Bouchenaki N, Herbort C P
Ophthalmology Unit Hôpital de la Tour Meyrin, Geneva, Switzerland.
Ophthalmology. 2001 Jan;108(1):54-64. doi: 10.1016/s0161-6420(00)00428-0.
The goal of this study was to analyze indocyanine green angiographic (ICGA) findings in Vogt-Koyanagi-Harada (VKH) disease and to determine their value in assessing choroidal involvement as well as their use for diagnostic and follow-up purposes.
Retrospective and prospective observational, interventional case series.
Ten patients with VKH disease documented with, for the retrospective cases, at least one concomitant fluorescein and indocyanine green angiogram and, for the prospective cases, follow-up angiograms performed regularly.
Indocyanine green angiography was performed according to a standard protocol used for inflammatory disorders. Systemic steroids were used for treatment.
Indocyanine green angiographic findings were correlated with funduscopy, fluorescein angiography, inflammatory activity, disease stage, and response to systemic steroids.
In newly diagnosed acute disease with exudative retinal detachments, the main features observed in all three patients were: (1) signs indicating choroidal inflammatory vasculopathy, including choriocapillaris perfusion delay in the very early angiographic phase, perivascular leakage of individual vessels in the early phase, diffusely leaking fuzzy vessels in the intermediate phase, and diffuse choroidal hyperfluorescence in the late phase; (2) hypofluorescent dark dots during the intermediate phase of angiography, either becoming isofluorescent in the late phase of the angiogram or remaining hypofluorescent, probably representing partial or full-thickness granuloma; (3) disc hyperfluorescence indicating severe papillitis; and (4) hyperfluorescent pinpoints in the area of exudative retinal detachment. Recurrences in the six patients with chronically evolving disease did not show the hyperfluorescent pinpoints. Otherwise, they showed the same features, albeit less pronounced, together with peripheral atrophic hypofluorescent lesions. In the two patients with "healed" disease for whom high-dose steroids had been initiated at an early stage, only dark hypofluorescent areas in the intermediate and late phases on the fluorescein angiogram were seen, probably representing choroidal scarring.
Consistent ICGA findings in 10 VKH patients allowed the authors to establish a fairly precise pattern of choroidal involvement. Indocyanine green angiography was especially useful to observe the evolution of choroidal inflammatory involvement and to monitor the effect of steroid therapy.
本研究的目的是分析葡萄膜大脑炎（VKH）疾病的吲哚菁绿血管造影（ICGA）结果，并确定其在评估脉络膜受累情况以及诊断和随访中的价值。
回顾性和前瞻性观察性、介入性病例系列。
10例VKH疾病患者，回顾性病例至少有一次荧光素和吲哚菁绿血管造影，前瞻性病例定期进行随访血管造影。
根据用于炎症性疾病的标准方案进行吲哚菁绿血管造影。使用全身类固醇进行治疗。
吲哚菁绿血管造影结果与眼底检查、荧光素血管造影、炎症活动、疾病分期及全身类固醇治疗反应相关。
在新诊断的伴有渗出性视网膜脱离的急性疾病中，所有3例患者观察到的主要特征为：（1）提示脉络膜炎症性血管病变的体征，包括血管造影极早期脉络膜毛细血管灌注延迟、早期单个血管周围渗漏、中期弥漫性渗漏模糊血管以及晚期弥漫性脉络膜高荧光；（2）血管造影中期低荧光暗点，在血管造影晚期变为等荧光或保持低荧光，可能代表部分或全层肉芽肿；（3）视盘高荧光提示严重视乳头炎；（４）渗出性视网膜脱离区域的高荧光小点。6例慢性进展性疾病患者的复发未显示高荧光小点。否则，他们表现出相同的特征，尽管不那么明显，同时伴有周边萎缩性低荧光病变。在2例“治愈”疾病患者中，早期开始使用高剂量类固醇，荧光素血管造影仅在中期和晚期可见暗的低荧光区，可能代表脉络膜瘢痕形成。
10例VKH患者一致的ICGA结果使作者能够建立相当精确的脉络膜受累模式。吲哚菁绿血管造影对于观察脉络膜炎症受累的演变以及监测类固醇治疗效果特别有用。
