专家述评
ENGLISH ABSTRACT
正确分析周边部视网膜超广角荧光素眼底血管造影特征
陈长征
王晓玲
作者及单位信息
·
DOI: 10.3760/cma.j.cn115989-20190401-00158
To correctly analyze ultra-wide field fluorescein angiography in peripheral retina
Chen Changzheng
Wang Xiaoling
Authors Info & Affiliations
Chen Changzheng
Ophthalmology Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
Wang Xiaoling
Ophthalmology Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
·
DOI: 10.3760/cma.j.cn115989-20190401-00158
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摘要

超广角荧光素眼底血管造影(UWFFA)是近年来出现的新技术,可以观察传统7视野之外的视网膜广泛区域的荧光征象,在观察糖尿病视网膜病变(DR)、视网膜静脉阻塞(RVO)和家族性渗出性视网膜病变等血管性疾病周边视网膜时优势明显。传统荧光素眼底血管造影(FFA)的正常荧光和异常荧光表现已较明确,但对正常眼周边荧光特征了解尚少。周边部荧光表现不同于后极部和赤道部,需考虑RPE分布不同、色素差异、血管发育及玻璃体后皮质等因素,还要关注年龄及全身代谢疾病的影响。对于部分荧光表现还需要动态全程分析,结合彩色眼底照相和前置镜检查。明确视网膜不同部位不同时间的正常荧光是判定异常荧光的前提。在临床工作中,特别是在诊断RVO、DR等血管性疾病时,需审慎解读UWFFA周边部荧光征象。不断积累周边部视网膜正常和异常的荧光征象判读经验,进一步提升UWFFA技术应用水平。

正常眼/诊断;诊断技术/眼科;荧光素血管造影术;述评
ABSTRACT

Ultra-wide field fluorescein angiography (UWFFA) is a new technique emerging in recent years.UWFFA can observe the fluorescence signs of wide areas of retina beyond the traditional 7-field of vision.UWFFA has obvious advantages in peripheral retina of vascular diseases, such as diabetic retinopathy (DR) , retinal vein occlusion (RVO) and familial exudative retinopathy.Traditional fundus fluorescein angiography (FFA) has accumulated much experience in normal fluorescence and abnormal fluorescence, but little is known about the fluorescence characteristics of normal eye periphery.Periphery fluorescence performance is different from posterior pole and equator.It is necessary to consider the distribution of retinal pigment epithelium (RPE) , pigmentation, vascular development and posterior vitreous cortex.At the same time, more attention should be paid to the influence of age and systemic metabolic diseases on some fluorescence.Light performance also needs dynamic whole-course analysis, combined with color fundus photography and anterior endoscopy analysis.Defining normal fluorescence of different parts of retina at different times is the premise of judging abnormal fluorescence.In clinic, it is necessary to carefully interpret the peripheral fluorescence signs of UWFFA, especially in diagnosis of vascular diseases, such as RVO and DR.It is essential to continuously accumulate experience in interpreting fluorescence signs of normal and abnormal peripheral retina, and further improve the application of UWFFA technology.

Normal eyes/diagnosis;Diagnostic techniques/ophthalmological;Fluorescein angiography;Editorial
Chen Changzheng, Email: mocdef.3ab61hzhcnehcuhw
引用本文

陈长征,王晓玲. 正确分析周边部视网膜超广角荧光素眼底血管造影特征[J]. 中华实验眼科杂志,2020,38(07):562-565.

DOI:10.3760/cma.j.cn115989-20190401-00158

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1961年荧光素眼底血管造影技术(fundus fluorescein angiography,FFA)问世以来在眼底疾病中得到广泛应用。随着FFA技术的改进,从30°镜头到55°镜头,再到102°广角镜头,可观察到更大范围的视网膜 [ 2 ]。近年出现的200°超广角荧光血管造影(ultra-wide field fluorescein angiography,UWFFA)1次成像可获取82%的视网膜面积。UWFFA在糖尿病视网膜病变(diabetic retinopathy,DR)、视网膜静脉阻塞(retinal vein occlusion,RVO)、家族性渗出性视网膜病变(familial exudative vitreoretinipathy,FEVR)和中间葡萄膜炎等周边视网膜病变中更有优势 [ 3 , 4 , 5 , 6 ]。UWFFA可发现更多的周边无灌注区、新生血管、周边视网膜血管炎渗漏等,为疾病诊断、治疗和随访提供全面的信息。应用UWFFA测量DR和RVO等视网膜血管性疾病的周边无灌注区的缺血指数(ischemia index,ISI),可进行量化分析。目前,已对不同区域ISI进行量化研究,ISI有望成为重要预测指标,指导靶向激光治疗 [ 7 ]
UWFFA可以观察到传统视野造影拼图观察不到的区域,同时也对一些疾病的传统诊断标准、分期及干预治疗也提出挑战,如周边部均匀高荧光是否考虑为变性区,周边血管晚期荧光渗漏是否考虑为中间葡萄膜炎,周边血管形态异常是否考虑与血管疾病相关,周边部无血管区是否需要考虑为RVO或其他血管性疾病,周边片状无血管区是否需要激光治疗等 [ 4 , 8 ]。目前,RVO和DR中ISI与黄斑水肿、新生血管形成的关系等都是研究的热点 [ 9 , 10 ],区分眼部生理性无血管区是首要问题。
明确视网膜不同部位不同时间的正常荧光是判定异常荧光的前提。目前,已有少量研究报道正常眼周边部荧光特征,如终末血管网、直角血管、吻合型与分枝型等不同的周边血管形态,周边无血管区、微血管瘤、造影晚期渗漏等表现,周边均匀高荧光及高低荧光混杂的边界等非血管相关的特征,正确区分正常与异常荧光具有重要意义。传统7视野范围造影已积累大量经验,对于UWFFA周边的荧光特征的总结和分析还在初始阶段,尚缺乏统一的认识,要认识这些荧光特征,需要深入了解相关的解剖结构。
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