Takahashi Atsushi, Nagaoka Taiji, Yoshida Akitoshi
Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan.
Retin Cases Brief Rep. 2016 Winter;10(1):79-82. doi: 10.1097/ICB.0000000000000158.
To report the detailed changes in the macular morphology documented by spectral domain optical coherence tomography in a 74-year-old woman with macular hole (MH) formation after vitreomacular detachment with an operculum.
History and clinical examinations included slit-lamp biomicroscopy, best-corrected visual acuity, color fundus photography, and spectral domain optical coherence tomography.
The patient was referred for decreased vision in the left eye (visual acuity, right eye, 20/20; left eye, 20/50). Spectral domain optical coherence tomography showed a full-thickness MH in the left eye. The right eye had a lamellar MH, and the photoreceptor inner/outer segment line was uninterrupted beneath the central fovea. The right eye had vitreomacular detachment with a small round operculum suggestive of an elevated inner foveal retina. Thirty-seven months after the initial visit, the patient returned with visual acuity in the right eye that had decreased to 20/50 and a full-thickness MH had developed in the presence of vitreomacular detachment. An epiretinal membrane appeared nasal to the fovea, and the macular surface had a triangular dimple beneath the membrane. A large retinal schisis developed nasal to the hole. A tightrope-like structure bridged the MH edges.
In this case, the MH resulted from the tangential traction caused by the epiretinal membrane after vitreomacular detachment developed; the MH was accompanied by a small round operculum, a retinal dimple beneath the membrane, and a tightrope-like structure that bridged the hole edges. The operculum likely comprised a detached inner foveal retina alone and did not include retinal photoreceptor cells.
报告一名74岁女性在伴有盖膜的玻璃体黄斑脱离后形成黄斑裂孔（MH），通过光谱域光学相干断层扫描记录的黄斑形态的详细变化。
病史和临床检查包括裂隙灯生物显微镜检查、最佳矫正视力、彩色眼底照相和光谱域光学相干断层扫描。
患者因左眼视力下降前来就诊（视力，右眼20/20；左眼20/50）。光谱域光学相干断层扫描显示左眼为全层MH。右眼为板层MH，中央凹下的光感受器内/外节线未中断。右眼存在玻璃体黄斑脱离，有一个小圆形盖膜，提示中央凹视网膜内层隆起。初诊37个月后，患者右眼视力降至20/50，在玻璃体黄斑脱离的情况下出现了全层MH。在中央凹鼻侧出现了视网膜前膜，膜下黄斑表面有一个三角形凹陷。在裂孔鼻侧出现了一个大视网膜劈裂。一个类似绳索的结构连接着MH边缘。
在该病例中，MH是在玻璃体黄斑脱离发生后由视网膜前膜引起的切线牵引所致；MH伴有一个小圆形盖膜、膜下视网膜凹陷以及连接裂孔边缘的类似绳索的结构。盖膜可能仅由脱离的中央凹视网膜内层组成，不包括视网膜光感受器细胞。
