视网膜血管瘤样增生和湿性年龄相关性黄斑病变的鉴别

摘要

视网膜血管瘤样增生( retinal angiomatous proliferation, RAP)是湿性年龄相关性黄斑变性( age-related macular degeneration,AMD)的一种特殊类型,临床一般分三期,晚期有新生血管形成,但与起源于脉络膜的新生血管不同,多数学者认为RAP的新生血管起源于视网膜深层毛细血管网。目前对RAP和湿性AMD两者到底是同一种疾病的不同亚型还是独立的两种疾病还存在争议,由于两者的病程、预后及治疗存在差异,因此临床鉴别诊断十分重要。近年来,随着吲哚菁绿血管造影( indocyanine green angiography,ICGA )技术和新一代光学相干断层扫描( optical coherence tomography, OCT )技术的应用,对 RAP和湿性AMD的鉴别取得了显著进步。本文就两者的临床表现、自然病程、治疗方法及预后等方面做一综述。%Retinal angiomatous proliferation ( RAP ) is a special type of wet age-related macular degeneration ( AMD ) and is classified into stages Ⅰ ~ Ⅲ by clinical manifestations, the form of neovascularization at the end stage. Differed with several types of neovascular AMD, the neovascularizations in RAP are believed to originate from the inner retinal capillary network. At present, it is controversial that RAP and wet AMD are different subtypes of the same disease or two independent diseases. Clinical differential diagnosis of the two diseases are important because of their different nature history, prognosis and treatments. In recent years, the identification of RAP and wet AMD has made significant progress with new technology application, such as the indocyanine green angiography ( ICGA ) and optical coherence tomography ( OCT) . In this paper, the clinical manifestations, natural history, treatments and prognosis of the two diseases were reviewed.