109例中心性浆液性脉络膜视网膜病变患者眼底荧光素血管造影临床分析

发布时间：2018-06-05 09:32

本文选题：中心性浆液性脉络膜视网膜病变 + 眼底荧光血管造影　；参考：《河北医科大学》2010年硕士论文

【摘要】： 中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy, CSC) (简称“中浆病”)是一种较为常见的损害视力的眼底黄斑疾病,以后极部视网膜色素上皮层和视网膜神经层渗出性脱离为特征。1866年首次由VonGraefe报道,患者多为青年和中年,男性较多,单眼发病显著多于双眼,该病为自限性疾病,一般疗程3～4个月,易复发,反复发作将发生永久性视力减退,虽不致盲目,但其对工作生活带来诸多不便。本病发生与精神兴奋、紧张、脑力劳动过度有关,但由于病理取材的困难,中浆病的病因与发病机理一直困扰着几代眼科学者。上世纪60年代,荧光素眼底血管造影技术用于眼底病检查,使中浆病的研究有了突破进展,此项检查能反映出活体眼血-视网膜内屏障和外屏障的改变,对眼底病的诊断、鉴别诊断、指导治疗及预后等方面帮助很大。目的:观察分析经我院门诊荧光素眼底血管造影检查诊断为中浆病的109例(115只眼)患者的临床特点以及眼底荧光血管造影(fundus fluoresce- in angiography,FFA)中的动态表现,分析总结中浆病的临床特征、发病机理与治疗方法。方法:记录109例(115只眼)中浆病患者的一般情况(包括初诊年龄、病程、教育程度、患病率)、视力情况、眼底检查结果(包括视网膜情况、黄斑情况、视网膜血管情况)、性别,采用海德堡共焦激光扫描系统(Heidelberg retina angiography,HRA)对109例中浆病患者行双眼FFA检查,记录FFA特征(包括渗漏点的类型、造影表现分型、渗漏点分布情况)进行分析。结果:中浆病的FFA表现归纳4种类型:(1)渗漏点型(包括圆点扩大型、喷出型和玻璃膜疣状或窗样缺损样或视网膜色素上皮炎型) ;(2)RPE脱离型;(3)混合复杂型;(4)无渗漏点型。在109例(115只眼)中浆病患者中,女性中浆病患病率比男性低(1: 6.27),其中男性94例(86.24%),女性5例(13.76%),患病平均年龄39.8岁,以31～40岁居多(46.81%),单眼发病103例(94.49%),双眼发病6例(5.5%)。115只眼中,平均视力0.5,27例患者(23.48%)视力低于0.3。仔细询问病史,约60%患者在患病前有影响其精神心理因素的事件发生。初发或急性期患者FFA上渗漏以喷出型较为多见,渗漏点多为单发。病程较长者以墨渍样扩散较为常见。115只眼中,病程小于2周的29只眼(25.21%),平均视力0.5,以喷出型为主17只眼(58.62%),墨渍型12例(41.38%);病程大于3个月的5例(4.35%),平均视力0.6,主要以墨渍型为主3只眼(60%)。约10%的渗漏点在中心凹1mm直径范围内,其余在黄斑周围,以鼻上方和乳头黄斑束处多见,其次为鼻下,颞上和颞下。结论:FFA对中浆病的病理过程和病变部位有重要意义。病变部位是中浆病患者视力减退的主要因素,对预后及治疗有临床指导作用。由于眼底荧光血管造影可以准确的显示色素上皮屏障破坏的部位和数量,通过对109例中浆病患者进行双眼FFA检查,我们得出以下结论: 1 .渗漏位于距离黄斑中心凹1mm直径范围内,视力较差。 2 .渗漏位于中心凹2mm直径范围以外,对视力影响相对较轻。病变部位或荧光渗漏点位置距离黄斑中心凹越近,患者视力越差。 3 .神经上皮脱离范围愈大漏渗面积愈大,愈接近黄斑中心,视力损害愈严重。 4 .患者视力好坏与发病时间并无显著性相关关系,并非患者发病时间越长,视力就越差;反之亦然,患者发病时间越短,并非其视力越好。中浆病是一种与全身状态有关的疾病,单眼发病率高,它可能是全身性疾病的局部表现之一。CSC的复发可能由于隐匿的脉络膜病灶进一步发展,使局部视网膜色素上皮功能受损,导致视功能障碍;激光封闭渗漏点能促进该处的视网膜色素上皮修复,但不能预防复发。今后,全身性治疗可能成为有效的治疗手段。
[Abstract]:The central serous chorioretinopathy ( CSC ) ( hereinafter referred to as " middle - pulp disease " ) is a common type of fundus macular disease , which is a common lesion with visual acuity . In 1866 , it has been reported by VonGraefe . The disease is a self - limited disease . The disease is self - limited disease . The disease is a self - limited disease . The disease is a self - limited disease . The disease is a self - limited disease . The disease is a self - limited disease .

Objective : To observe the clinical characteristics and dynamic expression of fundus fluorescein angiography ( FFA ) in 109 patients ( 115 eyes ) diagnosed by fundus fluorescein angiography ( fundus fluorescein angiography ) in our hospital .

Methods : 109 patients ( 115 eyes ) were recorded in general conditions ( including age , duration , educational level , prevalence ) , visual acuity , fundus examination results ( including retinal , macular , retinal vessels ) , sex , and in 109 patients with moderate pulp disease by FFA . The characteristics of FFA ( including type of leak point , type of contrast manifestation , distribution of leakage point ) were recorded .

Results : FFA showed four types : ( 1 ) leakage point type ( including dot enlargement type , spray type and glass membranous verrucous or window - like defect like dermatitis type ) ; ( 2 ) RPE detachment type ; ( 3 ) mixed complex ; ( 4 ) no leakage point type .

Among the 109 cases ( 115 eyes ) , the prevalence of seroprevalence was lower than that in males ( 1 : 6.27 ) . Among them , 94 ( 86.24 % ) males and 5 females ( 13.76 % ) had a visual acuity of 39.8 years .

Conclusion : FFA is of great significance to the pathological process and the lesion part of middle - pulp disease . The lesion site is the main factor of visual deterioration in the patients with mid - pulp disease , and has a clinical guiding role in the prognosis and treatment . As the fundus fluorescein angiography can accurately display the location and quantity of the damage of pigment epithelial barrier , we conclude that the following conclusions are obtained by performing binocular FFA examination on 109 patients with moderate pulp disease :

1 . The leakage is located in the diameter range of 1 mm from the center of the macula , and the visual acuity is poor .

2 . The leakage is located outside the 2 mm diameter range of the central recess , which is relatively light to the visual effect . The closer the lesion site or the location of the fluorescence leak point is closer to the center of the macula , the worse the patient ' s vision .

3 . The larger the leakage area of the neuroepithelial cells , the more the healing approaches the center of the macula , the more severe the visual impairment .

4 . There was no significant correlation between the patient ' s visual acuity and the onset time . The longer the patient was , the worse the visual acuity ; and vice versa , the shorter the onset time of the patient , the better the visual acuity .

In the future , systemic treatment may be an effective means of treatment . In the future , systemic treatment may be an effective treatment .
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774.1

【参考文献】