Yuzawa M, Kawamura A, Yamaguchi C, Shouda M, Shimoji M, Matsui M
Department of Ophthalmology, Nihon University, School of Medicine, Tokyo, Japan.
Ophthalmology. 1995 Apr;102(4):622-9. doi: 10.1016/s0161-6420(95)30990-6.
Several forms of retinal pigment epithelial detachment have been reported. The authors used indocyanine green (ICG) videoangiography, which is useful to study the choroidal vasculature and Bruch membrane, to study pigment epithelial detachments.
Ninety-eight pigment epithelial detachments in 75 eyes were classified based on the appearance of choroidal neovascular membranes or late phase findings of ICG videoangiography done at the initial examination. The authors also followed the evolution of 51 such detachments not associated with choroidal neovascularization (CNV).
Sixty-four pigment epithelial detachments without CNV were divided into five groups. Among eyes with pigment epithelial detachments that showed intense hyperfluorescence, all except one of the patients had both eyes involved and had several pigment epithelial detachments, sometimes with exudative retinal detachments. Weak hyperfluorescence was observed more often in younger patients. During follow-up of eyes with pigment epithelial detachments that showed irregular hypofluorescence, a neovascular membrane developed in one eye, microrips developed in four eyes and retinochoroidal folds in one eye. Most eyes that showed irregular hyperfluorescence developed atrophy of the retinal pigment epithelium. In 34 pigment epithelial detachments with CNV, either irregular hypofluorescence or absence of fluorescence was observed in areas that corresponded to the pigment epithelial detachment.
The intense hyperfluorescence is thought to be due to the accumulation of protein-rich fluid within the pigment epithelial detachment. Most pigment epithelial detachments that showed weak fluorescence probably represent variants of central serous choroidopathy. Pigment epithelial detachments that showed irregular hypofluorescence or hyperfluorescence were associated with age-related macular degeneration, and the former was correlated closely with CNV. Close follow-up therefore is recommended for eyes with pigment epithelial detachments that show irregular hypofluorescence.
已报道了几种视网膜色素上皮脱离的形式。作者使用吲哚菁绿（ICG）血管造影术来研究色素上皮脱离，该技术有助于研究脉络膜血管系统和布鲁赫膜。
根据初次检查时脉络膜新生血管膜的外观或ICG血管造影术的晚期表现，对75只眼中的98处色素上皮脱离进行分类。作者还对51处不伴有脉络膜新生血管形成（CNV）的此类脱离的演变过程进行了随访。
64处无CNV的色素上皮脱离被分为五组。在色素上皮脱离且显示强烈高荧光的眼中，除1例患者外，所有患者均双眼受累且有多处色素上皮脱离，有时伴有渗出性视网膜脱离。弱高荧光在年轻患者中更常见。在对显示不规则低荧光的色素上皮脱离眼进行随访期间，一只眼出现了新生血管膜，四只眼出现了微小裂孔，一只眼出现了视网膜脉络膜皱褶。大多数显示不规则高荧光的眼发生了视网膜色素上皮萎缩。在34处伴有CNV的色素上皮脱离中，在与色素上皮脱离相对应的区域观察到不规则低荧光或无荧光。
强烈高荧光被认为是由于色素上皮脱离内富含蛋白质的液体积聚所致。大多数显示弱荧光的色素上皮脱离可能代表中心性浆液性脉络膜病变的变异型。显示不规则低荧光或高荧光的色素上皮脱离与年龄相关性黄斑变性有关，前者与CNV密切相关。因此，对于显示不规则低荧光的色素上皮脱离眼，建议密切随访。
