目的: 观察老年性黄斑变性(Age-related macular degeneration, AMD) 和息肉状脉络膜视网膜病变(Polypoidal choroidal vasculopathy, PCV) 患者眼底陈旧性出血在吲哚青绿血管造影(Indocyanine green angiography, ICGA) 中的自发荧光表现。

方法: 对伴有眼底陈旧性出血的AMD和PCV患者共36例(36只眼)行ICGA检查。受试者在进行ICGA检查前, 均经过详细的眼底镜检查、眼底彩色照相及荧光素眼底血管造影(Fundus fluorescein angiography, FFA) 检查。

结果: 眼底陈旧性出血灶 ICGA 均表现出相应的自发荧光。陈旧性出血灶呈浅灰黄色, 其自发荧光的形态大小与眼底彩色图像所示的陈旧性出血灶相一致, 边界清晰; 造影后期陈旧性出血灶的自发荧光强度最强，与 AMD 的斑状及焦点状脉络膜新生血管 (Choroidal neovasculari-zation, CNV) 及 PCV 的息肉状脉络膜血管扩张灶的荧光表现不同。陈旧性眼底出血的自发荧光多与 CNV 或息肉状病灶重叠或位于其边缘(27只眼, 75%) 。

结论: ICGA 中陈旧性眼底出血所致的自发荧光易与 CNV 及息肉状病灶性强荧光相混淆, 将眼底彩色图像与 ICGA 图像对比分析及掌握其与CNV及息肉状血管扩张灶的不同荧光特性有助于鉴别诊断。

Objective: To investigate the autofluorescence of stale fundus haemorrhage in age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) with indocyanine green angiography (ICGA) .

Methods: The color photographs and ICGA were performed in 36 eyes of 36 cases of exudative AMD or PCV with stale fundus haemorrhage. All of the cases were examined by funduscopy and fundus fluorescein angiography (FFA) .

Results: Autofluorescence could be observed in all of the stale haemorrhage cases. Stale haemorrhage showed grayish color and the shapes and sizes of autofluoresence in ICGA were in accordance with those of the stale haemorrhage in the color photographs. The boundaries of autofluorescence were clear and the intensities were strong. The percentage of choroidal neovascularization (CNV) or PCV in or beside stale haemorrh-age was significantly higher than that outside the stale haemorrhage (27 eyes, 75%) . 

Conclusions: Autofluorescence of stale haemorrhage in ICGA can be mixed up with the high fluorescence of CNV and grapes-like polypoidal dilatation. It is helpful to compare the color photographs with ICGA and recognize the different ICGA characteristics in the assessment of ICGA results in these circumstances.

眼结核的表现形式多样，有时会被误诊漏诊。本病例为一年轻男性，以右眼视力突发下降为主诉就诊，眼部表现可见黄斑区脉络膜占位病灶及视网膜内小病灶，经γ-干扰素释放试验、胸部CT等检查，确诊为血型播散性肺结核，眼部诊断为结核性脉络膜结节联合视网膜结节，全身接受抗结核治疗后，眼部病灶消退。

Ocular tuberculosis encompasses a variety of clinical manifestations, which is easily misdiagnosed sometimes. In this article, a young male was admitted to our hospital with a chief complaint of sudden blurred vision in his right eye. His ocular examination detected a tiny mass in the choroid and a small lesion in the retina. After interferon-gamma release assay (IGRA) and chest CT scan, the patient was diagnosed with military tuberculosis. The ocular examination confirmed the diagnosis of choroidal tubercle complicated with intrarentinal tubercle, which were healed after systemic anti-tuberculosis therapy.

目的：观察急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy，CSC)的自然病程中渗漏点的形态及变化。方法：本研究为前瞻性研究，使用光学相干断层扫描(optical coherence tomography，OCT)观察从发病到发病后5~13个月的CSC患者的渗漏点的OCT形态，测量并计算Hall层、脉络膜全层各自厚度及比值，并进行比较。结果：共20例患者[男14例，女6例，年龄33~59(中位数41)岁]纳入研究。随访时间为5~13个月。在19例患者中观察到微小视网膜色素上皮脱离(pigment epithelium detachment，PED)。1例患者可见视网膜色素上皮(retinal pigment epithelium， RPE)小凸起。在随访期间，仅1例患者的PED完全恢复，其他19例患者在视网膜下液被完全吸收时，RPE和Bruch膜之间仍存在微小分离。渗漏点处的Haller层/脉络膜厚度显著高于中央凹处(初诊时0.806±0.08 vs 0.863±0.06，P=0.003；最后1次随访时为0.801±0.07 vs 0.851±0.06，P=0.004)。结论：本研究观察到在急性CSC患者自然病程中，即使视网膜下液吸收，OCT显示渗漏点处仍存在持续的PED，更厚的Haller层及更薄的内层脉络膜，这些发现为CSC的发病机制提供了更多线索。

Objective: To observe the morphology and changes of leakage points in the natural course of acute central serous chorioretinopathy (CSC). Methods: This study was a prospective study, using optical coherence tomography to observe the OCT morphology of leakage points in CSC patients from onset to 5 to 13 months after onset, measuring the thickness and ratio of Hall layer and the whole choroid, and then compare them. Results: A total of 20 patients were included in the study, including 14 males and 6 females, aged from 33 to 59, with the median being 41 years old. The follow-up time ranged from 5 months to 13 months. Minute retinal pigment epithelial detachments (PED) were observed in 19 patients. A small bulge of retinal pigment epithelium (RPE) was observed in 1 patient. During the follow-up, only one patient totally recovered. Small separation between RPE and Bruch membrane still exit even subretinal fluid were absorbed completely in the other 19 patients. The thickness of Haller layer or choroid at the leakage point was significantly higher than that of the fovea (0.806±0.08 vs 0.863±0.06, P=0.003, at the first visit; 0.801±0.07 vs 0.851±0.06, P=0.004, at the last follow-up). Conclusion: This study observed that in the natural course of acute CSC patients, even if the subretinal fluid was absorbed, OCT still showed that there was persistent PED at the leakage point, thicker Haller layer and thinner inner choroid layer. These findings provided more clues to the pathogenesis of CSC.

目的：观察急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy，CSC)的自然病程中渗漏点的形态及变化。方法：本研究为前瞻性研究，使用光学相干断层扫描(optical coherence tomography，OCT)观察从发病到发病后5~13个月的CSC患者的渗漏点的OCT形态，测量并计算Hall层、脉络膜全层各自厚度及比值，并进行比较。结果：共20例患者[男14例，女6例，年龄33~59(中位数41)岁]纳入研究。随访时间为5~13个月。在19例患者中观察到微小视网膜色素上皮脱离(pigment epithelium detachment，PED)。1例患者可见视网膜色素上皮(retinal pigment epithelium，RPE)小凸起。在随访期间，仅1例患者的PED完全恢复，其他19例患者在视网膜下液被完全吸收时，RPE和Bruch膜之间仍存在微小分离。渗漏点处的Haller层/脉络膜厚度显著高于中央凹处(初诊时0.806±0.08 vs 0.863±0.06，P=0.003；最后1次随访时为0.801±0.07 vs 0.851±0.06，P=0.004)。结论：本研究观察到在急性CSC患者自然病程中，即使视网膜下液吸收，OCT显示渗漏点处仍存在持续的PED，更厚的Haller层及更薄的内层脉络膜，这些发现为CSC的发病机制提供了更多线索。

Objective: To observe the morphology and changes of leakage points in the natural course of acute central serous chorioretinopathy (CSC). Methods: This study was a prospective study, using optical coherence tomography to observe the OCT morphology of leakage points in CSC patients from onset to 5 to 13 months after onset, measuring the thickness and ratio of Hall layer and the whole choroid, and then compare them. Results: A total of 20 patients were included in the study, including 14 males and 6 females, aged from 33 to 59, with the median being 41 years old. The follow-up time ranged from 5 months to 13 months. Minute retinal pigment epithelial detachments (PED) were observed in 19 patients. A small bulge of retinal pigment epithelium (RPE) was observed in 1 patient. During the follow-up, only one patient totally recovered. Small separation between RPE and Bruch membrane still exit even subretinal fluid were absorbed completely in the other 19 patients. The thickness of Haller layer or choroid at the leakage point was significantly higher than that of the fovea (0.806±0.08 vs 0.863±0.06, P=0.003, at the first visit; 0.801±0.07 vs 0.851±0.06, P=0.004, at the last follow-up). Conclusion: This study observed that in the natural course of acute CSC patients, even if the subretinal fluid was absorbed, OCT still showed that there was persistent PED at the leakage point, thicker Haller layer and thinner inner choroid layer. These findings provided more clues to the pathogenesis of CSC.