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目的应用眼底荧光素血管造影(FFA)和相干光断层成像(OCT)两种影像检查评估渗出型老年性黄斑变性脉络膜新生血管(CNV)的分型和性质。设计回顾性病例系列。研究对象50例(68眼)老年性黄斑变性患者。方法所有患者均采用眼底荧光素血管造影(FFA)和Stratus-TM型OCT仪两种检查并相互印证。主要指标CNV的形态及类型。结果以FFA检查能否清楚显示CNV边界来分类,典型性CNV5眼(7.4%),部分典型性CNV14眼(20.6%),隐匿性CNV43眼(63.2%)(其中纤维血管性色素上皮脱离型38眼,晚期无源性渗漏5眼),CNV瘢痕化5眼(7.4%)。以OCT检查CNV所在部位来分类,CNVI型(RPE下型)5眼(7.4%),CNVII型(视网膜下型)19眼(27.9%),混合型38眼(55.9%)(又分为松散型、纺缍型、Duplicate型和高隆起型4种),CNV瘢痕化5眼(7.4%)。在FFA上显示为典型性CNV,在OCT上显示CNV多位于视网膜下(I型)或RPE复合体光带水平。CNV前无伴发病变的遮蔽。在FFA上显示为隐匿性CNV,在OCT上显示CNV多位于RPE复合体光带水平或位于RPE下(II型),主要是CNV比较松散或CNV前常有伴发病变的遮蔽或两者具有。伴发病变包括视网膜水肿出血、黄斑囊样水肿、视网膜和/或RPE的浆液性或出血性脱离。结论渗出型老年性黄斑变性的CNV分为I型、II型及混合型比较实用。两种影像检查相互印证,特别是在遮挡因素较重时,OCT极有助于对CNV的分型和性质的判断,为治疗提供有价值的参考。
Objective To evaluate the classification and properties of exudative age-related macular degeneration choroidal neovascularization (CNV) by fundus fluorescein angiography (FFA) and coherence tomography (OCT). Design retrospective case series. The study included 50 patients (68 eyes) with age-related macular degeneration. Methods All patients underwent fundus fluorescein angiography (FFA) and Stratus-TM OCT two checks and confirmed each other. The main indicators CNV morphology and type. The results were categorized according to whether the FFA was able to clearly show the CNV border. Typical CNV5 eyes (7.4%), some typical CNV14 eyes (20.6%), and occult CNV43 eyes (63.2%) (of which fibrovascular pigment epithelium detachment type 38 Eyes, 5 cases of late passive leakage), 5 eyes of CNV scarring (7.4%). There were 5 eyes (7.4%) of CNVI type (RPE type), 19 eyes (27.9%) of CNVII type (subretinal type) and 38 eyes (55.9%) of mixed type by OCT examination. Type, Spinning type, Duplicate type and high protuberance type 4), CNV scarring in 5 eyes (7.4%). Displayed as a canonical CNV on FFA with CNV mostly at the level of retinal (type I) or RPE complex bands. No shadowing of associated lesions before CNV. Is displayed as an occult CNV on FFA, with CNV mostly at the level of RPE complex light band or under RPE (type II) on OCT, mainly with CNV loose or with CNV often obscuring lesions or both with . Associated lesions include retinal edema, cystoid macular edema, serous or hemorrhagic detachment of the retina and / or RPE. Conclusion Exudative age-related macular degeneration CNV is divided into type I, type II and mixed more practical. Two kinds of imaging confirms each other, especially when the occlusion factors are heavy, OCT can help to determine the type and nature of CNV and provide a valuable reference for the treatment.