Lecleire-Collet Amélie, Offret Olivier, Gaucher David, Audren François, Haouchine Belkacem, Massin Pascale
Department of Ophthalmology, Lariboisière Hospital, University of Paris, Paris, France.
Acta Ophthalmol Scand. 2007 Nov;85(7):795-8. doi: 10.1111/j.1600-0420.2007.00925.x. Epub 2007 Apr 24.
Full-thickness macular hole associated with diabetic macular oedema is a rare feature and its pathogenesis remains incompletely elucidated. We report the occurrence of a full-thickness macular hole, documented with optical coherence tomography (OCT), in a patient with diabetic cystoid macular oedema treated by intravitreal triamcinolone injections.
A 48-year-old woman with refractory diabetic cystoid macular oedema underwent successive intravitreal triamcinolone injections, which were followed by a progressive thinning of the neurosensory retina at the fovea, and then by a full-thickness macular hole, associated with a perifoveal posterior hyaloid detachment, visible on OCT. During pars plana vitrectomy, a thin epiretinal macular membrane was diagnosed and removed.
Pathogenesis of the present full-thickness macular hole associated with diabetic macular oedema is different from that of idiopathic macular holes because anteroposterior vitreous tractions were not involved in its formation. Recurrent intravitreal triamcinolone injections may have had an indirect role in the development of the macular hole, by favouring the rupture of distended Muller cells and intraretinal pseudocysts.
与糖尿病性黄斑水肿相关的全层黄斑裂孔是一种罕见特征，其发病机制仍未完全阐明。我们报告了1例经玻璃体腔注射曲安奈德治疗的糖尿病性黄斑囊样水肿患者出现全层黄斑裂孔，并经光学相干断层扫描（OCT）记录。
1例48岁难治性糖尿病性黄斑囊样水肿女性患者接受了连续的玻璃体腔注射曲安奈德治疗，随后黄斑中心凹处的神经感觉视网膜逐渐变薄，进而出现全层黄斑裂孔，并伴有中心凹周围玻璃体后脱离，OCT可见。在玻璃体切除术中，诊断并切除了一层薄的黄斑视网膜前膜。
目前与糖尿病性黄斑水肿相关的全层黄斑裂孔的发病机制与特发性黄斑裂孔不同，因为前后方向的玻璃体牵拉未参与其形成。反复玻璃体腔注射曲安奈德可能通过促使扩张的米勒细胞和视网膜内假性囊肿破裂，在黄斑裂孔的形成中起间接作用。
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