Clinical features of early and late stage polypoidal choroidal vasculopathy characterized by lesion size and disease duration
Clinical features of early and late stage polypoidal choroidal vasculopathy characterized by lesion size and disease duration
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DOI：
10.1007/s00417-007-0680-8
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发表时间：
2008-04-01
影响因子：
2.7
通讯作者：
Sakamoto, Taiji
中科院分区：
文献类型：
--
作者：
Okubo, Akiko;Hirakawa, Mayumi;Sakamoto, Taiji
背景息肉状脉络膜血管病变（PCV）的发病机制，甚至其临床特征，是有争议的。先前的组织病理学研究已经确定了不同的特征;扩张的脉络膜血管或布鲁赫内新生血管。这些差异可能部分归因于疾病阶段的影响。方法对97例110眼PCV患者的临床资料进行回顾性分析。研究了主观视觉异常发作与在我们诊所检查之间的时间以及首次检查时总病变的最大线性尺寸。视力障碍的时间和病变大小数据按升序排列，以确定第一四分位数点。两个值均等于或低于第一四分位数点的眼睛被归类为“小-短”（早期）。两个值至少等于第三四分位数的眼睛被分类为“大-长”（晚期）。结果12例患者中有12只眼为小-短型病例（视力障碍时间≤ 1个月，病变大小≤ 2.0个视盘直径）。10例患者的11只眼为大长病例（视力障碍期36个月或更长，病变大小至少为5.0椎间盘直径）。大长眼的特征是隐匿性脉络膜新生血管膜或继发于渗出性年龄相关性黄斑变性的瘢痕组织。在小-短眼中，视网膜色素上皮细胞萎缩性改变、脉络膜血管通透性增高和搏动明显。视力预后和临床过程是不同的groups.Conclusions组之间的临床特征的差异可能反映了不同的疾病阶段，虽然不是所有的功能观察到的小短组出现代表那些记录在大长组的早期阶段。因此，以前的报告中的组织病理学特征的变化可能部分归因于疾病阶段的差异。
Background The pathogenesis of polypoidal choroidal vasculopathy (PCV), and even its clinical features, are controversial. Previous histopathological studies have identified different features; either dilated choroidal vessels or intra-Bruch's neovascularization. These differences might be partly attributable to the influence of the disease stage. We therefore evaluated the clinical features of early and late stage PCV.Methods The medical records of 110 eyes of 97 PCV patients were retrospectively reviewed. The time between the subjective onset of visual abnormality and examination at our clinic and the greatest linear dimension of the total lesion at the first examination were investigated. The period of disturbed vision and lesion size data were placed in ascending order to determine the first quartile point. Eyes with both values at or below the first quartile point were classified as 'small-short' (early stage). Eyes with both values equal to at least the third quartile point were classified as 'large-long' (late stage). Fundus photography, indocyanine green and fluorescein angiography, visual acuity, and clinical course were compared.Results Twelve eyes from 12 patients were small-short cases (period of disturbed vision of 1 month or less, lesion size 2.0 disc diameters or less). Eleven eyes from ten patients were large-long cases (period of disturbed vision 36 months or more, lesion size at least 5.0 disc diameters). The large-long eyes were characterized by occult choroidal neovascular membrane or scar tissue secondary to exudative age-related macular degeneration. Noticeable in the small-short eyes were atrophic changes in the retinal pigment epithelium, choroidal vessel hyperpermeability and pulsation. The visual prognosis and clinical course were different between the groups.Conclusions The difference of clinical features between the groups might reflect different disease stages, although not all of the features observed in the small-short group appeared to represent the early stages of those recorded in the large-long group. Thus, the variation in histopathologic features among previous reports might be partly attributable to differences in disease stage.