息肉状脉络膜血管病变

目的 观察息肉状脉络膜血管病变（polypoidal choroidal vasculopathy，PCV）的发病率及其临床特征。方法 回顾性分析1997～2003年诊断为渗出型AMD163例157眼脉络膜新生血管（choroidal neovascu larization，CNV）的眼底血管造影资料。结果 54例55眼符合PCV，分别占本组CNV患者163例157眼的33％和35％。除1例为双眼发病外，其余均为单眼。男性36例36眼、女性18例19眼，经统计学分析男女发病率无明显差别（t=1．847，P〉0．05）。年龄47～75岁，平均61．8岁。网膜下出血部位主要位于后极部，39眼可见橘红色病灶，其中34眼合并黄白色脂质渗出，13眼合并玻璃体积血。荧光素眼底血管造影（fundus fluorescein angiographv，FFA）显示：22眼出血性色素上皮脱离，12眼网膜下出血联合浆液性色素上皮脱离，9眼出血性色素上皮脱离联合浆液性神经上皮脱离。2眼浆液性色素上皮脱离。8眼仅表现为网膜下出血遮蔽伴息肉状斑点样高荧光而无色素上皮和或神经上皮脱离；息肉状斑点样高荧光位置：黄斑区32眼，混合区（黄斑区＋血管弓区、黄斑＋乳头旁、视盘旁＋血管弓区）7眼，血管弓区5眼，视盘旁区3眼，中周区1眼，7眼未显现斑点样高荧光。结论 PCV多见于老年病人，大部分为单眼发病，男女发病率差异不明显，通过临床上见到的后极部大片网膜下出血性合并橘红色病灶和（或）黄白色脂质渗出以及FFA所显示的脉络膜斑点状或花簇状高荧光及其位置，可作出初步诊断。

Polypoidal choroidal vasculopathy

Objective] To observe the incidence rate and clinical feature of polypoidal choroidal vasculopathy (PCV). Method] To investigate 157 eyes with age related exudative macular degeneration (AMD) (163 cases) from 1997 to 2003, retrospectively analyzing angiography data of choroidal neovascularization(CNV) in these eyes. Result] 55 eyes(54 cases) were diagnosed as coincident to PCV, the percentage is 35%, they occurs in right eye or left eye but 1 case was in both eyes; There were no significant difference in incidence rate between males (36 eyes in 36 cases)and females(19 eyes in 18 cases)(t=1.847, P>0.05). The patients aged from 47 to 75 years ang the age was average 61.8 years. Subretinal hemorrhage were most frequently seen at posterior pole. 39 eyes had subretinal hemorrhage with reddish-orange lesion at the posterior pole, among these 34 eyes demonstrating yellow-white lipid exudation.and 13 eyes coexisting vitreous hemorrhage. Fundus fluorescein angiography (FFA) showed: hemorrhagic detachment of retinal pigment epithelium occurred in 22 eyes; Subretinal hemorrhage associated serous detachment of retinal pigment epithelium occurred in 12 eyes; Hemorrhagic detachment of retinal pigment epithelium associated with serous detachment of retinal pigment epithelium occurred in 9 eyes; Serous detachment of retinal pigment epithelium occured in 2 eyes; Only 8eyes had subretinal hemorrhage accompanied by polypoidal high fluorescent, but no detachment of retinal pigment epithelium and neuroepithelium. coexisted Locus of polypoidal high fluorescence: 32 eyes located at macular, 7 eyes at mix area(macular+vascular arcades, macular +parapapilla, parapapilla +vascular arcades), 5 eyes at vascular arcades, 3 eyes at parapapilla, one eye located at central periarea. Absence of polypoidal high fluorescence were observed in 7 eyes. Conclusions] PCV often occurre in old patients, mostly single eye involved. There are no significant difference in incidence rate between males and females. We can make preliminary assessment by large sheet hemorrhage or/and association with reddish-orange lesio or yellow-white lipid exudation at posterior pole and by dotted hyperfluorescence of choroid and location of them in FFA.