Ophthalmology Department of the University of Lausanne, Jules-Gonin Eye Hospital, Switzerland.
Am J Ophthalmol. 2012 May;153(5):910-922.e2. doi: 10.1016/j.ajo.2011.10.017. Epub 2012 Feb 4.
To investigate choroidal vascular abnormalities in peripheral exudative hemorrhagic chorioretinopathy, using dynamic ultrawide-field fluorescein angiography (FA) and indocyanine green angiography (ICGA).
Prospective observational case series.
This institutional study comprised a consecutive series of 40 patients (48 eyes) with peripheral exudative hemorrhagic chorioretinopathy. Choroidal vascular abnormalities were assessed with dynamic ultrawide-field (150-degree) FA and ICGA, using the Staurenghi 230 SLO Retina Lens and the Heidelberg scanning laser ophthalmoscope. The main outcome measures were morphologic descriptions of structural vascular abnormalities and choroidal hemodynamics (comparison with 30 normal eyes).
The peripheral mass lesions were highly exudative and hemorrhagic, and usually associated with a pigment epithelium detachment. FA revealed nonspecific alterations corresponding to the visible fundoscopic changes (window defects, blockage, staining), but no neovascular membrane. However, despite frequent masking, ICGA showed hyperfluorescent polyp-like structures in the choroid of the lesion area in 33 eyes (69%) and an abnormal choroidal vascular network in 24 eyes (50%). The abnormal choroidal vascular network filled in the arterial or early venous phase, while the polyp-like structures filled some seconds later. Optical coherence tomography revealed the typical dome-shaped elevation of the pigment epithelium over the vascular polyps. Peripheral choriocapillaris closure was observed as well as dilated shunting vessels.
Peripheral exudative hemorrhagic chorioretinopathy shares many characteristics (polyp-like choroidal telangiectases, abnormal choroidal vascular networks, exudative and hemorrhagic presentation) with polypoidal choroidal vasculopathy. Clarification of the precise role of these abnormalities requires further studies.
应用动态超广角荧光素血管造影（FA）和吲哚青绿血管造影（ICGA）观察周边渗出性出血性脉络膜视网膜病变的脉络膜血管异常。
前瞻性观察性病例系列。
本研究纳入 40 例（48 只眼）周边渗出性出血性脉络膜视网膜病变患者，均为连续病例。采用 230 SLO 视网膜镜和海德堡扫描激光检眼镜对脉络膜血管异常进行动态超广角（150 度）FA 和 ICGA 检查。主要观察指标为形态描述结构性血管异常和脉络膜血液动力学（与 30 只正常眼比较）。
周边肿块病变高度渗出性和出血性，通常伴有色素上皮脱离。FA 显示与可见眼底改变相对应的非特异性改变（窗缺损、阻塞、染色），但无新生血管膜。然而，尽管经常出现遮蔽，ICGA 在 33 只眼（69%）的病变区脉络膜中显示出息肉样结构的高荧光，在 24 只眼（50%）中显示出异常脉络膜血管网络。异常脉络膜血管网络在动脉期或早期静脉期充盈，而息肉样结构则在几秒钟后充盈。光学相干断层扫描显示色素上皮上方血管息肉的典型圆顶状隆起。还观察到周边脉络膜毛细血管闭塞和扩张的分流血管。
周边渗出性出血性脉络膜视网膜病变与息肉样脉络膜血管病变（polypoidal choroidal vasculopathy，PCV）具有许多相似的特征（息肉样脉络膜毛细血管扩张、异常脉络膜血管网络、渗出性和出血性表现）。这些异常的确切作用需要进一步研究。
