Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil University Paris XII, Creteil, France.
Retina. 2010 Feb;30(2):222-34. doi: 10.1097/IAE.0b013e3181bceef0.
The purpose of this study was to analyze the angiographic (confocal scanning laser ophthalmoscopy technology) and corresponding (eye-tracked) spectral-domain optical coherence tomography (SD-OCT) features and to propose a classification for the progressive phases establishing retinal-choroidal anastomosis (RCA).
We reviewed all consecutive eyes with RCA that underwent Heidelberg Retina Angiograph angiography and tracked Spectralis SD-OCT at the University Eye Clinic of Creteil between September 2007 and March 2009.
Twenty-six eyes of 23 patients (8 men and 15 women, aged 70-88 years) showing RCA naïve to any treatment were included for analysis. In 6 of 7 eyes showing a discrete focal hyperfluorescence (focal staining), the corresponding (eye-tracked) SD-OCT scan showed a focal retinal pigment epithelium (RPE) erosion ("erosion sign") over a small, localized RPE elevation (which appeared filled with a hyperreflective material); in 7 of 8 eyes showing a typical "hot spot" in the late angiographic frames (focal leakage) and absence of a serosanguineous pigment epithelium detachment, the corresponding (eye-tracked) SD-OCT scan showed a focal RPE break leaving 2 free RPE flaps ("flap sign") at the level of a small, localized RPE elevation. In 10 of 11 eyes showing a typical hot spot in the late angiographic frames and presence of a serosanguineous pigment epithelium detachment, the corresponding (eye-tracked) SD-OCT scan showed, at the level of a large serosanguineous RPE detachment, a focal funnel-shaped RPE joining (kissing) an inverted focal funnel-shaped inner neuroepithelium ("kissing sign").
An early neovascularization (a discrete focal hyperfluorescence) arising from the choroid initially simply erodes the basement membrane/RPE (erosion sign; Phase 1) and later breaks the basement membrane/RPE (flap sign), infiltrating first into the outer retina forming an early RCA (Phase 2, a typical hot spot without a serosanguineous pigment epithelium detachment) and later into the inner retina (kissing sign) forming an established RCA (Phase 3, a typical hot spot with a serosanguineous pigment epithelium detachment).
本研究旨在分析新生血管性（共焦扫描激光检眼镜技术）和相应（眼跟踪）频域光相干断层扫描（SD-OCT）特征，并提出视网膜脉络膜吻合（RCA）渐进阶段的分类。
我们回顾了 2007 年 9 月至 2009 年 3 月在克里泰尔大学眼科诊所接受海德堡视网膜血管造影和跟踪 Spectralis SD-OCT 的所有连续 RCA 眼。
23 例患者（8 名男性和 15 名女性，年龄 70-88 岁）的 26 只眼未经任何治疗显示 RCA 纳入分析。在 7 只显示离散局灶性高荧光（局灶性染色）的眼中，相应的（眼跟踪）SD-OCT 扫描显示小的局灶性 RPE 隆起上有局灶性 RPE 侵蚀（“侵蚀征”）（表现为充满高反射物质）；在 8 只显示典型晚期血管造影中“热点”（局灶性渗漏）且无浆液性视网膜色素上皮脱离的眼中，相应的（眼跟踪）SD-OCT 扫描显示局灶性 RPE 破裂，在小的局灶性 RPE 隆起处留下 2 个游离的 RPE 瓣（“瓣征”）。在 11 只显示典型晚期血管造影中“热点”且存在浆液性视网膜色素上皮脱离的眼中，相应的（眼跟踪）SD-OCT 扫描显示在大的浆液性 RPE 脱离水平处，局灶性漏斗状 RPE 与倒置的局灶性漏斗状内神经上皮“亲吻”（“亲吻征”）。
脉络膜的早期新生血管（局灶性高荧光）最初简单地侵蚀基底膜/RPE（侵蚀征；第 1 期），然后破坏基底膜/RPE（瓣征），首先渗透到外视网膜形成早期 RCA（第 2 期，无浆液性视网膜色素上皮脱离的典型热点），然后渗透到内视网膜（亲吻征）形成已建立的 RCA（第 3 期，有浆液性视网膜色素上皮脱离的典型热点）。
