摘要目的 观察脉络膜转移癌患者的眼底多模式影像特征.方法 回顾性临床观察性研究.2016年1月至2018年11月在云南省第二人民医院眼科检查确诊的脉络膜转移癌患者28例38只眼纳入研究.其中,男性12例,女性16例;单眼18例,双眼10例.平均年龄(50.8±6.9)岁.全身抗肿瘤治疗后,脉络膜转移病灶消退3例4只眼.所有患者均行超广角眼底彩色照相、红外眼底照相(IR)、FAF、FFA、频域OCT、B型超声检查.结果 超广角眼底彩色照相检查发现,所有患眼瘤体均位于视网膜后极部或中周部.其中,孤立性病灶26只眼,多灶性病灶12只眼.瘤体均呈黄白色隆起,其中伴或不伴色素沉着分别为11、27只眼.合并渗出性视网膜脱离12只眼.较新鲜瘤体26只眼,陈旧瘤体10只眼,新旧瘤体共存2只眼.抗肿瘤治疗后瘤体消退的4只眼,瘤体明显缩小,变平,表面色素沉着.IR检查发现,瘤体均呈不同程度斑驳状反射;渗出性视网膜脱离区域IR呈相对弱反射.FAF检查发现,瘤体内呈斑块状较强自身荧光(AF) 14只眼,呈强弱荧光混合形成的斑驳状AF13只眼.陈旧瘤体10只眼中,可见“豹斑样”AF 3只眼.FFA检查发现,瘤体早期呈弱荧光,中期其周围出现针尖样强荧光点,晚期呈弥漫性强荧光32只眼.陈旧瘤体呈“豹斑样”荧光2只眼.频域OCT检查发现,所有患眼脉络膜及RPE层不同程度波浪状隆起,视网膜神经上皮层与RPE层间可见大量细颗粒状或团状强反射物质堆积.抗肿瘤治疗后瘤体消退的4只眼,治疗后瘤体变平消失,RPE点状突起.B型超声检查发现,所有患眼后极部实质性占位病变、内部回声均匀.瘤体呈扁平形23只眼,扁平半球形12只眼,不规则形3只眼.结论 眼底彩色照相可显示转移病灶的大小、部位,色素改变及周围视网膜病变情况;IR可在瘤体、渗出区、萎缩区呈现不同反射信号;FAF可显示病变内RPE破坏情况;FFA较新鲜瘤体荧光素渗漏,而陈旧萎缩瘤体则为透见荧光;频域OCT可反映瘤体高度、RPE改变等特征.

abstractsObjective To observe the multimodal imaging characteristics ofchoroidal metastasis.Methods A retrospective clinical observation study.From January 2016 to November 2018,28 patients with choroidal metastasis diagnosed in Department of Ophthalmology in the Second People's Hospital of Yunnan Province were included in the study.There were 12 males and 16 females,with the mean age of 50.8±6.9 years.There were 18 unilateral patients and 10 bilateral patients.The lesion of choroidal metastasis was regressed after systemic antitumor therapy in 3 patients (4 eyes).All patients underwent ultra-wide-angle fundus photography,infrared fundus imaging,fundus autofluorescence,FFA,frequency-domain OCT,and B-ultrasound examinations.Results In the ultra-wide-angle fundus photography,metastatic tumors were located in the posterior or middle part of the retina,of which 26 were isolated lesions and 12 were multifocal.A yellow-white bulge lesion with (11 eyes) or without pigmentation (27 eyes).There were 12 eyes with exudative retinal detachment.Infrared photography of the fundus showed that the tumor area showed varying degrees of mottled brightness change,and the infrared photograph of the exudative retinal detachment area was relatively low.Fundus autofluorescence showed that 14 eyes had plaque-like strong autofluorescence in the tumor,13 eyes had a mottled autofluorescence formed by strong and weak fluorescence in the tumor;3 eyes of old lesions showed "leopard-like" autofluorescence.Among the 38 eyes in the fluorescein angiography,32 eyes of the early lesions showed low fluorescence,and the venous phase showed a needle-like high fluorescence point,and the post-leakage fluorescence gradually increased.Two eyes with old lesions showed a "leopard-like" change.In 38 eyes,OCT showed wavy ridges of the choroid and pigment epithelium,and a large number of fine-grained or cluster-like high-reflector accumulations were observed between the retinal neuroepithelial layer and the pigment epithelial layer.B-ultrasound showed substantial lesions in the posterior pole and uniform internal echo.There were 23 eyes with flat shape,12 eyes with flat hemisphere,and 3 eyes with irregular shape.Conclusions Color photography of the fundus showed the size,location,pigmentation and peripheral retinopathy of the metastatic lesions.Infrared photography showed different reflex signals in the tumor,exudation,and atrophy.The autofluorescence of the fundus showed the damage of pigment epithelium in the lesion.In the fluorescein angiography,the fresh tumor showed fluorescence leakage,while the atrophic tumor showed transmitted fluorescenc.OCT reflected the height of the lesion and the change of pigment epithelium.