362例息肉样脉络膜血管病变患者的临床特征分析

摘要

目的 观察华中地区息肉样脉络膜血管病变(PCV)患者的临床特征.方法 经眼底检查、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)和光相干断层扫描(OCT)检查确诊为PCV的362例患者403只眼纳入研究.回顾分析最佳矫正视力(BCVA)、眼底表现、影像学检查结果等临床特征.结果362例患者中,男性249例,占68.8％;女性113例,占31.2％.年龄45～91岁,平均年龄(64.81±9.31)岁.双眼发病41例,占11.3％;单眼发病321例,占88.7％.BCVA手动～1.2.403只眼中,眼底可见典型橘红色病灶162只眼,占40.2％;黄白色渗出185只眼,占45.9％;面积较大的不同程度视网膜下出血268只眼,占66.5％;玻璃膜疣23只眼,占5.7％;色素增生20只眼,占5.0％;纤维血管性瘢痕96只眼,占23.8％.PCV病灶位于黄斑区386只眼,占95.8％;位于视盘周53只眼,占13.2％;PCV病灶呈多灶性67只眼,占16.6％.病灶呈囊袋样荧光积存304只眼,占75.4％;脉络膜异常血管网152只眼,占37.7％.出血性视网膜色素上皮脱离(PED) 200只眼,占49.6％;浆液性PED 96只眼,占23.8％;同时存在出血性及浆液性PED 25只眼,占6.2％.视网膜神经上皮层间囊样暗腔56只眼,占13.9％;视网膜色素上皮与Bruch膜层分离,出现“双层征”109只眼,占27.0％.RPE层下穹窿状隆起274只眼,占68.0％;神经上皮层脱离151只眼,占37.6％.结论 华中地区PCV患者单眼发病率、男性患病率较高;病灶绝大多数位于黄斑区,眼底多可见视网膜下出血、息肉样病灶及脉络膜异常血管网,出血性PED比例较浆液性PED高.%Objective To investigate the clinical characteristics of patients with polypoidal choroidal vasculopathy (PCV) from Central China.Methods This was a retrospective study,and 403 eyes of 362patients diagnosed as PCV by ocular fundus photography,fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were enrolled.The general clinical data,fundus manifestation and ocular fundus examinations were statistically analyzed.Results Three hundred and sixty-two cases included 249 males (68.8％) and 113 females (31.2％).Age ranged from 45 to 91 years old,and mean age was (64.81±9.31) years old.Bilateral lesions were observed in 41 patients (11.3％) and unilateral lesions were observed in 321 patients (88.7％).In these 403 eyes,typical orange-red lesions were observed in 162 eyes (40.2 ％) ; yellowish-white exudate could be found in 185 eyes (45.9％); 268 eyes (66.5％) showed variable degrees of subretinal hemorrhage.Drusen was found in 23 eyes (5.7％),pigment proliferation in 20 eyes (5.0％) and fiber vascular scar in 96 eyes (23.8％).The lesions of 386 eyes (95.8％) located in macular region,53 eyes (13.2％) in peripapillary area.Lesions presented multi-foci in 67 eyes (16.6％).Three hundred and four eyes (75.4％) presented typical polypoidal lesions and 152 eyes (37.7％) with abnormal branching choroidal networks.Hemorrhagic retinal pigment epithelial detachments (PED) were found in 200 eyes (49.6％) and serous PED in 96 eyes (23.8％),both existed in 25 eyes(6.2％).OCT showed 56 eyes (13.9％) presented cystoid dark chamber between the neurosensory retina and 109 eyes (27.0％) with double-layer sign formed by the separation of retinal pigment epithelium and Bruch's membrane (27.0％).Two hundred and seventy-four eyes (68.0 ％)were found with cone-like elevation beneath the RPE layer and 151 eyes (37.6％) with neurosensory detachment.Conclusions In Central China,the majority of PCV patients were male,unilateral.Most PCV lesions were located in the macula.Subretinal hemorrhage,polypoidal lesions and abnormal choroidal vascular networks were common in the PCV patients.Hemorrhagic PED presented a higher ratio than serous PED.