Miyoshi Yukiko, Tsujikawa Akitaka, Manabe Saki, Nakano Yuki, Fujita Tomoyoshi, Shiragami Chieko, Hirooka Kazuyuki, Uji Akihito, Muraoka Yuki
Department of Ophthalmology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kagawa, Japan.
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Graefes Arch Clin Exp Ophthalmol. 2016 Oct;254(10):1941-1949. doi: 10.1007/s00417-016-3343-9. Epub 2016 Apr 19.
To investigate the prevalence, detailed characteristics, and pathogenesis of paravascular inner retinal defects (PIRDs) in eyes with epiretinal membranes (ERMs).
In this prospective observational case series, we included 81 eyes of 81 patients with idiopathic ERMs, without high myopia. The retinal structure surrounding the PIRDs was assessed using sequential thin sectioning of optical coherence tomography. The PIRDs were classified into three grades. Typical defects of the inner retinal tissue were defined as grade 3. Inner retinal cleavages with openings to the vitreous cavity and no apparent defect of the inner retinal tissue were defined as grade 2. Inner retinal cleavages or cystoid spaces with no connection to the vitreous cavity were defined as grade 1.
Of 81 eyes with ERMs, 31 (38.3 %) had PIRDs along the temporal arcade vessels (grade 1 in six eyes, grade 2 in four eyes, and grade 3 in 21 eyes). PIRDs were frequently accompanied by broad defects of the inner retinal tissue (grade 3). Although some ERMs directly adhered to the edge of a PIRD or the retinal vessels, PIRDs were often located outside the area of adhesion to the ERM. In some OCT sections, vitreous traction on the inner retina seemed to contribute to the progression of PIRDs. Visual field abnormalities corresponded to the location of the PIRDs in 44.4 % of eyes with grade 3 PIRDs.
Deviation of retinal vessels due to the traction of the ERMs may contribute to the pathogenesis of PIRDs. PIRDs often cause visual field abnormalities corresponding to the location of the defect.
研究视网膜前膜（ERM）患者中血管旁视网膜内层缺损（PIRD）的患病率、详细特征及发病机制。
在这个前瞻性观察性病例系列中，我们纳入了81例特发性ERM患者的81只眼，这些患者均无高度近视。使用光学相干断层扫描的连续薄层扫描评估PIRD周围的视网膜结构。PIRD分为三个等级。视网膜内层组织的典型缺损定义为3级。与玻璃体腔相通且视网膜内层组织无明显缺损的视网膜内层劈裂定义为2级。与玻璃体腔无连接的视网膜内层劈裂或囊样间隙定义为1级。
在81只患有ERM的眼中，31只（38.3%）沿颞侧弓形血管出现PIRD（6只眼为1级，4只眼为2级，21只眼为3级）。PIRD常伴有视网膜内层组织的广泛缺损（3级）。尽管一些ERM直接附着于PIRD边缘或视网膜血管，但PIRD常位于与ERM粘连区域之外。在一些光学相干断层扫描图像中，玻璃体对视网膜内层的牵拉似乎促进了PIRD的进展。在44.4%的3级PIRD眼中，视野异常与PIRD的位置相对应。
ERM的牵拉导致视网膜血管偏移可能是PIRD发病机制的一个因素。PIRD常导致与缺损位置相对应的视野异常。
