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Characteristics of clinic and fluorescein angiogram of multifocal choroiditis

Objective To observe the clinical manifestations and feat ures of fundus fluorescein angiograms(FFA)of patients with multifocal choroiditis (MFC)MethodThe data of 8 patients who had been diagnosed by clinic and FFA as with MFC were collected, and their clinical manifestatio ns and results of FFA were analyzed and valued.ResultsThe age of the 7 female and 1 male patients ranged from 16 to 32, and all of the 8 patients had high myopia (from -6.00 D to -8.00 D) with binocular multiple small yellowish white lesions in posterior pole of the fundus and a few phlogistic ce lls in vitreous body. In addition, macular choroidal neovascularization membrane (CNV) was found in 6 patients, binocular in 2 and monocular in 4. The results of FFA in 7 patients showed hypofluorescence of the yellowish white lesions at t he early phase and pigmentation at the late phase; Corresponding manifestations of FFA could be found in the patients attended by CNV surrounded by leakage.ConclusionMFC are mostly diagnosed in young females with myopia. Most of the patients had binocular affection with multiple small yellowish white lesions at the posterior pole, whose FFA shows hypofluoresence of the active lesions at the early phase and pigmentation at the late phase. CNV may occur in patients with MFC.(Chin J Ocul Fundus Dis，2004，20：335－338)

多灶性脉络膜炎的临床表现与治疗

多灶性脉络膜炎(multifocal choroiditis, MC)是一种特发性脉络膜视网膜病变，主要侵犯中青年女性。常双眼发病，临床表现有前葡萄膜炎、玻璃体炎，典型眼底表现为散在的脉络膜视网膜病灶， 直径50~350 mu;m。约1/3患者出现黄斑部或视盘周围脉络膜新生血管，导致视力下降。主要鉴别疾病有鸟枪弹样脉络膜视网膜病变、多发性一过性白点综合征(multiple evanescent white dot syndrome, MEWDS)、MC伴视网膜下纤维增生(diffuse subretinal fibrosis, DSF) 、类肉瘤病、结核、梅毒、莱姆病和视网膜外层弓形虫病等。最佳治疗方案尚未统一，Tenon囊下注射和口服糖皮质激素有一定疗效。不靠近中心凹的脉络膜新生血管可行激光光凝治疗。慢性复发性患者可考虑使用免疫抑制剂治疗。 （中华眼底病杂志，2003，19：195-197）

Indocyanine green angiography findings in choroiditis

Purpose To study choroidal vascular abnormal characteristics in choroidal vascular abnormal characteristics in choroiditis using indocyanine green angiography(ICGA). Methods Thirteen cases (16 eyes) of choroiditis were examined with fundus fluorescein angiography (FFA) and ICGA. Results ICGA findings in choroiditis were as follows:(1) dilatation of choroidal vessels with segmentary appearance and irregular margind;(2) hyperpermeability of choroidal vessels;(3) choroidal filling defects; (4) choroidal hypofluorescence with edema;(5) dilatation of vortex veins. (Chin J Ocul Fundus Dis,1998,14:92-84) Conclusion ICGA is useful in evaluating the lesions and circulation disturbance of choroiditis which cannot usually be demonstrable in FFA.

弓形体性视网膜脉络膜炎

Clinical observation of multifocal choroiditis

Objective To investigate the clinical features of multifocal choroiditis (MC) and guide the diagnosis and treatment. Methods Retrospective analysis of clinical data of 18 MC cases (28 eyes) who were diagnosed through fluorescein angiography (FFA) or indocyanine green angiography (ICGA) and fundus characteristics. Results Multiple round to oval lesions scattered throughout the posterior pole and peripheral areas of ocular fundi of all of the 28 eyes(binocular in 10 and monocular in 8) were found. Active focal lesions of ocular fundi were seen in 8 patients and inactive lesions in 10 patients. active and 10 cases were inactive. Choroidal neovascularization(CNV) in macular area was found in 7 patients. The images of FFA of the legions showed hypofluorescence in the early phase, with late leakage and gradual staining or window is defect in the late phase. Conclusions MC is a rare disease and often misdiagnosed to other disease and FFA helpful in diagnosis. (Chin J Ocul Fundus Dis, 2005, 21: 367-370)

脉络膜炎伴视网膜色素上皮带状萎缩一例

弓形体性视网膜脉络膜炎

玻璃体切割联合光动力疗法治疗息肉状脉络膜血管病变二例

Clinical features of punctate inner choroidopathy in Chinese patients

　　Objective　To characterize the clinical features of punctate inner choroidopathy (PIC) in Chinese patients.Methods　The clinical data of 75 PIC patients (112 eyes) attending this center from June 1999 to October 2009 were reviewed retrospectively. All patients received routine examination and fluorescein fundus angiography (FFA). Twentyeight patients also received indocyanine green angiography (ICGA). VISUPAC 3.3 software was used to determine the size of lesions in early image of FFA at the artery stage. Results　Of the 75 PIC patients (112 eyes), 54 patients (72%) were female, 37 patients (49%) were bilateral cases. Sixty patients (80%) were myopic, including eight patients (7%) with mild myopia, 22 patients (20%) with moderate myopia, and 57 patients (51%) with high myopia. The mean age at presentation was 32 years (range: 17-61). Multifocal PIC lesions (1-56 lesions) were mostly restricted to posterior pole of affected eyes (95%). Eightyfour eyes (75%) had 10 PIC lesions. The active lesions were yellowwhite and butterlike, 20-500mu;m in diameter. FFA showed that most acute lesions were early hyperfluorescence, and stained or slightly leaked on late period. The atrophic lesions were pouchedout, 502000 mu;m in diameter, with irregular pigmentation. Choroidal neovascularization developed in 70 eyes (63%). Papilledema (three eyes, 3%), staining of optic disc on latephase fluorescein angiography (three eyes, 3%), and segmental retinal phlebitis (two eyes, 2%) were rare.Conclusions　PIC primarily affects young women with moderate or high myopia. It is featured by multifocal small yellow creamy lesions and/or atrophic punchedout lesions principally in the posterior pole. Choroidal neovascularization is the most common complication.

Clinical observation on the evolution of fundus lesions in different subtypes of serpiginous choroiditis

ObjectiveTo observe the clinical evolution process and imaging characteristics of choroidal lesions in different subtypes of serpiginous choroiditis (SC), and to explore the clinical significance of subtype classification. MethodsA retrospective, uncontrolled and observational study. A total of 45 eyes of 25 SC patients diagnosed in Yunnan Eye Hospital from May 2009 to September 2021 were included in the study. According to the initial location of the lesion and fundus images, including fundus color photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and other examination results. SC was divided into peripapillary serpiginous choroiditis, macular serpiginous choroiditis and ampiginous choroiditis. According to the shape of the lesions at the first diagnosis, it can be divided into new lesions with only infiltrating edema, old lesions with only atrophy and recurrent lesions with coexistence of edema and atrophy. the imaging features, development and complications of different subtypes of ocular lesion were observed. ResultsAmong the 45 eyes of 25 cases, 15 cases were male and 10 cases were female, 20 cases of binocular and 5 cases of monocular, age was 42.3±5.7 years old. There were 21 eyes with active lesions, of which 5 eyes were new lesions and 16 eyes with recurrent lesions; 24 eyes were old lesions. Concurrent optic disc edema occurred in 3 eyes; mild vitreitis occurred in 5 eyes; retinal occurred vasculitis in 3 eyes; choroidal neovascularization occurred in 3 eyes. Among the 16 cases (64%, 16/25) of the peripapillary serpiginous choroiditis, 2 cases (2 eyes) were monocular, and 14 cases (28 eyes) were binocular. Active lesions were found in 16 eyes, of which patients with binocular lesions only one had active lesions. The choroidal lesions that were close to the optic disc or around the optic disc, expanded outwards centrifugally with the prolongation of the disease course, and can progress to the macula. The edge of the lesion was tortuous, with a geographic-like, amoeboid-like and finger-like, polypoid or propeller-like shape. Active lesions in FFA showed weak fluorescence in the early stage and strong fluorescence in the late stage; the old lesions showed weak fluorescence in the early stage and mottled fluorescence in the late stage, and mostly strong fluorescence on the edge. OCT showed thickening of active lesions and thinning of old lesions. Among the 4 cases (16.0%, 4/25) of macular type, 2 cases (2 monocular eyes) had active lesions; 2 cases (4 eyes) had lesion in both eyes, among them, 1 case (2 eyes) had old lesion, and the other case had alternate active lesions. The initial lesions were all located in the off-center of the macula, and most of them were disk-shaped and progressing centrifugally to the periphery. The FFA and OCT imaging findings of the lesions were similar to those of the peridisc type. Among the 5 cases (20.0%, 5/25) of ampiginous choroiditis, 1 case (1 eye) was monocular and 4 cases (8 eyes) were binocular. These lesions were multiple old lesions of varying sizes, gray-white with pigmentation, with clear borders in the posterior pole. Among them 4 eyes have new active lesions appeared near the old lesions. The old lesions showed weak fluorescence with clear borders, and the fluorescein leakage at the late edge formed a strong fluorescence ring; the active lesions showed weak fluorescent spots with blurred edges, and the fluorescence was slightly enhanced in the late stage. In old lesions, atrophy of the photoreceptor layer, RPE and choroid can be seen, and RPE hyperplasia in some areas. ConclusionsSC subtype is a classification of the location of the first lesion, but the characteristics of the repeated attack of this disease can lead to the annihilation of each subtype due to the continuous expansion of the lesion. The phenomenon that the fundus active lesions only occur in one eye that can explain the clinical manifestations of asymmetric morphology of binocular lesions. The characteristics of binocular subtype warn that the predilection site of the healthy eye should be paid attention to.