Study on endoscopic fluorescein angiography of extreme peripheral retina

我们在眼内窥镜下玻璃体切除术中发展了荧光素血管造影术。我们研究了常规眼底相机没有观察到的视网膜边缘和睫状体的荧光素表现。首先，我们发现许多增殖性糖尿病视网膜病变的眼睛在视网膜的极端边缘表现出不寻常的发现，这与视网膜循环障碍的严重程度有关。其次，我们将这项技术应用于细菌性眼内炎和葡萄膜炎等炎症性疾病。细菌性眼内炎患者，尽管视网膜功能严重异常，但荧光素表现正常，这可能是细菌内毒素对视网膜内层的可逆性损害。葡萄膜炎患者，玻璃体出血手术中，荧光素血管造影显示睫状体扁平部有新生血管形成，手术时可成功治疗。我们的结论是，新生血管可以在炎症过程中发展，与血管闭塞无关。除了荧光素血管造影，我们还成功地记录术中增殖性糖尿病视网膜病变和老年性黄斑变性患者的术中吲哚青绿血管造影，其中我们发现脉络膜新生血管即使在手术切除后仍经常存在。老年性黄斑变性已经成为致盲的主要原因之一，我们应该继续用这些新技术与之作斗争。

We developed intraoperative fluorescein angiography during vitrectomy using ophthalmic endoscope. We studied the fluorescein findings of extreme retinal periphery and ciliary body which had not been observed by regular fundus camera. First of all, we found that many eyes with proliferative diabetic retinopathy showed unusual findings in the extreme retinal periphery, which correlated the severity of retinal circulatory disturbances. Second, we applied this technique for the inflammatory disease such as bacterial endophthalmitis and uveitis. In bacterial endophthalmitis, the fluorescein findings appeared normal despite the severe functional abnormalities of the retina, which might be reversible retinal damage of inner retina by bacterial endotoxins. In uveitis, the fluorescein angiography revealed the neovascularization at the pars plana of ciliary body during surgery for vitreous hemorrhage which we could treat successfully at the time of surgery. We concluded that the neovascularization could develop during the inflammatory process not associated with vascular occlusion. Third, we successfully analyzed the mean retinal circulation time directly by recording the fluorescein angiography during operation.In addition to fluorescein angiography, we successfully recorded intraoperative indocyanin green angiography for patients with proliferative diabetic retinopathy and age-related macular degeneration in which we found choroidal new vessels remained frequently even after surgical removal. Age-related macular degeneration has become one of chief cause of blindness which we should continue to fight against with these new techniques.