息肉状脉络膜血管病变42例临床特征研究
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摘要
目的:观察息肉状脉络膜血管病变(PCV)的眼底、造影表现、光学相干断层扫描(OCT)特征及对玻璃体腔注射抗VEGF(雷珠单抗)药物后的治疗反应。方法:取经荧光素眼底血管造影(FFA)、吲哚氰绿造影(ICGA)及OCT确诊的42例(42只眼)PCV患者,观察PCV患者的眼底、造影及OCT的表现,并对这42只眼行玻璃体腔注射抗VEGF药物,每月1次,连续3次,观察患者最佳矫正视力(BCVA)的变化,OCT测量黄斑中心凹厚度(CRT)的变化,脂状突起及双层征的变化。结果:PCV患者视网膜下出血、橘红色病灶及脂质沉着为眼底镜下特征性表现;息肉(Polyps)及脉络膜异常分枝血管网(BVN)为ICGA的影像特征;脂状突起,双层征为OCT的影像特征。抗VEGF治疗3个月,患者的BCVA多数有改善;所有患者的CRT均较治疗前降低,部分患者脂状突起及双层征消退。结论:PCV有其特征性的眼底、ICGA和OCT特征,通过对这些特征的把握可更好的诊断PCV;玻璃体腔注射抗VEGF药物对PCV的治疗有明确的效果,可做为治疗方法之一。
Objective:To investigate the clinical features of polypoidal choroidal vasculopathy(PCV) in fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA), optical coherence tomography(OCT)and the efficiency of intravitreal ranibizumab therapy for polypoidal choroidal vasculopathy. Methods: 42 patients(42 eyes) confirmed by fundus examination, FFA, ICGA and OCT were diagnosed PCV, the lesions were located in macular area. Observed the characteristic of FFA, ICGA and OCT of PCV. All patients received intravitreal ranibizumab once a month, a total of three times. Observed the change of the best corrected visual acuity(BCVA), OCT measure the central retinal thickness(CRT), the changes of retinal pigment epithelium serration and the doubleline symptom. Results: Underretinal hemorrhage, orange nodular lesion and lipidosis were the characteristic ocular fundus changes; Polyps and branching vascular networks(BVN) were the characteristic of ICGA image; Retinal pigment epithelium serration and doubleline symptom were the characteristic of OCT image. 3 months after anti-VEGF treatment, the best corrected visual acuity(BCVA) almost improved; all patients' CRT were decreased then prior treatment. Some of the eyes existd retinal pigment epithelium serration and doubleline symptom were partial disappeard after treatment. Conclusion: PCV has its ICGA and OCT imaging features and characteristic clinical feature. These features can help us make the right diagnosis. Anti-VEGF drugs have a definite effect on the treatment of PCV which can be used as one of the methods to treat PCV.
Objective:To investigate the clinical features of polypoidal choroidal vasculopathy(PCV) in fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA), optical coherence tomography(OCT)and the efficiency of intravitreal ranibizumab therapy for polypoidal choroidal vasculopathy. Methods: 42 patients(42 eyes) confirmed by fundus examination, FFA, ICGA and OCT were diagnosed PCV, the lesions were located in macular area. Observed the characteristic of FFA, ICGA and OCT of PCV. All patients received intravitreal ranibizumab once a month, a total of three times. Observed the change of the best corrected visual acuity(BCVA), OCT measure the central retinal thickness(CRT), the changes of retinal pigment epithelium serration and the doubleline symptom. Results: Underretinal hemorrhage, orange nodular lesion and lipidosis were the characteristic ocular fundus changes; Polyps and branching vascular networks(BVN) were the characteristic of ICGA image; Retinal pigment epithelium serration and doubleline symptom were the characteristic of OCT image. 3 months after anti-VEGF treatment, the best corrected visual acuity(BCVA) almost improved; all patients' CRT were decreased then prior treatment. Some of the eyes existd retinal pigment epithelium serration and doubleline symptom were partial disappeard after treatment. Conclusion: PCV has its ICGA and OCT imaging features and characteristic clinical feature. These features can help us make the right diagnosis. Anti-VEGF drugs have a definite effect on the treatment of PCV which can be used as one of the methods to treat PCV.
引文
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[10] 梁燕华,宋艳萍,丁琴,等.单纯光动力疗法与玻璃体腔注射雷珠单抗以及两者联合治疗息肉样脉络膜血管病变的疗效比较[J].中华眼底病杂志,2016,32:31-35.
[11] Chung SE,Kang SW,Lee JH,et al.Choroidal thickness in polypoidal choroidal vasculopathy and exudative age-related macu- lar degeneration[J].Ophthalmology,2011,118(5):840-845.
[12] Koizumi H,Yamagishi T,Yamazaki T,et al.Subfoveal choroidal thickness in typical age-related macular degeneration and polypoidal choroidal vasculopathy[J].Graefes Arch Clin Exp Ophthalmol,2011,249(8) :1123-1128.
[2] 廖明怡,陈青山.采用光学相干断层扫描诊断息肉状脉络膜病变的敏感性及特异性分析[J].中国实用医药,2018,13(18):22-24.
[3] 陈奇,杨建军,李敏.息肉状脉络膜血管病变的诊治现状与进展[J].国际眼科杂志,2017,17(8):1457-1460.
[4] 韦春宜,刘冉.息肉样脉络膜血管病变患者频域光相干断层扫描图像特征与视力预后的相关性观察[J].中华眼底病杂志,2014,30(3):241-244.
[5] Zuo CG,Wen F.Angiographic leakage of pol- ypoidal choroidal vasculopathy on indocyanine angiography [J].Chin Med J,2010,123:1548-1552.
[6] 文峰,吴德正,李海涛,等.息肉状脉络膜血管病变的眼底特征分析[J].中华眼底病杂志,2003,19(10):269-272.
[7] 王达良,罗曼,缪茶英,等.雷珠单抗治疗息肉状脉络膜血管病变的疗效观察[J].国际眼科杂志,2016,16(11):2079-2081.
[8] 王怀华.息肉样脉络膜血管病变的临床特征分析[D].济南大学,2014.
[9] 纪振宇,徐奕爽.玻璃体腔注射雷珠单抗对息肉状脉络膜血管病变中心凹下脉络膜厚度的影响[J].武汉大学学报:医学版,2019,40(1):121-124.
[10] 梁燕华,宋艳萍,丁琴,等.单纯光动力疗法与玻璃体腔注射雷珠单抗以及两者联合治疗息肉样脉络膜血管病变的疗效比较[J].中华眼底病杂志,2016,32:31-35.
[11] Chung SE,Kang SW,Lee JH,et al.Choroidal thickness in polypoidal choroidal vasculopathy and exudative age-related macu- lar degeneration[J].Ophthalmology,2011,118(5):840-845.
[12] Koizumi H,Yamagishi T,Yamazaki T,et al.Subfoveal choroidal thickness in typical age-related macular degeneration and polypoidal choroidal vasculopathy[J].Graefes Arch Clin Exp Ophthalmol,2011,249(8) :1123-1128.