【摘要】 探讨眼底荧光素血管造影（fundus fluorescein angiography, FFA）在年龄相关性黄斑变性（agerelated macular degeneration, AMD）患者中的特征及临床意义。方法：用日本Nikon NF505 眼底照相机对112例149眼进行FFA 检查。结果：在149眼中,萎缩型90眼（60.4%），渗出型59眼(39.6%)，依据CNV造影特点和CNV与黄斑中心凹的距离分为中心凹下CNV包括经典型7眼，隐匿型26眼，盘状瘢痕化9眼，旁中心凹CNV包括经典型2眼，隐匿型12眼，中心凹外CNV 3眼均为隐匿型。结论：FFA可以发现AMD患者的CNV，并能分辨其性质和部位，有助于指导治疗和评价预后。
【关键词】 年龄相关性黄斑变性 眼底荧光素血管造影 特征
INTRODUCTION
Agerelated macular degeneration (AMD) is a chronic, progressive eye disorder that mainly affects people over the age of 50. It is the leading cause of irreversible visual damage in population aged over 60 years in the western world[1]. The average life expectancy of Chinese people is increasing and the prevalence of AMD is rising too. In a sampling survey of vision disability in partial Chinese provinces, it was found that the agerelated retinopathy including AMD is the second cause of visual disability[2,3]. Performance of fundus fluorescein angiography (FFA) for suspected AMD patients can help to confirm the diagnosis with the information about the composition and location of lesions and can provide guidelines for treatment of the disease. We retrospectively analyzed the FFA results of 149 eyes of 112 patients diagnosed as AMD from Department of Ophthalmology, Peoples Hospital of Sichuan Province between January 2007 and December 2007.
PATIENTS AND METHODS
Patients In the 149 eyes of 112 AMD patients aged between 49 and 85 years, there were 62 male patients and 50 female patients, including uniocular 75 cases and binocular 37 cases. All the patients were divided into atrophic AMD (dry AMD) and exudative AMD (wet AMD) based on the protocol of AMD clinical diagnosis criteria constituted in the second national conference on ocular fundus diseases in 1986[4], including 90 eyes of 67 cases with atrophic AMD (60.4%) and 59 eyes of 45 cases with exudative AMD (39.6%). The mean age was 64.42±9.61years. There were 57 eyes of 40 AMD patients aged between 49 and 60 years, 46 eyes of 39 AMD patients aged between 61 and 70 years, 39 eyes of 29 patients aged between 71 and 80 years, and 7 eyes of 4 patients aged over 81 years. The best corrected visual acuity (BCVA)(LogMAR) of 45 eyes was less than 1.0; BCVA of 59 eyes ranged from 1.0 to 0.4; BCVA of 39 eyes was between 0.3 and 0.1; BCVA of 6 eyes was better than 0.1.
Methods All the patients were performed complete ophthalmic examinations including the best corrected visual acuity, slitlamp microscopy, and binocular direct or indirect ophthalmoscopy after mydriasis. The visual acuity was measured by international standard visual acuity chart and converted to LogMAR form.
Information about systemic and allergic history was obtained from each patient before FFA. Patients who had no such contraindications were injected intravenously 5.0mL 10g/L sodium fluorescein and observed 20 minutes. If patients did not have abnormal symptoms, they were then quickly injected 2.5mL 200g/L sodium fluorescein. Timing was started from the point of injection. During the first 30 seconds photos were taken every 2 seconds, while from 30 seconds till 1 minute photos were taken every 5 seconds. Valuable angiograms at early stage were taken from posterior pole of ocular fundus, supratemporal, inferotemporal, supranasal, inferonasal quadrants. After that the photos were taken at 2, 5, 10, 20 minutes respectively. Furthermore, in light of the FFA appearance photos were increased or decreased.
RESULTS
Fundus Characteristics In 90 eyes (60.4%) with atrophic AMD, light reflection of macular fovea disappeared, with pigment disorder and whitishyellow drusens of different sizes. Some had distinct boundary and appeared like yellowish round spots, which were hard drusens; whereas some had varied shapes and sizes and fused into "patches" or "clumps", which were soft drusens. Some drusens distributed beyond temporal upper and lower vascular arch, with mottled hypopigmentation or chorioretinal atrophic spots, including 46 eyes with pigment abnormality, 37 eyes with drusens of different sizes and shapes, and 7 eyes with geographic atrophy. There were 59 eyes (39.6%) with exudative AMD, which was characterized by macular CNV, serous retinal pigment epithelial detachments, exudation, hemorrhage and formation of disciform scars, in which 40 eyes had macular subretinal gray or yellowishwhite lesions, all but two eyes with hemorrhage, 3 eyes with subretinal large hemorrhage at posterior pole, 7 eyes with yellowishwhite exudation and hemorrhage, 9 eyes with disciform scars and hyperpigmentation, including 5 out of 9 eyes with diffuse blood spots.
FFA Characteristics In 90 eyes with atrophic AMD, 46 eyes had windowlike high density fluorescence in macular lesion at early stage of FFA which was enhanced, weakened and faded with background fluorescence. Eleven of the 46 eyes were found low fluorescence resulted from abnormal pigment accumulation; 29 eyes with pigmented drusens were enhanced or weakened with background fluorescence with invariable size; 5 eyes with drusens did not have pigmentation of fluorescence; 3 eyes with drusens beyond temporal upper and lower vascular arches appeared hypofluorescence; 7 eyes with geographic atrophy (GA) behaved like large window defects and fluorescence was partially masked by pigment. In 59 eyes of exudative AMD, the spots, clumps or plaques of choroidal neovascularization (CNV) were found at the early stage of FFA.
Gradually the hyperfluorescence area was formed with blurry margin due to fluorescent leakage and confluence. When the background fluorescence faded, the lesion still appeared relative hyperfluorescence. During the course of angiography, the fluorescence was masked by hemorrhage.
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