Hixson Angeline, Reynolds Sherrol
Nova Southeastern University College of Optometry, Davie, Florida 33328, USA.
Optometry. 2011 Oct;82(10):602-6. doi: 10.1016/j.optm.2011.02.018.
Vitreoretinal traction syndrome may occur in patients with incomplete posterior vitreous detachment. Although vitreoretinal traction of the macula is well-documented in the literature, the manifestations of peripapillary vitreoretinal traction are rarely discussed.
A 62-year-old black woman presented for a comprehensive examination. She reported having uncontrolled diabetes and hypertension. Best-corrected visual acuities were 20/30 in the right eye (OD) and 20/25 in the left eye (OS). Dilated examination found a flame-shaped hemorrhage OD. The optic nerve margins OS were blurred, with the margins appearing elevated with peripapillary intraretinal hemorrhages. Cirrus spectral domain optical coherence tomography (OCT) found the presence of peripapillary vitreoretinal traction with concurrent vitreomacular traction OS.
Although the effects of vitreoretinal traction are most commonly associated with the macula or peripheral retina, residual attachment can occur at the optic nerve head. Peripapillary vitreoretinal traction can cause optic nerve head elevation with the appearance of edema that must be distinguished from sight- or health-threatening etiologies. OCT is a valuable diagnostic tool in confirming peripapillary vitreoretinal traction.
玻璃体视网膜牵拉综合征可发生于不完全性玻璃体后脱离患者。尽管黄斑部玻璃体视网膜牵拉在文献中有充分记载,但视乳头周围玻璃体视网膜牵拉的表现却鲜有讨论。
一名62岁黑人女性前来进行全面检查。她自述患有未得到控制的糖尿病和高血压。右眼(OD)最佳矫正视力为20/30,左眼(OS)为20/25。散瞳检查发现右眼有火焰状出血。左眼视盘边缘模糊,边缘因视乳头周围视网膜内出血而显得隆起。Cirrus频域光学相干断层扫描(OCT)发现左眼存在视乳头周围玻璃体视网膜牵拉并伴有玻璃体黄斑牵拉。
尽管玻璃体视网膜牵拉的影响最常与黄斑或周边视网膜相关,但在视神经乳头处可发生残余附着。视乳头周围玻璃体视网膜牵拉可导致视神经乳头隆起并出现水肿表现,必须与威胁视力或健康的病因相鉴别。OCT是确诊视乳头周围玻璃体视网膜牵拉的重要诊断工具。