孤立性脉络膜血管瘤共焦激光扫描眼底血管造影影像分析

目的探讨孤立性脉络膜血管瘤共焦激光扫描眼底血管造影的影像学特征及其临床意义。方法采用海德堡HRA2共焦激光扫描血管造影系统对21例21只眼孤立性脉络膜血管瘤进行眼底血管造影检查，其中12例行荧光素眼底血管造影（fundus fluorescein angiography，FFA）检查，9例行FFA和吲哚菁绿血管造影（indocyanine green angiography，ICGA）同步检查，分析比较孤立性脉络膜血管瘤2种检查的影像学特征。结果FFA检查动脉前期或动脉早期血管丛状或斑状强荧光，静脉期强荧光灶明显渗漏融合，晚期瘤体呈弥漫性强荧光。6例瘤体表面有明显的不规则点片状弱荧光，13例瘤体表面及周围视网膜毛细血管扩张。10例可见与视网膜色素上皮带状萎缩相应的透见荧光。ICGA检查影像特征为早期瘤体由不规则网状血管团样强荧光，中期瘤体呈强荧光团，晚期所有病例均有特征性的“冲洗现象”。FFA和ICGA同步检查同屏显示，成像清晰，有可比性，ICGA比FFA更清晰显示瘤体范围。结论孤立性脉络膜血管瘤ICGA影像比FFA更具有特征性，并能清晰显示肿瘤大小边界；FFA则可清晰显示视网膜血管及视网膜色素上皮的继发性损伤。激光扫描FFA和ICGA同步检查可为孤立性脉络膜血管瘤诊断、治疗及疗效监测提供更多的临床信息。

Angiography of Circumscribed Choroidal Hemangiomas Using Confocal Scanning Laser Ophthalmoscope

Objective To investigate the iconographic characteristics of confocal scanning laser ophthalmoscopic angiography in circumscribed choroidal hemangiomas.Methods Twenty one eyes of 21 patients with circumscribed choroidal hemangiomas were examined with HRA2 confocal scanning laser ophthalmoscope.Twelve of them were examined by fundus fluorescein angiography(FFA),9 of them took FFA and indocyanine green angiography(ICGA) simultaneously. Results FFA showed that the tumor was composed of vasculature hyperfluorescence during the arterial phase;copious dye leakage appeared in venous phase and persisted into the late phase of angiography.Among the 21 eyes,6 eyes showed hypofluorescence spots,13 eyes showed the retinal capillary dilatation on the tumor and 10 eyes had window defect from retinal pigment epithelium(RPE) atrophy around the tumor.ICGA revealed that the vascular tissue of the hemangioma filled rapidly with dye during the early phase,and "wash-out" phenomenon could be observed in the late phase of angiography.FFA and ICGA by confocal scanning laser ophthalmoscope might take clear and comparable images.Among the 9 eyes in simultaneous FFA and ICGA,8 of them could be better defined in ICGA than in FFA.Conclusions ICGA reveals more iconographic characteristics than FFA for circumscribed choroidal hemangiomas,and FFA may show much more secondary retinal injuries.Simultaneous FFA and ICGA may play role as an important technique in diagnosis,treatment and followup of circumscribed choroidal hemangiomas.