病理性近视黄斑出血的眼底特征及光学相干断层扫描分析

目的:探讨病理性近视黄斑出血的眼底改变及其光学相干断层扫描特征。方法:对42例43眼病理性近视(PM)黄斑出血患者进行眼底彩色照相、荧光素眼底血管造影(FFA)和光学相干断层扫描(OCT)检查。结果:病理性近视黄斑出血的表现分为两类:新生血管型:24例24眼,其眼底特征表现为出血灶呈类圆形,不超过1PD,周围少见渗出及水肿,部分可见新生血管膜;其FFA特征表现为典型性CNV17眼(71%),隐匿性CNV7眼(29%);其OCT特征表现为21眼(87.5%)CNV呈纺锤形或类圆形团块状,呈强或中等强度反射,自视网膜色素上皮层向上突出,位于视网膜神经上皮层下,3眼(12.5%)CNV呈不规则增强紊乱的反射信号,位于视网膜色素上皮层平面。单纯型:18例19眼;其眼底特征表现为出血灶扁平,大小不等,边界欠整齐,周围无渗出及水肿,其FFA特征表现为出血遮蔽荧光,无CNV性高荧光征象,部分患眼可见漆裂纹样透见荧光;其OCT特征表现为色素上皮层下隆起低反射区,脉络膜毛细血管层光带连续。结论:病理性近视新生血管型黄斑出血绝大部分由典型性CNV引起,OCT的典型图像为色素上皮层局限的纺锤状或类圆形的强反射光团,边界较清,视网膜向上隆起,下方可有脉络膜遮蔽;单纯型黄斑出血表现为局限性色素上皮层出血性脱离,OCT检查有利于明确病理性近视黄斑出血的病变性质和病因,并有助于判断预后和指导治疗。

Optical coherence tomography and fundus fluorescein angiography for macular hemo-rrhage in pathological myopia

AIM:To evaluate the characterization of macular hemorrhage in pathological myopia (PM) with optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). ·METHODS:A series of retrospective cases study was designed. OCT,FFA and color photography were perform-ed on 42 patients 43 eyes of PM with macular hemorrhages. ·RESULTS:The causes and symptoms of PM with macular hemorrhage could be divided into two forms:new veins:macular hemorrhage with choroidal neovascularization (CNV) of 24 patients 24 eyes. The fundus characteristics were macular hemorrhage demonstrated oval,less than 1 disk diameter (PD),with rare edema and exudation around. And new membrana vasculosa can be seen partially. The FFA characterisitics were classic CNV of 17 eyes (71%) and occult CNV of 7 eyes (29%). The characteristics of OCT were 21 eyes (87.5%),spindle shape or circular conglomerate,strong or medium reflection,sticking out upwards from retinal pigment epithelial layers,under the epithelial layers of retinal neuroepithelial; 3 eyes (12.5%) CNV were irre-gular reflection signal which may aggregate disorder,and located on the level of retinal pigment epithelial layers. Simplex:macular hemorrhage without CNV of 18 patients 19 eyes. The fundus characteristics were flat hemorrhagic focus with different sizes and less-orderly boundary,without any exudation or edemas around. The FFA characterisitics were fluorescence blocked by hemorrh-age,without CNV high fluorescence pheno-menon. Lacquer cracks sometimes appeared at the sites of macular hemorrhage or around the hemorrhage. The characteristics of OCT were the protruded low reflection area under the retinal pigment epithelial. Choriocapillary layer with consistent photonic band. ·CONCLUSION:Most of macular hemorrhage in patho-logical myopia with new veins is caused by typical CNV. Typical figures of OCT are fusiform shape in pigment epithelium layers or quasicircular strong reflection mass,with clear boundary. Retinal protruded upwards,and choroids under it can be a shield. Simplex macular hemorrhage demonstrates as limited retinal pigment epithelial hemorrhagic detachment. OCT exami-nations were favorable for identifying the characteristics and reasons of macular hemorrhage in pathological myopia,and were helpful for diagnosis,prevention,guide and treatment.