儿童广角荧光素眼底血管造影在激光光凝治疗家族性渗出性玻璃体视网膜病变中的应用价值及疗效观察

摘要

目的 观察评估儿童广角荧光素眼底血管造影(FFA)在激光光凝治疗家族性渗出性玻璃体视网膜病变(FEVR)中的应用价值及疗效.方法 临床确诊为FEVR 2期的34例患儿46只眼纳入研究.所有患儿均于全身麻醉状态下应用儿童广角数码视网膜成像仪拍摄彩色眼底像,随后行FFA检查.对比分析彩色眼底像及FFA像对视网膜新生血管的识别度.根据FFA检查显示的异常渗漏血管范围,用双目间接检眼镜激光光凝视网膜周边血管异常渗漏处.波长532 nm,持续时间0.25 s,能量200～280 mW.激光光凝结束后,重复进行眼底影像检查并与治疗前检查像进行对照,对激光光凝遗漏区即刻补充激光光凝.治疗后平均随访时间14.4个月.激光光凝后3个月内,主要观察是否有新生血管、渗出病灶、玻璃体牵引以及激光光凝斑是否融合形成色素斑块;激光光凝3个月后,主要观察是否有纤维增生膜牵拉黄斑、牵引性视网膜脱离、玻璃体积血或类Coats样反应出现大量渗出等视网膜不良结构.同时观察治疗后并发症发生情况.结果 彩色眼底像对血管识别困难,有时会遗漏无血管区,无法从血管形态辨别新生血管;FFA像可以发现彩色眼底像中无法识别的新生血管,异常新生血管表现为无血管区交界处荧光素渗漏.FFA像结合相同角度的彩色眼底像,沿血管定位,能在双目间接检眼镜下快速精准地定位病变区域.所有患眼治疗过程中均未发现激光光凝遗漏区,未再补充激光光凝.激光光凝后3个月内,所有患眼未出现新的新生血管、渗出病灶及玻璃体牵引.随访期末,所有患眼均未发生视网膜不良结构.FFA检查过程中以及激光光凝治疗过程中和治疗后,所有患儿均未发生眼部及全身并发症.结论 FEVR患眼激光光凝治疗前应用儿童广角FFA检查,可清晰识别异常新生血管,定位病变区域;在其指导下行激光光凝治疗可一次成功,无眼部及全身并发症发生.%Objective To observe the application value and therapeutic efficacy of wide-field digital pediatric retinal imaging system (Retcam Ⅲ) fundus fluorescein angiograms (FFA) assisted photocoagulation on familial exudative vitreoretinopathy (FEVR).Methods The study included 46 eyes of 34 patients with staging 2 FEVR.All patients received color fundus photography and FFA under general anesthesia.The blood vessel reliability of color fundus photography and FFA was comparatively determined.Binocular indirect ophthalmoscope laser photocoagulation was applied to peripheral retina with abnormal leakage as indicated by FFA,the wavelength was 532nm,the duration was 0.25 s and the energy was 200-280 mW.After laser photocoagulation,fundus imaging and FFA was repeated.Further laser photocoagulation was immediately added to areas with vessel leakage but missing the photocoagulation.After treatment,the mean follow-up duration was 14.4 months.The follow up focused on neovascularization,exudative lesions,vitreous traction and merging of photocoagulation spots within 3 months,and on fibrosis membrane resulting in macular traction,tractional retinal detachment,vitreous hemorrhage or Coats disease-like retinal exudates after 3 months.Results It was hard to identify the blood vessels based on the color fundus images and some avascular zone maybe missed.Neovascularization can't be determined by shape of the blood vessels.On the other hand,those new blood vessels can be easily recognized by FFA as leakage sites at the boundary of avascular zone.The surgeon could quickly and accurately locate the FEVR area guided by the color fundus images and FFA from same angle under binocular indirect ophthalmoscope.During the treatment,there was no retinal FEVR area missed laser photocoagulation for all patients.There was no neovascularization,exudative lesions,vitreous traction within 3 months,and no fibrosis membrane,tractional retinal detachment,vitreous hemorrhage or Coats disease-like retinal exudates after 3 months.There were no ocular and systemic complications during and after the FFA and laser photocoagulation.Conclusion Wide-field Retcam Ⅲ FFA can help retinal specialists to identify abnormal neovascularization,locate the lesion area,and thus increase the success rate of laser photocoagulation,reduce the ocular and systemic complications for FEVR.