Bouchenaki Nadia, Cimino Luca, Auer Carlos, Tao Tran V, Herbort Carl P
Western Swiss Centers for Inflammatory Eye Diseases at La Source Eye Center, Lausanne & at Hôpital de la Tour, Meyrin, Geneva, Switzerland.
Klin Monbl Augenheilkd. 2002 Apr;219(4):243-9. doi: 10.1055/s-2002-30661.
By allowing one to detect fluorescence beyond the retinal pigment epithelium, indocyanine green angiography (ICGA) has made it possible to analyse the choroidal vessels. Our aim was to characterize choroidal vasculitis in posterior uveitis using ICGA.
Charts of active posterior uveitis patients with a specific diagnosis seen in the different centers participating in the study who had undergone dual fluorescein and ICG angiography were reviewed. The type of inflammatory involvement of the choroidal circulation at entry and the treatment response on follow-up angiograms were analysed.
A total of 129 patients were analysed. Choroidal vasculitis could be subdivided into two main patterns: (1) primary inflammatory choriocapillaropathy and (2) stromal inflammatory vasculopathy. The first pattern consisted of hypofluorescent areas up to the late phase of angiography characteristic for choriocapillaris non-perfusion and included entities such as multiple evanescent white dot syndrome (MEWDS), acute posterior multifocal placoid pigment epitheliopathy (APMPPE), multifocal choroiditis (MC), ampiginous choroidopathy and serpiginous choroidopathy. The second pattern consisted of fuzzy indistinct appearance of vessels in the intermediate angiographic phase and diffuse choroidal hyperfluorescence in the late phase indicating inflammatory vasculopathy of larger choroidal vessels. This pattern was found in all cases of active Vogt-Koyanagi-Harada disease, ocular sarcoidosis and tuberculosis and birdshot chorioretinopathy. In Behçet's uveitis of recent onset, choriocapillaris perfusion delay and fuzzy choroidal vessels without diffuse late choroidal hyperfluorescence was found. In posterior scleritis, enlargement of vorticous veins was an additionnal ICGA sign. Stromal inflammatory vasculopathy always responded to anti-inflammatory therapy. A third group of patients with severe retinal or choroidal inflammation presented with associated secondary inflammatory choriocapillaropathy angiographically identical to the primary involvement.
ICGA allowed the hitherto impossible characterization of inflammatory involvement of the choroidal vessels, showing either predominant inflammation of the choriocapillaris or predominant inflammation of the stromal choroidal vessels with or without secondary choriocapillaritis. ICGA will be indispensable for the correct evaluation and follow-up of posterior inflammation with suspected choroidal involvement.
通过使人们能够检测视网膜色素上皮之外的荧光，吲哚菁绿血管造影（ICGA）使得分析脉络膜血管成为可能。我们的目的是使用ICGA对后葡萄膜炎中的脉络膜血管炎进行特征描述。
回顾了参与该研究的不同中心中患有特定诊断的活动性后葡萄膜炎患者的病历，这些患者均接受了荧光素和ICG血管造影检查。分析了初诊时脉络膜循环的炎症累及类型以及随访血管造影的治疗反应。
共分析了129例患者。脉络膜血管炎可分为两种主要类型：（1）原发性炎症性脉络膜毛细血管病变和（2）基质性炎症性血管病变。第一种类型表现为造影晚期的低荧光区，这是脉络膜毛细血管无灌注的特征，包括多种一过性白点综合征（MEWDS）、急性后极部多灶性鳞状色素上皮病变（APMPPE）、多灶性脉络膜炎（MC）、匐行性脉络膜病变和匐行性脉络膜视网膜病变等疾病。第二种类型表现为造影中期血管模糊不清，晚期脉络膜弥漫性高荧光，提示较大脉络膜血管的炎症性血管病变。这种类型见于所有活动性Vogt - 小柳 - 原田病、眼结节病、结核病和鸟枪弹样视网膜脉络膜病变病例。在近期发作的白塞氏葡萄膜炎中，发现脉络膜毛细血管灌注延迟和脉络膜血管模糊，但无弥漫性晚期脉络膜高荧光。在后巩膜炎中，涡状静脉增粗是ICGA的另一个表现。基质性炎症性血管病变总是对抗炎治疗有反应。第三组患有严重视网膜或脉络膜炎症的患者表现出相关的继发性炎症性脉络膜毛细血管病变造影表现与原发性病变相同。
ICGA使迄今无法实现的对脉络膜血管炎症累及情况的特征描述成为可能，显示出脉络膜毛细血管的主要炎症或基质性脉络膜血管的主要炎症，伴或不伴有继发性脉络膜毛细血管炎。ICGA对于正确评估和随访疑似脉络膜受累的后部炎症将是不可或缺的。
