Retinal choroidal anastomoses and occult choroidal neovascularization in age-related macular degeneration
Retinal choroidal anastomoses and occult choroidal neovascularization in age-related macular degeneration
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DOI：
10.1016/s0161-6420(00)00009-9
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发表时间：
2000-04-01
期刊：
影响因子：
13.7
通讯作者：
Orlock, DA
中科院分区：
文献类型：
--
作者：
Slakter, JS;Yannuzzi, LA;Orlock, DA
目的：本研究旨在确定隐匿性脉络膜新生血管（CNV）和吲哚菁绿（ICG）血管造影局灶热点患者中视网膜脉络膜吻合的发生率，确定有助于识别的临床和血管造影特征，并确定这些吻合病变的存在是否影响激光治疗的结果。设计：前瞻性和回顾性横断面联合研究。参与者：150名连续患者对新诊断的继发于渗出性年龄相关性黄斑变性的隐匿性 CNV 和 ICG 血管造影的局灶性热点进行了前瞻性评估。此外，对先前报道的在 ICG 引导下接受激光光凝治疗的 79 只眼睛进行了回顾性审查。方法和测试：在所有病例中，均获得立体彩色和无红照片、立体荧光素和数字 ICG 血管造影照片进行评估。主要结果指标：评估通过所有四种技术获得的图像是否存在视网膜脉络膜吻合。记录了相关的临床和血管造影结果。在回顾性审查中，激光治疗的成功率与是否存在视网膜脉络膜吻合术相关。结果：在前瞻性评估的 150 只眼睛中，31 只 (21%) 被发现存在视网膜脉络膜吻合术。 27% 的伴有浆液性色素上皮脱离 (PED) 的患者存在视网膜脉络膜吻合，而 13% 的患者不伴有视网膜色素上皮升高。百分之七十一的眼睛有多个吻合连接。百分之九十的眼睛至少有一根视网膜静脉参与吻合连接。视网膜前和视网膜内出血和囊性水肿的临床证据加上视网膜内染料渗漏的血管造影证据是视网膜脉络膜吻合术的关键特征。在回顾性回顾中，7名患者被发现存在视网膜脉络膜吻合并伴有浆液性FED，并且激光治疗的成功率非常低（14%）。 结论 视网膜脉络膜吻合可能是年龄相关性黄斑变性渗出过程的主要表现。无论有或没有视网膜色素上皮脱落，都可以在眼睛中看到它们。已经确定了特定的临床和血管造影特征，可以帮助诊断这些血管异常。它们的存在对于成功的 ICG 引导激光治疗来说是一个不良的预后标志。 (C) 2000 年由美国眼科学会颁发。
Objective: This study was designed to identify the incidence of retinal choroidal anastomoses in patients with occult choroidal neovascularization (CNV) and focal hot spots on indocyanine green (ICG) angiography, to identify the clinical and angiographic features that would assist in their identification, and to determine if the presence of these anastomotic lesions affect the outcome of laser therapy.Design: Combined prospective and retrospective cross-sectional study.Participants: One hundred fifty consecutive patients with newly diagnosed occult CNV secondary to exudative age-related macular degeneration and focal hot spots on ICG angiography were evaluated prospectively. In addition, a retrospective review was performed on 79 eyes previously reported to have undergone laser photocoagulation treatment with ICG guidance.Methods and Testing: In all cases, stereo color and red-free photographs, and stereo fluorescein and digital ICG angiograms were obtained for evaluation.Main Outcome Measures: Images obtained by all four techniques were evaluated for the presence of a retinal choroidal anastomosis. Associated clinical and angiographic findings were noted. In the retrospective review, the success rate of laser treatment was correlated with the presence or absence of a retinal choroidal anastomosis.Results: Of the 150 eyes evaluated prospectively, 31 (21 %) were found to have a retinal choroidal anastomosis. Retinal choroidal anastomoses were found in 27% of patients with associated serous pigment epithelial detachment (PED), whereas 13% were found in those without an associated elevation of the retinal pigment epithelium. Seventy-one percent of eyes had multiple anastomotic connections. Ninety percent of eyes had at least one retinal vein involved in the anastomotic connection. Clinical evidence of preretinal and intraretinal hemorrhage and cystic edema coupled with angiographic evidence of intraretinal dye leakage were key features of retinal choroidal anastomoses. in the retrospective review, seven patients were found to have retinal choroidal anastomoses with associated serous FED and demonstrated a very low (14%) success rate for laser treatment.Conclusions Retinal choroidal anastomoses can present as a primary manifestation of the exudative process in age-related macular degeneration. They may be seen in eyes with and without detachment of the retinal pigment epithelium. Specific clinical and angiographic features have been identified that can aid in the diagnosis of these vascular anomalies. Their presence represents a poor prognostic sign for successful ICG-guided laser treatment. (C) 2000 by the American Academy of Ophthalmology.