Spolaore R, Gaudric A, Coscas G, de Margerie J
Am J Ophthalmol. 1984 Dec 15;98(6):707-16. doi: 10.1016/0002-9394(84)90685-8.
Four eyes (of three patients) with sectorial choroidal ischemia by temporal arteritis or carotid obstruction underwent fluorescein angiography during and after the acute phase. In all cases hypoperfusion affected the whole temporal choroid; however, disturbance of retinal pigment epithelium was much less extensive. In two cases the retinal pigment epithelium became necrotic and scarred within a limited area that was typically triangular in shape; in the third case scarring was limited to some pigmented streaks, and in the fourth case, retinal pigment epithelium remained normal. The triangular scar that appeared after episodes of choroidal hypoperfusion did not seem to be a true reflection of the extent of the choroidal artery obstruction in the acute phase. Our observations suggest that the deficient choroidal perfusion involved more than the choroidal artery supplying the triangular area of pigment epithelium disturbance. Several mechanisms (for example, retrograde venous filling, restoration of perfusion) reduce the deleterious effects of ischemia. Thus the necrosis of the retinal pigment epithelium would appear in only those sectors where ischemia was particularly severe or prolonged.
三名患有颞动脉炎或颈动脉阻塞导致扇形脉络膜缺血的患者（共四只眼）在急性期及之后接受了荧光素血管造影。在所有病例中，灌注不足累及整个颞侧脉络膜；然而，视网膜色素上皮的紊乱范围要小得多。两例中，视网膜色素上皮在一个典型三角形的有限区域内发生坏死并形成瘢痕；第三例中，瘢痕仅限于一些色素沉着条纹，第四例中，视网膜色素上皮保持正常。脉络膜灌注不足发作后出现的三角形瘢痕似乎并非急性期脉络膜动脉阻塞程度的真实反映。我们的观察结果表明，脉络膜灌注不足所涉及的范围超过了供应色素上皮紊乱三角形区域的脉络膜动脉。几种机制（例如，逆行静脉充盈、灌注恢复）减轻了缺血的有害影响。因此，视网膜色素上皮坏死仅出现在缺血特别严重或持续时间特别长的那些区域。
