Pathogenesis of polypoidal choroidal vasculopathy focusing on the peculiarity of chorotial vessels

【背景与目的】息肉样脉络膜血管病变（Polypoidal choroidal vascular pathy， PCV）以脉络膜血管分支伴息肉样末梢动脉瘤扩张为特征。临床上，血管异常出现在脉络膜内，由2个基本元素组成：息肉状血管和分支血管网。虽然已知PCV对亚洲人群有偏爱，但其确切病理尚不清楚，目前也没有治疗指南。在本研究中，我们旨在评估脉络膜血管系统，并寻找有效的治疗方法。我们报道了PCV的脉络膜血管系统随着时间的推移而改变，在脉络膜内甚至绒毛膜毛细血管中的一些血管可能会关闭，侧支血管和/或新血管可能会发育形成分支血管网络。(2)搏动性血流我们回顾了一系列伴有搏动性息肉样血管的PCV病例，并评估了这些血管在PCV中的特征。这是一个独特的和重要的特征，没有报道与任何其他绒毛膜-视网膜疾病。（眼科学，出版中）曲安奈德（triamcinolone acetonide， TA）治疗渗出性年龄相关性黄斑变性（macular degeneration， AMD）/PCV的疗效评价：玻璃体内注射TA治疗渗出性年龄相关性黄斑变性（macular degeneration， AMD）/PCV的疗效。玻璃体内TA可在短期内改善渗出性AMD患者的视力和眼底表现，且无眼压升高和眼内炎等明显副作用。从有效性、安全性和成本的角度来看，Trans-Tenon的球后TA注射可能是治疗PCV的潜在选择。（格雷夫临床和实验眼科学档案，已出版）

[Background and Purpose]Polypoidal choroidal vasculopathy(PCV) is characterized by branching choroidal vessels with polyp-like terminal aneurismal dilations. Clinically, the vascular abnormality appears to be in the inner choroid and is composed of 2 basic elements : a polypoidal vessel and a branching vascular network. Although PCV is known to have a predilection for Asian populations, the exact pathology of it remains unclear and there are no current treatment guidelines. In this study, we aimed to evaluate choroidal vasculature and find efficient treatments for patients win PCV.[Results]1.Choroidal vessels in PCV(1)Branching vascular networkWe reported that in PCV the choroidal vasculature is altered with time, in that some vessels in the inner choroid and even the choriocapillaris may close and collateral vessels and/or new vessels may develop to form the branching vascular network. (Graefe's Archive for Clinical and Experimental Ophthalmology, 242:962-5,2004)(2)Pulsatile blood flowWe reviewed our series of cases of PCV with pulsatile polypoidal vessels and evaluated the features of such vessels in PCV. It is a unique and important characteristic that has not been reported with any other chorio-retinal diseases. (Ophthalmology, in press)2.Effect of Injection of triamcinolone acetonide(TA) for exudative age related macular degeneration/PCVWe evaluated the effect of intravitreal/sub-Tenon TA with exudative age related macular degeneration(AMD)/PCV. Intravitreal TA provided short-term improvement in visual acuity and fundus findings in exudative AMD without significant side effects such as intraocular pressure increase and endophthalmitis. (Ophthalmologica, in press)Trans-Tenon's retrobulbar TA injection may be a potential option for treating PCV from the point of view of effectiveness, safety, and cost. (Graefe's Archive for Clinical and Experimental Ophthalmology, in press)