Objective To analysis the fundus characteristics of fundus fluorescein angiography (FFA) of retinopathy of prematurity (ROP).
Methods Eighty-four cases (168 eyes) who were diagnosed with ROP by a binocular indirect ophthalmoscope were included in the study. Among the 84 cases, there were 2 cases (4 eyes) of stage 1 ROP, 26 cases (52 eyes) of stage 2 ROP, 40 cases (80 eyes) of stage 3 ROP, 4 cases (8 eyes) of stage 4 ROP, and 4 cases (8 eyes) of stage 5 ROP, 9 cases (18 eyes) of plus disease, 8 cases (16 eyes) of aggressive posterior ROP (APROP). All infants received FFA with RetCam Ⅱ under general anesthesia and mydriasis. The retinal vein morphology, capillary filling state, neovascularization morphology and fluorescein leakage were observed.
Results FFA revealed increased branching, expansion and tortuous peripheral retinal capillaries, increased capillary permeability with a small amount of fluorescein leakage in stage 1 ROP. There was a clear dividing line between the vascular area and the remote avascular area. In stage 2, the peripheral branches of temporal retinal blood vessels increased, and parallel distributed like a broom. The capillary end anastomosed with each other to form a loop. The fibrous tissues at the lesion edge proliferated as a ridge, with popcorn phenomenon. In stage 3, the ridge continued broadening, and the neovascular fibrous membrane formed breakthrough internal limiting membrane, stretched into the vitreous with a lot of fluorescein leakage. The ridge and remote avascular zone demarcated clearly. In stage 4 and 5, the vessel changes had similar phenomenon with the stage 2 and 3 in undetached retina, but the vessels in the detached retina expanded with fluorescein leakage. As for plus disease, the retinal arterioles in the posterior pole were tortuous, there were a large number of non-perfusion area in the peripheral retina with hemorrhage and obscured fluorescence. The retinal vessels in posterior pole in AP-ROP were also tortuous, and the capillaries were extreme expanded, while there were very few tortuous vessels and no capillary formation in the other part of retina.At the avascular zone boundaries, there were a large group of neovascularization with fluorescein leakage.
Conclusions The demarcation line separating the avascular from the vascularized retinal regions is formed in stage 1, 2 and 3, and the amount of fluorescein leakage gradually increase from stage 1 to stage 3 ROP. The detached retina of stage 4 and stage 5 has an unclear focal length in the FFA. The plus disease mainly has arteriolar tortuosity in the posterior pole retina. In the AP-ROP cases, both of the arterioles and venules in posterior pole of retina are tortuous and expanding with neovascularization leakage of fluorescein.
Citation:
XieXuelu, TangFei, ZhouXiaozhou. Fundus fluorescein angiography in retinopathy of prematurity. Chinese Journal of Ocular Fundus Diseases, 2014, 30(1): 17-20. doi: 10.3760/cma.j.issn.1005-1015.2014.01.005
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- 1. 吴本清,宋金枝. 早产儿视网膜病变的危险因素和发病机制[M]//黄丽娜,张国明,吴本清. 早产儿视网膜病变. 广州:广东科技出版社,2007:22-26.
- 2. 中华医学会. 早产儿治疗用氧和视网膜病变防治指南[J].中国生育健康杂志, 2004, 15:132-133.
- 3. 黄欣,单海冬,常青,等. 急进性后部型早产儿视网膜病变的临床特征及治疗[J]. 中华眼底病杂志, 2012, 28:33-36.
- 4. 郭九玲,刘文军. 眼底荧光血管造影相关性副反应的预见性护理[J]. 护理学研究, 2005, 19:724.
- 5. Yokoi T, Hiraoka M, Miyamoto M, et al. Vascular abnormalities in aggressive posterior retinopathy of prematurity detected by fluorescein angiography[J]. Ophthalmology, 2009, 116:1377-1382.