息肉状脉络膜血管病变导致黄斑下出血的治疗进展
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Progress in treatment of submacular hemorrhage due to polypoid choroidal vasculopathy
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    摘要:

    息肉状脉络膜血管病变(PCV)以往被称为特发性息肉状脉络膜血管病变(IPCV),是一种慢性脉络膜血管异常性疾病,由于脉络膜血管的渗出和出血导致多发性、反复性和出血性色素上皮层脱离。PCV包括出血型和渗出型两种类型,其中出血型容易并发黄斑下出血(SMH)。近年来随着吲哚菁绿血管造影(ICGA)和光学相关断层扫描血流成像(OCTA)在眼科学广泛应用,国内和国外对该病的研究逐渐深入。目前对该疾病的诊断主要是通过散瞳眼底检查、光学相干断层扫描(OCT)、OCTA、荧光素血管造影(FFA)+ICGA等辅助检查确诊。当并发少量的SMH可自行吸收,当SMH较大时很难自行吸收且对视力影响较大,主要的治疗方法包括抗VEGF药物、PDT、气体、t-PA以及联合玻璃体切除术等。本文结合国内外研究的最新进展,对PCV并发SMH的流行病学、发病机制、诊断、治疗等进行综述,并对其治疗方法进行讨论和展望。

    Abstract:

    Polypoidal choroidal vasculopathy(PCV)in the past referred to as “Idiopathic polypoidal choroidal vasculopathy(IPCV)”. It is a chronic vascular abnormality resulting in multiple, recurrent, serosanguinous retinal pigment epithelial detachments(PEDs)secondary to leakage and bleeding from choroidal vascular lesions. PCV have two types, including hemorrhagic type and exudative type, in which hemorrhagic type is prone to submacular hemorrhage. In recent years, with the widely used of indocyanine green angiography and optical coherence tomography angiography in ophthalmology, the research on this disease has gradually deepened. At present, the diagnosis of this disease is mainly confirmed by dilated pupil fundus examination, optical coherence tomography(OCT), OCTA, fluorescence fundus angiography(FFA)+ICGA and other auxiliary examinations. When complicated with a small amount of SMH, it can be absorbed by itself. When SMH is large, it is difficult to be absorbed by itself and has a great influence on vision. The main treatment included anti-VEGF drugs, PDT, gas, t-PA and combined vitrectomy. This article combining the latest progress in the study of domestic and foreign, the SMH induced by PCV epidemiology, pathogenesis, diagnosis, treatment were summarized, and the treatment methods were discussed and prospected.

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张霜,张杰,徐鑫彦,等.息肉状脉络膜血管病变导致黄斑下出血的治疗进展.国际眼科杂志, 2019,19(6):950-955.

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  • 收稿日期:2018-09-27
  • 最后修改日期:2019-04-26
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  • 在线发布日期: 2019-05-22
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