Kim Hanna Y, Hodapp Elizabeth, Grajewski Alana L, Sarraf David, John Vishak J, Hess Ditte J, Berrocal Audina M
*Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; †Department of Ophthalmology, University of Minnesota, Minneapolis, Minneapolis; and ‡Department of Ophthalmology, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California. Dr. Kim is now at the Department of Ophthalmology, Kaiser Permanente, Woodland Hills, California.
Retina. 2015 May;35(5):1028-35. doi: 10.1097/IAE.0000000000000415.
To report wide-field fluorescein angiography findings in the peripheral retina of eyes with childhood glaucoma.
Fluorescein angiograms were examined retrospectively in 12 patients with childhood glaucoma who underwent wide-field fluorescein angiography after surgical or medical treatment of glaucoma. This series included 12 eyes of 6 patients with primary congenital glaucoma, 5 eyes of 3 patients with glaucoma associated with congenital cataract surgery, 4 eyes of 2 patients with glaucoma associated with a systemic condition, and 1 eye of 1 patient with phakomatosis pigmentovascularis Type II. RetCam fundus photography images and digital fluorescein angiography were performed under general anesthesia.
The most common finding observed in our series was peripheral retinal nonperfusion, which affected 20 eyes (91%). Other notable features seen were circumferential branching of the retinal vessels parallel to the ora serrata (77%), venous shunts (50%), and abnormal capillary branching patterns, including capillary dilatation (41%) and tortuous capillary tangles (18%). Leakage at the junction of vascular and avascular retina was not commonly seen (13.6%). None of the eyes had evidence of retinal neovascularization or fibrovascular proliferation.
Retinal vascular abnormalities and peripheral nonperfusion are novel findings in childhood glaucoma. Further studies are needed to understand the significance and possible long-term consequences of these findings.
报告儿童青光眼患者周边视网膜的广角荧光素血管造影结果。
回顾性检查12例儿童青光眼患者的荧光素血管造影，这些患者在青光眼手术或药物治疗后接受了广角荧光素血管造影。该系列包括6例原发性先天性青光眼患者的12只眼，3例与先天性白内障手术相关的青光眼患者的5只眼，2例与全身性疾病相关的青光眼患者的4只眼，以及1例II型色素血管性母斑病患者的1只眼。RetCam眼底摄影图像和数字荧光素血管造影在全身麻醉下进行。
在我们的系列中观察到的最常见发现是周边视网膜无灌注，累及20只眼（91%）。其他显著特征包括与锯齿缘平行的视网膜血管的圆周分支（77%）、静脉分流（50%）以及异常的毛细血管分支模式，包括毛细血管扩张（41%）和曲折的毛细血管缠结（18%）。血管性和无血管性视网膜交界处的渗漏并不常见（13.6%）。所有眼睛均无视网膜新生血管或纤维血管增生的证据。
视网膜血管异常和周边无灌注是儿童青光眼的新发现。需要进一步研究以了解这些发现的意义和可能的长期后果。
