视网膜大动脉瘤的多模态眼底影像和疾病 特征

目的：分析视网膜大动脉瘤（RAM）的多模态眼底影像学特点及疾病特征。方法：回顾性研究。连续 纳入2003年5月至2020年1月在北京协和医院眼科确诊的RAM患者57例（58眼）。分析患者彩色眼底 照相、荧光素血管造影（FFA）、吲哚菁绿血管造影（ICGA）及光学相干断层扫描（OCT）的影像学特点， 并总结疾病特征。结果：纳入患者年龄为（69.0±9.3）岁，其中女性占75%，单眼发病患者占98%， 共发现瘤体65个。彩色眼底照示95%的瘤体位于颞侧动脉，32%位于动脉主干，29%位于视网膜动 脉分支处或动静脉交叉处。85%伴不同程度出血，86%伴硬性渗出。FFA的瘤体检出率为92%，动脉 期可呈圆点状或梭状强荧光，周围出血或硬性渗出遮蔽荧光，晚期荧光增强并出现渗漏。ICGA的瘤 体检出率为95%，可透过出血的遮蔽荧光见视网膜动脉壁上瘤体高荧光，造影晚期瘤体荧光仍较背 景荧光强。OCT的瘤体检出率为63%，可见RAM局部高隆起，病灶处可见圆形强反射瘤体腔壁。结论： RAM常见于老年女性。多模态影像学检查可从多角度显示RAM的瘤体形态、活动性以及伴随的出 血、渗出表现。其中，ICGA对于瘤体的检出率更高，显示RAM更为清晰。

Multimodal Fundus Imaging Analysis and Clinical Characteristics of Retinal Arterial Macroaneurysm

Objective: To summarize the clinical and multimodal fundus imaging characteristics of retinal arterial macroaneurysm (RAM). Methods: Fifty-seven patients (58 eyes) who were diagnosed with RAM in the Department of Ophthalmology, Peking Union Medical College Hospital from May of 2003 to January of 2020 were included in this retrospective study. Fundus photography (FP), fluorescein angiography (FFA), indocyanine green radiography (ICGA), and optical coherence tomography (OCT) imaging features were analyzed. Results: The average age of the patients was 69.0±9.3 years, of which 75% were females, and 98% had monocular onset. Sixty-five RAMs were detected. FP showed that 95% of the RAMs werelocated in the temporal artery, 32% were in the main artery, 29% were at the branch of the retinal artery or the arteriovenous intersection; 85% had hemorrhages to varying degrees and 86% had hard exudates. The detection rate of RAMs with FFA was 92%. The hyperfluorescence of a dot or spindle shape had developed, with peripheral hemorrhages or hard exudates blocking the fluorescence in the early stages, while fluorescence enhancement and leakage were shown in the late stage. ICGA showed 95% of the RAMs, and the hyperfluorescence of the aneurysms could be seen through the masked hemorrhage and was still conspicuous in the late stage. 63% of the RAMs were detected with OCT, showing an inner retinal structure with a central lumen and hyperreflective border. Conclusions: RAMs mostly occur in elderly women. Multimodal imaging enables multi-perspective views of RAM by the shape, activity, accompanied hemorrhage and exudates. Among them, ICGA has a higher detection rate and clearer display of RAM