虹膜荧光素血管造影对具有棕色虹膜的中国人前葡萄膜炎的诊断价值

背景 前葡萄膜炎的炎症性损伤与血-房水屏障的破坏有关,裂隙灯下对其病情的检查有一定的限制,而荧光素血管造影能客观显示病情的变化.但目前国内对虹膜荧光素血管造影(IFA)的应用研究较少.目的 观察中国人棕色虹膜葡萄膜炎患者IFA图像,探讨IFA在葡萄膜炎诊断和治疗中的临床应用价值.方法 对正常中国人40人40眼和前葡萄膜炎、全葡萄膜炎累及眼前段的患者13例21眼进行裂隙灯、虹膜彩色照相和IFA检查,探讨前葡萄膜炎患眼IFA表现并与正常人进行对照.结果 正常对照眼IFA不显影,呈色素遮蔽荧光,＞60岁正常老年人4例4眼瞳孔缘可见轻微荧光素渗漏.本组葡萄膜炎患眼IFA均有异常荧光素渗漏,按照前葡萄膜炎的严重程度表现为:(1)瞳孔缘和基质层放射状虹膜血管荧光素渗漏.(2)虹膜弥漫性或局限性萎缩,表现为放射状血管透见荧光.(3)虹膜新生血管(NVI),表现为细线状或花团状强荧光,随造影时间延长,有不同程度的荧光素渗漏.结论 IFA可显示裂隙灯检查不能够显示的虹膜炎症性损害病灶并间接反映血-房水屏障和虹膜血管的损害,IFA表现取决于炎症类型、部位以及炎症活动性的严重程度,有助于判断前葡萄膜炎的病情和监测治疗过程.

Clinical value of iris fluorescein angiography in diagnosis of uveitis in Chinese with brown iris

Background The pathological change of the anterior uveitis is the disruption of blood-aqueous barrier. Slit lamp examination appears to be limited for the evaluation of inflammatory response, and fluoreseine angiography is an objective approach. However,there are few relative studies up to now in China. Objective Aim of this study was to observe the characteristics and assess the clinical applications of iris fluorescein angiography （IFA） in Chinese uveitis with brown iris. Methods Forty eyes of 40 normal subjects and 21 eyes of 13 patients with the anterior uveitis were collected in this study. IFA, slit-lamp examination and iris photograph were performed on the subjects. All individuals were informed consented at the initiation of this study. Results In normal eyes, fluorescence in iris vessels was blocked by the melanin pigment,but peripupillary weak fluorescent leakage was seen in the normal eyes with the age of 〉60 years old. The multiple patterns of fluorescence leakage were found in the patients suffered from uveitis of various etiologies although the negative slit-lamp finding, including the leakage of fluorescein around the pupillary margin and radial iris vessels in the eyes with mild diseases,transmitted fuorescence of regular iris vessels in the eyes with diffuse and local iris atrophy, and vascular tufts of the pupillary margin with coiled interwind tight clusters of thin vessels at the early phase in the eyes with dilated capillaries, microvascular anomalies and new vessel formation. The hyperfuorescence remained throughout the IFA duration. Conclusions IFA findings in uveitis vary depending on the topography, type and severity of inflammation. IFA has a good clinical applying value because of its objective assessment ability of the degree of the blood-aqueous barrier breakdown and iris neovascularization breakdown. It can exhibit the unvisible lesion under the slit-lamp and monitor the efficacy of medical theraphy in patients with actice or quiescent uveilis.