Department of Ophthalmology, Asahikawa Medical College, Asahikawa, Hokkaido, Japan.
Ophthalmology. 2010 Apr;117(4):806-10. doi: 10.1016/j.ophtha.2009.09.022. Epub 2010 Feb 4.
To report the case of a stage 1 macular hole and the sequential intrafoveal changes with spectral-domain optical coherence tomography (SD-OCT).
Single, observational case report.
A 51-year-old woman with a stage 1A macular hole that progressed to a stage 2 macular hole.
Clinical ophthalmologic examinations were repeated, including SD-OCT, during follow-up at intervals of several weeks.
Sequential intrafoveal tomographic alterations in a patient with a stage 1 macular hole. Foveal splits in the inner retina progressed to an enlarged pseudocyst that disrupted the outer retinal layer (ORL) resulting from the vitreous traction associated with a perifoveal posterior vitreous detachment (PPVD).
The patient was referred for decreased vision in the left eye. Her best-corrected visual acuity was 20/32 in the left eye. The SD-OCT showed intrafoveal splits of a typical stage 1A macular hole with a PPVD. Two weeks later, a small, triangularly shaped foveal detachment was detected beneath the central fovea. Four weeks after the initial visit, the splits expanded and the foveal surface was elevated anteriorly; a columnar structure between the splits beneath the central fovea was seen. Eight weeks after the initial visit, the columnar structure was pulled from the outer retina with formation of the PPVD; the structure had shortened anteriorly and formed a cone-shaped structure under the roof. Eleven weeks after the initial visit, the cone-shaped structure shortened and became smaller under the inner roof, and the ORL was separated completely. The anatomic features of the foveal pseudocyst were comparable with that of a typical stage 1B macular hole. Eighteen weeks after the initial visit, the cone-shaped structure disappeared under the inner roof. Thirty weeks after the initial visit, the roof opened with formation of the PPVD. The foveal anatomic features of the full-thickness macular hole became comparable with that of a typical stage 2 macular hole.
These OCT findings suggested that the cone-shaped structure was pulled from the outer retina by anteroposterior vitreous traction. This may cause a progressively enlarging pseudocyst that disrupts the ORL in some cases of stage 1 macular holes.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
报告 1 期黄斑裂孔的病例，并结合谱域光相干断层扫描（SD-OCT）观察其随时间的中心凹内变化。
单病例观察报告。
1 例 51 岁女性，患 1A 期黄斑裂孔，进展为 2 期黄斑裂孔。
对患者进行临床眼科检查，包括 SD-OCT，在数周的随访过程中，每隔几周重复一次。
1 期黄斑裂孔患者的中心凹内随时间变化的断层成像。内视网膜的中心凹分裂进展为扩大的假性裂孔，破坏了外层视网膜（ORL），这是由与周边部玻璃体后脱离（PPVD）相关的玻璃体牵引引起的。
患者左眼视力下降，到我院就诊。其最佳矫正视力左眼为 20/32。SD-OCT 显示 1A 期黄斑裂孔的典型中心凹分裂，伴有 PPVD。2 周后，在中央凹下发现一个小的三角形中心凹脱离。初次就诊后 4 周，裂孔扩大，中央凹表面向前抬高；在中央凹下的分裂之间可见柱状结构。初次就诊后 8 周，柱状结构从外视网膜被牵拉，形成 PPVD；该结构向前缩短，在屋顶下形成一个锥形结构。初次就诊后 11 周，锥形结构缩短并在内部屋顶下变小，ORL 完全分离。假性裂孔的解剖特征与典型 1B 期黄斑裂孔相似。初次就诊后 18 周，锥形结构在内层屋顶下消失。初次就诊后 30 周，屋顶开放形成 PPVD。全层黄斑裂孔的中心凹解剖特征与典型 2 期黄斑裂孔相似。
这些 OCT 发现提示，前后玻璃体牵引将锥形结构从外视网膜中牵拉出来。这可能导致假性裂孔逐渐增大，在某些 1 期黄斑裂孔中破坏 ORL。
作者没有与本文讨论的任何材料有关的专有或商业利益。
