摘要：
Objective To observe the prognosis of visual acuity (VA) of patients with different classification of polypoidal choroidal vasculopathy (PCV).Methods Sixty-seven PCV patients (68 eyes) diagnosed by fundus photography,fundus fluorescein angiography,indocyanine green angiography (ICGA)and ocular coherence tomography were enrolled in this retrospective study.The patients were classified into static,exudative,small hemorrhage and large hemorrhage according to activity and pathological characteristics of lesions.The patients were classified into aciniform,single or several single,combined branching choroidal vascular network (BVN) according to morphological characteristics and combination with BVN of lesions on ICGA.The patients also were classified into macular,vascular arcade,peripapillary and mixing zone according to distribution of lesions.The VA of all the types were observed.Results There were 16,19,19,14 eyes in the type of static,exudative,small hemorrhage and large hemorrhage PCV,which with logMAR VA of 0.34±0.52,0.70±0.98,0.60±0.50,0.91±0.75 respectively.The VA of static PCV patients was better than that in exudative,small hemorrhage and large hemorrhage PCV patients (q=4.75,4.26,5.13; P＜0.05).There was no significant difference of VA between exudative and small hemorrhage PCV patients (q=0.98,P＞0.05).There were 22,38 and eight eyes in the type of aciniform,single or several single,combined BVN PCV,which with logMAR VA of 0.52 ± 0.55,0.59 ± 0.43,0.80±0.95 respectively.The VA of combined BVN PCV patients was worse than that in aciniform and single or several single PCV patients (q＝3.81,3.02 ; P＜0.05 ).There were 34,13,8 and 13 eyes in the type of macular,vascular arcade,peripapillary and mixing zone PCV,which with logMAR VA of 0.78±0.43.0.5±0.37,0.38±0.27,0.74±0.41 respectively.The VA of macular PCV patients was less than that in vascular arcade and peripapillary PCV patients (q=4.61,5.11;P＜0.05).There was no significant difference of VA between macula and mixing zone PCV patients (q=0.73,P＞0.05).Conclusions The VA of PCV patients is variable.It is related to activity and pathological characteristics of lesions,morphological characteristics and combination with BVN of lesions on ICGA,and distribution of lesions.%目的 了解不同类型息肉样脉络膜血管病变(PCV)患者视力改变情况.方法 收集经眼底彩色照相、荧光素眼底血管造影、吲哚青绿血管造影(ICGA)以及光相干断层扫描检查确诊的67例PCV患者68只眼的临床资料.根据PCV的活动性与病理特征分为静止性、渗出性和出血性PCV;根据ICGA检查中息肉样病灶的形态特征以及是否合并分支状脉络膜血管网(BVN)分为葡萄状病灶型、单个病灶型和合并BVN的混合病灶型PCV;根据息肉样病灶分布部位分为黄斑区、血管弓区、视盘旁区、中周部和混合区PCV.观察各组的视力情况.结果 静止性、渗出性、少量出血性、多量出血性PCV分别有16、19、19、14只眼,其平均最小分辨角对数(logMAR)视力分别为0.34±0.52、0.70±0.98、0.60±0.50、0.91±0.75.静止性PCV患眼平均视力显著优于渗出性、少量出血性与多量出血性PCV患眼,组间比较,差异有统计学意义(q＝4.75、4.26、5.13,P＜0.05).渗出性PCV与少量出血性PCV患眼平均视力比较,差异没有统计学意义(q=0.98,P＞0.05).葡萄状病灶型、单个病灶或多处单个病灶型、合并BVN的混合病灶型PCV分别有22、38、8只眼,其平均logMAR视力分别为0.52±0.55、0.59±0.43、0.80±0.95.伴有BVN的混合病灶型PCV患眼平均视力显著差于葡萄状病灶型和单个病灶或多处单个病灶型PCV患眼,组间比较,差异有统计学意义(q=3.81、3.02,P＜0.05).黄斑区、血管弓区、视盘旁区、混合区PCV分别有34、1 3、8、13只眼,其平均logMAR视力分别为0.78±0.43、0.57±0.37、0.38±0.27、0.74±0.41.黄斑区PCV患眼平均视力差于血管弓区与视盘旁区PCV患眼,组间比较,差异有统计学意义(q=4.61、5.11,P＜0.05);黄斑区PCV与混合区PCV患眼平均视力比较,差异无统计学意义(q=0.73,P＞0.05).结论 PCV患者视力改变情况不一,且与PCV的活动性与病理特征、息肉样病灶的形态特征和分布部位以及是否合并BVN有关.
