posterior scleritis, choroidal osteoma, and hypopigmented congenital hypertrophy of the retinal pigment epithelium.     

Choroidal Folds in Acute Vogt-Koyanagi-Harada Disease

Purpose: To shed light on the clinical significance of choroidal folds (CFs) in acute Vogt-Koyanagi-Harada disease (VKH). Methods: Twenty-three acute uveitic VKH patients diagnosed between October 2001 and January 2008 were reviewed retrospectively. Results: Twelve (52%) patients had CFs; for patients with CFs, more had poor initial visual acuity (≤ 0.1 in either eye, p <.05), and more received immunomodulatory therapy (IMT) than those without CFs (p <.05). Patients without CFs had better best-corrected visual acuity (BCV) at final visit (p <.01). Conclusions: CFs are probably a sign of severe choroidal inflammation and associated with corticosteroid resistance and/or dependence, which indicates IMT.     

Frosted Branch Angiitis Secondary to Macular Choroidal Neovascularization in a Chinese Woman

Background This is perhaps the first report of frosted branch angiitis secondary to choroidal neovascularization (CNV) from China. We describe a case of frosted branch angiitis associated with macular CNV.Case A 19-year-old Chinese woman complained of metamorphopsia and blurred vision in the right eye on August 27, 2002.Observations Fluorescein angiography demonstrated CNV in the macula. Five months later, focal and atrophic choroidal scars were observed in the macular area. She complained of blurred vision again on April 14, 2003. Iridocyclitis and frosted branch angiitis were found in both fundi. Following treatment with systemic acycloguanosine and corticosteroids for 4 months, the fundi recovered almost completely.Conclusions A case of frosted branch angiitis secondary to macular choroidal neovascularization is reported in a Chinese woman. The relation between frosted branch angiitis and CNV remains to be further explored. Jpn J Ophthalmol 2005;49:228–230 © Japanese Ophthalmological Society 2005     

Correlation Between Angiographic and Pathological Findings in Experimental Choroidal Neovascular Membranes After Transpupillary Thermotherapy

Purpose To evaluate the correlation between angiographic and pathological findings in experimental choroidal neovascular membranes after transpupillary thermotherapy (TTT).Methods Experimental subretinal choroidal neovascular membranes were produced in the monkey eye macula by intense photocoagulation. TTT was delivered, targeting the choroidal neovascular membranes, using a diode laser at 810nm. One week and 4 weeks after TTT, indocyanine green angiography (IA), fluorescein angiography (FA), optical coherence tomography (OCT), and histological examinations were performed.Results One week after TTT, indocyanine green dye leakage from choroidal neovascular membranes was reduced on IA, and FA showed staining in the late phase. Light microscopic examination showed numerous small-caliber blood vessels and persistent subretinal exudation. Four weeks after TTT, there was no indocyanine green dye leakage on IA, and FA showed staining. OCT showed a decrease in retinal detachment. Light microscopic examination showed fewer blood vessels and subretinal exudation had disappeared. Choroidal neovascular membranes were composed of fibrous tissue.Conclusions Changes in angiographic and OCT findings observed after TTT were inferred to be the result of accelerated fibrosis due to TTT and the disappearance of exudation. Jpn J Ophthalmol 2004;48:535–541 © Japanese Ophthalmological Society 2004     

特发性息肉样脉络膜血管病变一例报告

目的：报道1例特发性息肉样脉络膜血管病变的眼底荧光血管造影与吲哚青绿血管造影的临床特点。方法：常规眼科检查、眼底照相、荧光血管造影、吲哚青绿血管造影分析以及文献复习。结果：特发性息肉样脉络膜血管病变患者缺乏典型的玻璃疣,但可在视乳头与黄斑间出现大量泥沙样黄色渗出,眼底荧光血管造影中没有老年性黄斑变性样的新生血管,吲哚青绿血管造影中可见典型的息肉样脉络膜血管扩张,可单眼发病。结论：特发性息肉样脉络膜血管病变在临床表现以及眼底血管造影方面均有特征性改变。区分特发性息肉样脉络膜血管病变与老年性黄斑变性在疾病的视力预后、转归以及治疗处理上都有实际的临床意义。     

The Abnormal Choroidal Vessels in Aged Patients

Background:To show the abnormal choroidal vessels in aged patients with indocyanine-green angiography(ICGA).Methods:ICGA was performed in 350 patients with TOPCON TRC-50IA fundus camera.The images were recorded and retrospectively reviwed.Results:Five aged patients out of 350 cases were found to have abnormal choroidal vessels,The incidence was 1.43%,The abnormal choroidal vessels showed round-shapet,focal enlargement,abnormal shape and entrance,satellite appearance,and vascular loops.These might be due to congenital abnormality of choroid.ICGA could be used to observe the abnormal abnormal choridal vessels.     

脈络膜肿瘤的临床分析

目的 探討脉絡膜腫瘤的診斷及治療方法。方法 回顧分析9例10眼脉絡膜腫瘤的臨床治療及6月-10年随訪资料。結果 脉絡膜轉移癌預后差;黑色素瘤手術治療后随訪5年,無眼外蔓延,視力穩定;血管瘤激光光凝后,視力穩定及增進者占50％。結論 脉絡膜腫瘤的治療方法與腫瘤的性質、部位、大小密切相關。     

Choroidal imaging biomarkers

The choroid is the vascular coat of the eye, and its role has been studied in multiple chorioretinal disorders. Recent advancements in choroidal imaging techniques, including enhanced depth imaging optical coherence tomography, swept source optical coherence tomography, en face optical coherence tomography, and optical coherence tomography angiography have facilitated an in-depth analysis of the choroid. The gradual shift from manual to automated segmentation and binarization methods have led to precise and reproducible measurements of choroidal parameters. These qualitative and quantitative parameters, called choroidal imaging biomarkers, have evolved over the past decade from a simple linear subfoveal choroidal thickness to more complex 3D choroidal reconstruction, thus widening the spectrum encompassing multiple parameters. These biomarkers have provided a better understanding of the pathogenesis, are helpful in diagnostic dilemmas, and, in the future may also help to devise treatment options. The lack of normative data, absence of standardized parameters, and limitations of the imaging techniques, however, have led to ambiguity and difficulty in the interpretation of these variables. We attempt to address these lacunae in the literature and provide a basic understanding of the choroid in both health and disease using these choroidal biomarkers.     

Choroidal Changes in Eyes With Polypoidal Choroidal Vasculopathy After Anti-VEGF Therapy Imaged With Swept-Source OCT Angiography

PurposeSwept-source optical coherence tomography angiography was used to investigate choroidal changes and their association with pigment epithelial detachments (PEDs) in eyes with polypoidal choroidal vasculopathy (PCV) after treatment with vascular endothelial growth factor (VEGF) inhibitors.MethodsPatients with treatment-naïve PCV were included and underwent anti-VEGF therapy. Mean choroidal thickness (MCT), choroidal vascularity index (CVI), and PED volume measurements were obtained before and after treatment.ResultsThirty-four treatment-naïve PCV eyes from 33 patients were included. The PED volume decreased after treatment (P < 0.05). The MCT decreased from 223.0 ± 79.6 µm at baseline to 210.9 ± 76.2 µm after treatment (P < 0.001). The CVI at baseline was 0.599 ± 0.024, and the CVI after treatment was 0.602 ± 0.023 (P = 0.16). There was a correlation between the decreased PED volumes and the decreased MCT measurements (r = 0.47; P = 0.006). Also, there was a correlation between the decreased PED volumes and the increased CVI measurements (r = −0.63; P < 0.001).ConclusionsIn treatment-naïve eyes with PCV, the decreases in PED volumes were correlated with the decrease in MCT and the increase in CVI measurements. We propose that, at baseline, the PCV lesions serve as high-volume arteriovenous shunts between choroidal arterial and venous circulation, causing transudation into the choroidal stroma. We propose that, after treatment, the blood flow through the vascular shunt is reduced, the excess stromal transudation is resorbed, and the exudation from the neovascular lesion is reduced, resulting in thinning of the choroid, resolution of the PEDs, and an increase in the CVI due to the resorption of excess choroidal transudation.     

Correlation Between Indocyanine Green Angiographic Findings and Histopathology of Polypoidal Choroidal Vasculopathy

Purpose To analyze the histopathology of polypoidal choroidal vasculopathy (PCV) and choroidal neovascularization (CNV) developing from PCV, the authors evaluated correlations between pathological findings and the findings of preoperative indocyanine green angiography (IA).Methods Two specimens were obtained during CNV excision associated with PCV. PCV tissue was excised with the CNV. The specimens were examined by light microscopy.Results In one case, IA revealed polypoidal lesions exhibiting hyperfluorescence in both the early and the late phase, and in the affected area, abnormally dilated vessels were identified histologically underneath relatively healthy retinal pigment epithelium (RPE). In the other case, the polypoidal lesions seen on IA showed early hyperfluorescence and late isofluorescence, and dilated vessels were observed under the RPE; perivascular amorphous material was present. The RPE adhered to the side of the choroid, and there was CNV under the neurosensory retina in both cases. The CNV had numerous vascular lumens, was not surrounded by the RPE, and exhibited few fibrous components.Conclusions IA findings vary depending on the condition of the RPE located above the PCV and the extent of amorphous material around the PCV. Jpn J Ophthalmol 2004;48:249–255 © Japanese Ophthalmological Society 2004     

脉络膜转移癌的荧光素和吲哚菁绿血管造影的影像分析

目的：比较脉络膜转移癌的荧光素眼底血管造影(FFA)及吲哚菁绿血管造影(ICGA)的影像特点,为该疾病的准确诊断提供依据。

方法：经临床诊断,有明确原发恶性肿瘤病灶的患者6例8眼,散瞳后行眼底照相,用海德堡眼底血管造影仪行FFA及ICGA同步造影,比较两种影像学检查的异同。

结果：FFA早期显示瘤体为低荧光,中期呈现针尖样或斑点样荧光,晚期表现为斑驳样强荧光,部分病例病灶边缘呈强荧光环带; ICGA显示的病灶表现为低荧光,整个造影过程中荧光强弱无明显变化,仅有1例病例在反转期出现中央及病灶周围的点状强荧光。

结论：FFA和ICGA对于脉络膜转移癌有较为特征性的表现,二者结合有助于脉络膜转移癌的诊断。     

脉络膜黑色素瘤临床病理分析

本文总结了我院１９８５年至１９９１年经病理证实的４０例脉络膜黑色素瘤。分析其临床、超声波、眼底荧光血管造影的特点及病理改变。并对荧光血管造影的病理机制进行初步探讨。眼底荧光血管造影中于肿瘤内的低荧由肿瘤细胞及其内色素、坏死、血窦等所致。而高荧主要由肿瘤内血管和其上脱落的变性的色素上皮细胞所致。     

Choroidal filling patterns in sickle cell patients

Two choroidal occlusion syndromes are recognized: the triangular syndrome after ciliary artery occlusions, and the multifocal lesions associated with choroidal arteriolar occlusions. Both syndromes have been described in sickle cell patients. We compared early venous phase fluorescein angiograms of 51 Hb SS or Hb SC patients and 15 age and race matched controls, to test whether geographic early filling defects of the choriocapillaris might be more common in these Theologically impaired patients. We found no difference in occurrence of these filling defects between the two groups, and conclude that choriocapillaris filling defects in the early venous phase only are not pathological.     

息肉状脉络膜血管病变的吲哚菁绿眼底血管造影分型研究

目的 分析黄斑区息肉状脉络膜血管病变(PCV)在吲哚菁绿眼底血管造影(ICGA)中的不同渗漏亚型及临床特点.方法 对经荧光素眼底血管造影(FFA)及ICGA确诊为PCV的137例144只患眼进行ICGA渗漏状态的分型及各型临床特点的分析.结果 在144只PCV患眼的ICGA中,110只眼出现晚期染料渗漏(渗漏型,76%).渗漏型又可分为三个亚型:息肉灶渗漏型(47只眼,42.7%)、异常分支状脉络膜血管渗漏型(14只眼,12.7%)和混合渗漏型(49只眼,44.5%).其他34只眼显示出晚期病灶的消退和(或)呈冲刷现象(消退型,24%).在渗漏型中,色素上皮脱离(PED)、最佳矫正视力(BCVA)<0.1及陈旧性视网膜下出血的比例分别为56.4%(62只眼),19.1%(21只眼)和4.6%(5只眼);消退型相应比例分别为8.8%(3只眼)、50%(17只眼)和38.2%(13只眼)(P<0.001),同时消退型的病程显著长于渗漏型(P<0.001).结论 在ICGA中可以观察PCV病灶的晚期渗漏及消退现象,其中以渗漏型居多.混合性渗漏是渗漏型中最常见的亚型.渗漏型多表现PED,较好的BCVA以及较短的病程,而消退型则更易表现视网膜下陈旧性出血、较差的BCVA以及较长的病程.这可能提示前者为活动性病灶或处于疾病的早期阶段,而后者则为静止性病灶或处于疾病的晚期阶段.     

脉络膜转移癌的眼底表现

目的探讨脉络膜转移癌眼底表现的特点及原发癌的病理分型和预后。方法应用回顾性系列病例研究方法。分析16例20眼脉络膜转移癌患者的临床资料。眼部检查包括视力、眼前节、散瞳眼底、B型超声、彩色眼底照相和荧光素眼底血管造影（FFA）检查。全身检查包括肿瘤标记物筛查,支气管活检,头部、胸部和腹部影像学检查及全身骨扫描等。结果 16例患者中男6例,女10例;年龄31～72岁,平均年龄50.9岁;随诊1～60个月,平均12.6个月。双眼患者4例;单眼患者12例,其中右眼8例,左眼4例。首诊于眼科者9例,其中8例原发癌为肺癌,1例乳腺癌为原发癌。初诊视力：光感者2眼,手动/眼前～0.1者4眼,0.2～0.5者6眼,0.6～1.0者5眼,〉1.0者3眼。裂隙灯显微镜检查：15眼眼前节正常,5眼有继发性青光眼。散瞳眼底检查：19眼可见视网膜下黄白色、扁平隆起的实性肿物,12眼伴有不同程度的渗出性视网膜脱离。B型超声检查结果显示,20眼均为脉络膜实性占位性病变。FFA可见早期脉络膜肿物遮挡背景荧光,晚期可见融合成斑驳样的高荧光。原发癌为肺癌者10例,乳腺癌者4例,直肠腺癌者1例,子宫颈鳞癌者1例。结论脉络膜转移癌眼底表现的特点是视网膜下实性肿物,常伴有渗出性视网膜脱离,可继发青光眼。原发癌病理分型以肺腺癌为主,乳腺癌次之。     

Fluorescein angiographic findings and results of laser treatment in circumscribed choroidal hemangioma

We studied retrospectively 12 eyes with a solitary choroidal hemangioma in 12 patients over a period of 13 years. A peculiar, even hyperfluorescence of the tumor within the retinal venous phases occurred in all 12 cases. In all but four patients, laser therapy was performed to reduce subretinal fluid and partially destroy the tumor. Two of the three eyes without extensive retinal detachment or cystoid macular edema at the initial visit regained a final vision of 20/30 or better. The remaining 5 patients with the two major complications had a final vision of 20/80 or worse due to degenerative retinal changes. We believe that laser treatment is definitely advisable in the early stages of a circumscribed choroidal hemangioma.The study was performed at the Institute of Ophthalmology, University of Nijmegen.