Veronese Chiara, Staurenghi Giovanni, Pellegrini Marco, Maiolo Chiara, Primavera Laura, Morara Mariachiara, Armstrong Grayson W, Ciardella Antonio P
Ophthalmology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Ophthalmology Unit, Sacco Hospital, University of Milan, Milan, Italy.
Retin Cases Brief Rep. 2019;13(3):260-265. doi: 10.1097/ICB.0000000000000575.
The aim of this study is to describe the clinical presentation of vortex vein varices with multimodal imaging.
The authors carried out a retrospective case series of eight patients (7 female, 1 male) with an average age of 60.2 years (min 8, max 84, median 68.5) presenting with vortex vein varices. All patients were evaluated at the Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy and at Luigi Sacco Hospital, University of Milan, Milan, Italy. Patients underwent complete ophthalmologic examinations, including best corrected visual acuity, intraocular pressure, anterior segment, and fundus examination. Imaging studies, including fundus color photography, near-infrared reflectance imaging, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and spectral-domain enhanced depth imaging optical coherence tomography were also performed. Ultra-widefield fluorescein angiography and ultra-widefield indocyanine angiography using the Heidelberg Retina Angiograph and the Staurenghi 230 SLO Retina Lens were used to demonstrate the disappearance of all retinal lesions when pressure was applied to the globe.
All eight cases initially presented to the emergency room. One patient presented secondary to trauma, two patients presented for suspected hemangioma, whereas the other five were referred to the authors' hospitals for suspected retinal lesions. On examination, retinal abnormalities were identified in all 8 patients, with 7 (87.5%) oculus dexter and 1 (12.5%) oculus sinister, and with 1 (12.5%) inferotemporally, 3 (37.5%) superonasally, 3 (37.5%) inferonasally, and 1 (12.5%) inferiorly. Fundus color photography showed an elevated lesion in seven patients and a nonelevated red lesion in one patient. In all patients, near-infrared reflectance imaging showed a hyporeflective lesion in the periphery of the retina. Fundus autofluorescence identified round hypofluorescent rings surrounding weakly hyperfluorescent lesions in all patients. On fluorescein angiography, all lesions were initially hyperfluorescent with a hypofluorescent ring, with the lesion becoming hyperfluorescent after injection of dye. Indocyanine green angiography demonstrated dilation of the vortex vein ampullae in all patients. Spectral-domain enhanced depth imaging optical coherence tomography demonstrated dilated choroidal vessels and a hyporeflective cavity without subretinal fluid in all patients. Ultra-widefield fluorescein angiography and ultra-widefield indocyanine angiography demonstrated disappearance of all retinal lesions when pressure was applied to the globe. Findings are consistent with the diagnosis of vortex vein varix in all eight patients, with six patients (75%) exhibiting a single varix and two patients (25%) exhibiting a double varix.
The diagnosis of vortex vein varices can be confirmed through clinical examination through the use of digital pressure to the globe during ophthalmoscopic examination. Adjunctive multimodal imaging (fundus color photography, near-infrared reflectance imaging, fundus autofluorescence, fluorescein angiography, indocyanine angiography, and spectral-domain enhanced depth imaging optical coherence tomography) was useful in the diagnosis of vortex vein varices in the authors' clinical cases. However, in more challenging clinical cases, the authors' novel use of the ultra-widefield contact lens for application of ocular pressure with a resulting resolution of the varix proved to be a useful and easy diagnostic imaging method for confirming the presence of vortex vein varices.
本研究旨在通过多模态成像描述涡静脉静脉曲张的临床表现。
作者对8例（7例女性，1例男性）平均年龄60.2岁（最小8岁，最大84岁，中位数68.5岁）的涡静脉静脉曲张患者进行了回顾性病例系列研究。所有患者均在意大利博洛尼亚大学圣奥索拉-马尔皮基医院和意大利米兰大学路易吉·萨科医院接受评估。患者接受了全面的眼科检查，包括最佳矫正视力、眼压、眼前节和眼底检查。还进行了影像学检查，包括眼底彩色照相、近红外反射成像、眼底自发荧光、荧光素血管造影、吲哚菁绿血管造影和光谱域增强深度成像光学相干断层扫描。使用海德堡视网膜血管造影仪和斯陶伦吉230 SLO视网膜透镜进行超广角荧光素血管造影和超广角吲哚菁绿血管造影，以显示当对眼球施加压力时所有视网膜病变的消失。
所有8例患者最初均到急诊室就诊。1例患者因外伤就诊，2例患者因疑似血管瘤就诊，而其他5例因疑似视网膜病变转诊至作者所在医院。检查发现，所有8例患者均有视网膜异常，右眼7例（87.5%），左眼1例（12.5%）；病变部位为颞下1例（12.5%）、鼻上3例（37.5%）、鼻下3例（37.5%）、下方1例（12.5%）。眼底彩色照相显示7例患者有隆起性病变，1例患者有非隆起性红色病变。在所有患者中，近红外反射成像显示视网膜周边有低反射病变。眼底自发荧光在所有患者中均识别出围绕弱高荧光病变的圆形低荧光环。在荧光素血管造影中，所有病变最初均为高荧光并伴有低荧光环，注射染料后病变变为高荧光。吲哚菁绿血管造影显示所有患者的涡静脉壶腹扩张。光谱域增强深度成像光学相干断层扫描显示所有患者脉络膜血管扩张且有一个无视网膜下液的低反射腔。超广角荧光素血管造影和超广角吲哚菁绿血管造影显示当对眼球施加压力时所有视网膜病变消失。所有8例患者的检查结果均符合涡静脉瘤的诊断，其中6例（75%）为单个瘤，2例（25%）为双个瘤。
通过在检眼镜检查期间对眼球施加数字压力进行临床检查，可以确诊涡静脉静脉曲张。辅助多模态成像（眼底彩色照相、近红外反射成像、眼底自发荧光、荧光素血管造影、吲哚菁绿血管造影和光谱域增强深度成像光学相干断层扫描）在作者的临床病例中对涡静脉静脉曲张的诊断很有用。然而，在更具挑战性的临床病例中，作者创新性地使用超广角接触镜施加眼压，从而使瘤消失，这被证明是一种有用且简便的诊断成像方法，可用于确认涡静脉静脉曲张的存在。
