Trinh L, Glacet-Bernard A, Colasse-Marthelot V, Leynaud J-L, Soubrane G
Clinique Ophtalmologique Universitaire de Créteil, Hôpital Intercommunal et Henri Mondor (Assistance Publique des Hôpitaux de Paris), Université de Paris XII, Créteil, France.
J Fr Ophtalmol. 2006 Nov;29(9):995-9. doi: 10.1016/s0181-5512(06)73887-6.
The occurrence of a retinal fold after vitrectomy for retinal reattachment is not often described. In this case report, its treatment, prevention, and mechanism are discussed.
A 45-year-old pseudophakic woman experienced a superotemporal retinal detachment with macula-on and numerous retinal tears. The treatment consisted of a vitrectomy, perfluorocarbon injection, cryotherapy, and a complete fluid/gas exchange. Postoperative examination disclosed a retinal fold centered by the fovea. The treatment of this macular fold included the creation of a new detachment of the posterior pole by means of an injection of balanced saline solution into the subretinal space through a 39-gauge cannula, the injection of perfluorocarbon liquid to move the fold superiorly, endolaser at the inferior limit of the fold, and silicone oil injection. At the postoperative examination, the macula was flattened and the fold was near the superior temporal arcade.
The formation of a macular fold after vitrectomy was probably caused by the complete fluid/gas exchange, which displaced the subretinal fluid from the periphery to the posterior pole, detaching the macula. Tangential traction exerted by the presence of intravitreal gas and subretinal fluid might have stretched the retina and resulted in the formation of the fold. This mechanism is similar to the technique used in macular translocation surgery. To avoid this complication in macula-on retinal detachment, we suggest not using perfluorocarbon liquid systematically and replacing the complete fluid/gas exchange with a limited bubble of expansive gas combined with postoperative positioning.
视网膜复位玻璃体切除术后视网膜皱褶的发生情况鲜有报道。在本病例报告中，将对其治疗、预防及机制进行讨论。
一名45岁的人工晶状体植入术后女性发生颞上象限视网膜脱离，黄斑未脱离且有多处视网膜裂孔。治疗包括玻璃体切除术、全氟碳化合物注射、冷冻疗法以及完全的液体/气体交换。术后检查发现以黄斑为中心的视网膜皱褶。对该黄斑皱褶的治疗包括通过39号套管向视网膜下间隙注射平衡盐溶液造成后极部新的视网膜脱离，注射全氟碳化合物液体使皱褶向上移动，在皱褶下缘进行视网膜光凝，以及硅油注入。术后检查时，黄斑变平，皱褶位于颞上弓附近。
玻璃体切除术后黄斑皱褶的形成可能是由于完全的液体/气体交换，使视网膜下液从周边移向后极部，导致黄斑脱离。玻璃体内气体和视网膜下液产生的切向牵引力可能拉伸了视网膜，从而导致皱褶形成。该机制类似于黄斑转位手术中使用的技术。为避免黄斑未脱离的视网膜脱离出现这种并发症，我们建议不要常规使用全氟碳化合物液体，并用有限的膨胀气体气泡联合术后体位调整替代完全的液体/气体交换。
