Zumbro David S, Jampol Lee M, Folk James C, Olivier Mildred M G, Anderson-Nelson Susan
Ophthalmology Service, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
Am J Ophthalmol. 2007 Jul;144(1):70-74. doi: 10.1016/j.ajo.2007.03.027. Epub 2007 May 9.
To describe a clinical syndrome of macular schisis and detachment in patients with acquired optic nerve head cupping resulting from glaucoma.
Retrospective review of five patients.
Patients were included if they had optic nerve cupping and macular schisis with or without detachment with no other identifiable cause. The patients had to have no leakage on fluorescein angiography and no vitreous traction on examination or on optic coherence tomography (OCT). These patients were followed up and visual acuity, intraocular pressure, and the findings of serial fundus and OCT examinations were noted.
Five patients had schisis with or without detachment of the macula with pronounced optic nerve head cupping. One patient had resolution of the macular fluid after filtering surgery for uncontrolled glaucoma. Two patients underwent a vitrectomy with intraocular gas and had almost total resolution of macular fluid and improved vision.
Macular schisis and detachment can occur in patients with presumed enlarged optic nerve head cups in the absence of obvious congenital anomalies of the disk. The authors believe the cause is leakage of fluid from the vitreous through a tiny hole in the thin tissue of the cup. This is a similar mechanism to that seen in patients with optic pits. A vitrectomy or steps to reduce the intraocular pressure may result in resolution of the fluid and improved vision.
描述青光眼所致获得性视神经乳头凹陷患者黄斑劈裂和脱离的临床综合征。
对5例患者进行回顾性研究。
纳入标准为患有视神经凹陷且伴有或不伴有脱离的黄斑劈裂，无其他可识别病因。患者在荧光素血管造影检查中无渗漏，检查或光学相干断层扫描（OCT）检查中无玻璃体牵拉。对这些患者进行随访，并记录视力、眼压以及系列眼底和OCT检查结果。
5例患者存在黄斑劈裂伴或不伴有脱离，视神经乳头凹陷明显。1例患者在因青光眼控制不佳行滤过手术后黄斑积液消退。2例患者接受了眼内注入气体的玻璃体切除术，黄斑积液几乎完全消退，视力改善。
在没有明显先天性视盘异常的情况下，黄斑劈裂和脱离可发生于视神经乳头杯扩大的患者。作者认为病因是玻璃体中的液体通过杯状薄组织中的小孔渗漏。这与视盘小凹患者的机制相似。玻璃体切除术或降低眼压的措施可能会使积液消退，视力改善。
