摘要目的 观察息肉样脉络膜血管病变(PCV)中分支血管网(BVN)的影像特征.方法 初诊为PCV且未经治疗的80例患者90只眼纳入研究.其中,男性58例,女性22例;年龄49～85岁,平均年龄61.4岁.所有患者均行眼底彩色照相、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)和光相干断层扫描(OCT)检查.FFA检查显示的荧光逐渐增强的视网膜下边界清楚的欠均质强荧光斑视为纤维血管性色素上皮脱离(PED);ICGA检查显示的晚期呈苔藓样边界清楚的强荧光斑视为晚期苔藓样强荧光斑;OCT检查显示的视网膜色素上皮(RPE)光带与Bruch膜光带较大范围的浅脱离视为双层征.结果 90只眼中,伴有BVN者76只眼,占84.4％.眼底检查发现,橘红色病灶中含有与BVN对应的分支状成分18只眼,占所有患眼的20.0％,占伴有BVN患眼的23.7％.FFA检查发现,伴有BVN的76只眼中,早期可透见部分或全部BVN者56只眼,占73.7％;BVN造影全程仅显示为对应的分支状透见荧光3只眼,占3.9％;表现为隐匿性脉络膜新生血管73只跟,占96.1％,其中表现为纤维血管性PED者21只眼,占伴有BVN患眼的27.6％.ICGA检查发现,伴有BVN的76只眼,其BVN显影均早于息肉样病灶,息肉样病灶位于BVN末端62只眼,占81.6％;晚期显示与BVN对应的苔藓样强荧光斑69只眼,占90.8％.苔藓样强荧光斑范围均等于或大于ICGA早期显示的BVN和息肉样病灶范围.OCT检查发现,伴有BVN的76只眼中,可见双层征72只眼,占94.7％.其中,双层征脱离腔内存在与ICGA影像中息肉样病灶对应的管腔样结构15只眼,占20.8％;双层征脱离腔内的中等反射填充不均匀,夹杂点状和线状强反射65只眼,占90.3％;双层征底部存在与ICGA影像中的BVN起点对应的短段弱反射和Bruch膜缺口2只跟,占2.8％;双层征范围与ICGA晚期显示的苔藓样强荧光斑范围吻合63只眼,占87.5％.结论 PCV中BVN眼底可表现为视网膜下的橘红色分支;FFA大多表现为早期可透见其分支行径但全程显示为隐匿性脉络膜新生血管;ICGA晚期大多表现为苔藓样强荧光斑;OCT主要表现为双层征且大部分与苔藓样强荧光斑范围吻合.

abstractsObjective To observe the imaging features of branching vascular network (BVN) in polypoidal choroidal vasculopathy (PCV).Methods Eighty PCV patients (90 eyes) were enrolled in this study.The patients included 58 males and 22 females.The age was ranged from 49 to 85 years,with a mean age of 61.4 years.All the patients were examined for fundus photography,fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA) and optical coherence tomography (OCT).The fibrovascular retinal pigment epithelium detachment (PED) was defined as a well-demarcated subretinal heterogeneous plaque with increasing fluorescence on FFA.The late lichenoid hyperfluorescent plaque was defined as a well-demarcated lichenoid hyperfluorescent plaque on late phase ICGA.The double-layer sign on OCT was defined as a wide range of shallow PED from Bruch membrane.Results BVN were found on early ICGA in 76 eyes among the 90 eyes (84.4％).Among these 76 eyes,18 eyes (23.7％) demonstrated the subretinal reddish-orange branches corresponding to BVN.Fifty-six eyes (73.7％) demonstrated all or part of the BVN on early FFA.Three eyes (3.9％) demonstrated branching transmitted fluorescence corresponding to BVN throughout the FFA.Seventy-three eyes (96.1％) were manifested by occult choroidal vascularization on FFA,and 21 eyes (27.6％) of them were fibrovascular PED.Among the 76 eyes with BVN,all BVN appeared earlier than polypoidal lesions on ICGA.Polypoidal lesions located on the terminal of BVN in 62 eyes (81.6％).Sixty-nine eyes (90.8％) on ICGA demonstrated the late lichenoid hyperfluorescent plaque,whose area was equal to or greater than the area of BVN shown on early ICGA.Seventy-two eyes (94.7％) had the double layer sign.Among these 72 eyes,15 eyes (20.8％) had lumen like structure within the double-layer sign.Sixty-five eyes (90.3％) had punctate and linear hyperreflectance within the double-layer sign.Two eyes (2.8％) demonstrated a hyporeflective short segment and a gap of Bruch membrane on OCT corresponding to the origin of the BVN.Sixty-three eyes (87.5％) had an area of double-layer sign that matched the area of late lichenoid hyperfluorescent plaque on ICGA.Conclusions BVN in PCV can be noted as reddish-orange branches on fundus examination.Most of the BVN are shown as early branching transmitted fluorescence but collectively an occult choroidal vascularization on FFA,as lichenoid hyperfluorescent plaque on late ICGA,and as double-layer sign on OCT whose area matches late lichenoid hyperfluorescent plaque.