荧光素虹膜血管造影联合眼底血管造影在DR合并新生血管性青光眼中的应用

背景 新生血管性青光眼(NVG)是由视网膜缺血缺氧继发的眼病.荧光素虹膜血管造影(IFA)可早期诊断NVG,但其不能全面反映眼底血管情况.IFA联合荧光素眼底血管造影(FFA)可全面检测视网膜及虹膜新生血管情况,但目前国内关于糖尿病视网膜病变(DR)合并NVG患者中此方法的应用研究较少. 目的 探讨IFA联合FFA检查在增生性糖尿病视网膜病变(PDR)患者合并新生血管性青光眼的临床应用.方法 采用回顾性研究方法.纳入2013年2月至2016年1月在河南省立眼科医院接受IFA和FFA联合检查的PDR患者79例133眼,其中无虹膜病变100眼,I期青光眼红变期21眼,Ⅱ期开角型NVG 12眼.所有患眼均行视力、眼压、裂隙灯显微镜、IFA联合FFA检查.采用McNemar非参数检验法对比分析裂隙灯显微镜和IFA检查在I期青光眼红变期患眼检出率的差异. 结果 IFA检查显示100眼无虹膜病变患者无异常虹膜荧光素渗漏,FFA检查显示接受全视网膜激光光凝术(PRP)治疗的32眼未发现视网膜新生血管,68患眼存在视网膜新生血管;早期IFA检查显示,21眼I期青光眼红变期患者瞳孔缘或虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管;早期IFA检查显示12眼NVG患者虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管.I期青光眼红变期患眼中IFA检查的检出率为100％(21/21),明显高于裂隙灯显微镜检查的71.43％(15/21),2种检测方法检出率的比较差异有统计学意义(P=0.03). 结论 IFA联合FFA检查可以及早发现PDR合并青光眼红变期,有助于及时指导治疗.

Application of iris fluorescein angiography combined with fundus fluorescein angiography in diabetic retinopathy with neovascular glaucoma

Background Neovascular glaucoma (NVG) is secondary to retinal ischemia and hypoxia.Iris fluorescein angiography (IFA) can be used for early detection of NVG,but it can not reflect the condition of retinal blood vessels comprehensively.IFA combined with fundus fluorescein angiography (FFA) can detect the condition of retina and iris neovascularization comprehensively,but its application on diabetic retinopathy(DR) with NVG was rare in China.Objective This study was to evaluate the clinical application of IFA combined with FFA in proliferative diabetic retinopathy (PDR) patients with NVG.Methods A retrospectively study was designed.One hundred and thirty-three eyes with PDR were enrolled in Henan Eye Hospital from February 2013 to January 2016,including 100 eyes with no iris diseases,21 eyes with rubeosis iridis,and 12 eyes with NVG.All eyes underwent ophthalmic examinations that included best-corrected visual acuity,intraocular pressure,slit lamp,IFA and FFA.The differences of IFA examination and slit lamp examination in the eyes with rubeosis iridis were compared and statistical analyzed by McNemar nonparametric test.Results In this study,100 eyes with no iris leakage were identified by IFA,32 eyes with panretinal photocoagulation (PRP) treatment history had no retinal neovascularization and 68 eyes had retinal neovascularization;21 rubeosis iridis eyes with iris leakage at pupillary border or on iris surface were observed at the early stage of IFA,and all the eyes were identified having retinal neovascularization according to FFA images;12 NVG eyes were observed having iris neovascular leakage on iris surface at the early stage of IFA,and all the eyes were identified having retinal neovascularization according to FFA images.The detection rate of IFA examination on rubeosis iridis was 100％ (21/21),which was higher than 71.43％ (15/21) of slit lamp examination,and there was a significant difference between the two detection methods (P =0.03).Conclusions IFA combined with FFA can detect PDR with rubeosis iridis early,and it is helpful to guide the treatment timely.