Evaluation of peripheral retinal angiopathy with endoscopic fluorescein angiography

为了评价远周缘眼底和睫状体的血管反应，我在玻璃体切除术中对50多只眼进行了内窥镜荧光素血管造影，这些眼底疾病包括糖尿病视网膜病变、视网膜静脉阻塞、眼结节病和老年性黄斑变性。内窥镜血管造影术被证明是确定手术中治疗方式的有用方法。我在玻璃体切割术中对23只糖尿病视网膜病变患者进行了内窥镜荧光素血管造影术。这项技术能够很好地检测视网膜新生血管和无灌注区。由于这一优点，激光腔内光凝和增生性组织的分层是合适的。23只眼中5只眼远周边眼底和睫状体可见强荧光。这一发现提示红斑或前部玻璃体纤维血管增生的早期征象。3只眼有荧光素染料从睫状体渗出，这似乎反映了S…房水更多的狂欢。在视网膜静脉阻塞的眼，内窥镜血管造影显示出血玻璃体切除后可见无灌注区和新生血管的范围，部分眼可见大片无灌注区累及远周眼底，直至锯齿孔。锯齿孔旁偶见网状强荧光。这些发现有助于激光光凝的设计。术中去除黄斑前膜后，术后黄斑花瓣样强荧光逐渐减弱。内窥镜血管造影术显示12眼眼结节病患者在玻璃体切除术中黄斑囊样水肿和周边脉络膜染料渗漏。摘除玻璃体凝胶和玻璃体后膜后，这些强荧光逐渐减弱。提示玻璃体是化学介质的储存层，玻璃体后膜加重了眼结节病黄斑囊样水肿。在老年性黄斑变性的眼睛中，内窥镜血管造影术清楚地显示了玻璃体切除过程中脉络膜新生血管的程度。它帮助完成了脉络膜新生血管的去除。在玻璃体切除术中，内窥镜血管造影术可用于监测波动输液压力下的视网膜循环。较少

To evaluate the vascular reaction in far peripheral fundus and ciliary body, I performed endoscopic fluorescein angiography during vitrectomy in more than 50 eyes with various fundus diseases including diabetic retinopathy, retinal vein occlusion, ocular sarcoidosis and age-related macular degeneration. Endoscopic angiography proved to be useful to determine the therapeutic modalities during surgery.1. I performed endoscopic fluorescein angiography in 23 eyes with diabetic retinopathy during vitrectomy. This technique enabled fine detection of retinal neovascularization and nonperfusion areas. Because of this advantage, endolaser photocoagulation and delamination of proliferative tissue was suitably performed. Hyperfluorescence was observed in far peripheral fundus and ciliary body in 5 of the 23 eyes. This finding suggested early sign of rubeosis or anterior hyaloidal fibrovascular proliferation. Fluorescein dye leaked from the ciliary body in 3 eyes, which seemed to reflect aqueous s … More ecretion.2. In eyes with retinal vein occlusion, endoscopic angiography revealed extent of nonperfusion areas and neovascularization after resection of hemorrhagic vitreous, In some eyes, large nonperfusion area involved far peripheral fundus until the ora serrata. Reticular hyperfluorescence was occasionally seen along the ora serrata. These findings helped to design the laser photocoagulation. After premacular membrane was removed during surgery, macular pettaloid hyperfluorescence gradually decreased postoperatively.3. Endoscopic angiography showed cystoid macular edema and dye leakage from the peripheral choroid during vitrectomy in 12 eyes with ocular sarcoidosis. After removal of vitreous gel and posterior hyaloid membrane, these hyperfluorescence gradually decreased postoperatively. It suggested that the vitreous plays as a reservoir of the chemical mediators and the posterior hyaloid membrane worsens cystoid macular edema in ocular sarcoidosis.4. In eyes with age-related macular degeneration, endoscopic angiography clearly showed the extent of choroidal neovascularization during vitrectomy. It helped complete removal of choroidal neovascularization. Endoscopic angiography was useful to monitor the retinal circulation under undulating infusion pressure during vitrectomy. Less