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目的探讨临床上误诊为渗出型老年性黄斑变性(AMD)的常见病因及其临床特点。设计回顾性病例系列。研究对象初诊时诊为渗出型AMD而最终诊断为其他眼底病的67例患者。方法患者初诊时均接受病史询问,裂隙灯显微镜、双目间接检眼镜等常规检查,并得出初步诊断。全部患者均接受眼底荧光素血管造影(FA)检查,根据病情需要,部分患者接受吲哚青绿血管造影(ICGA)、相干光断层扫描(OCT)检查。6例患者随访时间超过3个月。结合辅助检查结果和疾病转归特点得出患者的最终诊断。主要指标发生误诊的常见病因及其临床特点。结果误诊为渗出型AMD的疾病包括黄斑小分支静脉阻塞25例(37.3%)、视网膜大动脉瘤20例(29.9%)、中心性浆液性脉络膜视网膜病变(CSC)16例(23.9%)以及血管样条纹并发脉络膜新生血管形成(CNV)6例(9.0%)。黄斑小分支静脉阻塞患者中,22例(88%)病程均大于3个月。眼底彩像显示受累区域视网膜水肿,视网膜出血多呈散在点状。视网膜大动脉瘤患者眼底彩像显示动脉管壁膨隆部位因出血遮挡或与陈旧出血紧贴而难以分辨,而FA和(或)ICGA有助于发现病变部位。全部CSC患者均为慢性CSC,ICGA有助于确诊。血管样条纹并发CNV患者眼底彩像视盘周围放射状条纹显示欠清,ICGA晚期使其显示较清楚。结论掌握容易误诊为渗出型AMD常见疾病的种类及其临床特点,并结合相关的辅助检查有助于正确诊断。
Objective To investigate the common etiology and clinical features of clinically misdiagnosed exudative age-related macular degeneration (AMD). Design retrospective case series. The subjects were diagnosed as exudative AMD at the time of first visit and eventually diagnosed as 67 other patients with fundus disease. Methods Patients were admitted to the medical history inquiry, slit lamp microscope, binocular indirect ophthalmoscopy and other routine examination and draw a preliminary diagnosis. All patients underwent fundus fluorescein angiography (FA). According to the needs of the patients, some patients underwent indocyanine green angiography (ICGA) and coherence tomography (OCT). Six patients were followed up for more than 3 months. Combined with the results of the ancillary examination and disease outcome characteristics of the final diagnosis of patients. The main causes of misdiagnosis of the main indicators and their clinical features. Results Misdiagnosis of exudative AMD included 25 cases (37.3%) of macular branch vein occlusion, 20 (29.9%) cases of aortic aneurysm, 16 (23.9%) cases of central serous chorioretinopathy (CSC) There were 6 cases (9.0%) of stripe-like choroidal neovascularization (CNV). Among the patients with macular branch vein occlusion, 22 patients (88%) had longer duration than 3 months. Fundus color images showed retinal edema in affected areas, mostly retinal hemorrhage scattered spot-like. Fundus images of patients with retinal aneurysms showed that the bulging parts of the arterial wall were difficult to discern due to hemorrhage occlusion or clinging to old bleeding, while FA and / or ICGA helped to detect the lesion. All CSC patients are chronic CSC, ICGA contribute to the diagnosis. Vascular stripe-like CNV patients with fundus images around the radial disc radial stripes show less clear, ICGA late to make it more clearly. Conclusions It is helpful to correctly diagnose the types of misdiagnosed as common diseases of exudative AMD and its clinical features, combined with related auxiliary examinations.