Fryczkowski Piotr, Jedruch Anna, Kmera-Muszyńska Maria
Katedry i Kliniki Okulistyki II, Wydziału Lekarskiego Akademii Medycznej w Warszawie.
Klin Oczna. 2006;108(7-9):327-31.
The aim of this study is to present the case of a spontaneous retinal pigment epithelial tear in high myopia.
A 56 years old woman with high myopia (refractive error -10.0D) in both eyes and amblyopia in right eye since childhood, complained of a decrease in left eye vision for one and a half month. Full ophthalmic examination, fundus photography, ultrasound examination and indocyanine green angiography were performed.
At first visit BCVA was 5/25 in her left eye. A subretinal hemorrhage accompanied by retinal pigment epithelial tear inferotemporal to the fovea was found in ocular examination. B-scan ultrasound did not revealed any traction at the fovea. 3 months later BCVA was 5/16 OS. The area of the atrophy of RPE--Bruch's membrane--choriocapillaris complex expanded and hyperpigmentation occured above the RPE tear. 3 months later BCVA was 2/50 OS, we observed a dark brown pigment spot surrounded with a subretinal hemorrhage somewhat above the RPE tear. Indocyanine green angiography demonstrated an initial choroidal neovascularization at superotemporal edge of hypertrophic pigment epithelium (Fuch's spot).
A spontaneous RPE tear might be the beginning of Fuchs' spot. A mechanical stress associated with eye movement is transmitted through the thin sclera and Bruch's membrane onto RPE and may cause a tear in its most vulnerable place i.e. at the margin of posterior staphyloma.
本研究旨在呈现高度近视患者自发性视网膜色素上皮撕裂的病例。
一名56岁女性，双眼高度近视（屈光不正-10.0D），右眼自幼弱视，主诉左眼视力下降1个半月。进行了全面的眼科检查、眼底照相、超声检查和吲哚青绿血管造影。
初诊时左眼最佳矫正视力为5/25。眼部检查发现黄斑颞下有视网膜下出血伴视网膜色素上皮撕裂。B超未显示黄斑区有任何牵拉。3个月后左眼最佳矫正视力为5/16。视网膜色素上皮-布鲁赫膜-脉络膜毛细血管复合体萎缩区域扩大，视网膜色素上皮撕裂上方出现色素沉着。3个月后左眼最佳矫正视力为2/50，我们观察到在视网膜色素上皮撕裂上方稍上方有一个深棕色色素斑，周围有视网膜下出血。吲哚青绿血管造影显示肥厚色素上皮（富克斯斑）颞上缘有初始脉络膜新生血管形成。
自发性视网膜色素上皮撕裂可能是富克斯斑的起始。与眼球运动相关的机械应力通过薄的巩膜和布鲁赫膜传递到视网膜色素上皮，并可能在其最脆弱的部位即后巩膜葡萄肿边缘导致撕裂。
