Haruta Masatoshi, Yamakawa Ryoji
Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, Japan.
Retina. 2017 May;37(5):915-920. doi: 10.1097/IAE.0000000000001244.
To evaluate the efficacy of vitrectomy in the treatment of macular retinoschisis without a detectable optic disk pit.
This retrospective interventional case series included eight patients with acquired, unilateral macular retinoschisis with or without foveal detachment. Patients with an optic disk pit, vitreomacular traction, or high myopia were excluded. Six of the eight patients underwent vitrectomy with internal limiting membrane peeling and fluid-air exchange. The surgical outcome was evaluated in terms of the improvement in the macular anatomy and the best-corrected visual acuity.
During vitrectomy, all the six eyes were confirmed to have preexisting posterior vitreous detachment. Macular retinoschisis was resolved or reduced in all the six eyes after vitrectomy. The mean central foveal thickness showed significant improvement at the time of the patient's final visit after vitrectomy. The mean best-corrected visual acuity was 20/52 before surgery and 20/31 at the final visit.
Vitrectomy might be effective for the treatment of macular retinoschisis without an optic disk pit. Although clinically similar to optic pit maculopathy except for the absence of pit, our intraoperative observations of the posterior hyaloid membrane suggest that maculopathy without optic disk pit has a distinct pathogenesis.
评估玻璃体切除术治疗无明显视盘小凹的黄斑视网膜劈裂症的疗效。
本回顾性介入性病例系列研究纳入了8例获得性单侧黄斑视网膜劈裂症患者,伴或不伴有黄斑中心凹脱离。排除患有视盘小凹、玻璃体黄斑牵拉或高度近视的患者。8例患者中有6例行玻璃体切除术联合内界膜剥除及液气交换。根据黄斑解剖结构的改善情况及最佳矫正视力评估手术效果。
玻璃体切除术中,所有6只眼均证实存在既往的玻璃体后脱离。玻璃体切除术后,所有6只眼的黄斑视网膜劈裂均得到缓解或减轻。玻璃体切除术后患者末次随访时,平均中心凹厚度有显著改善。术前平均最佳矫正视力为20/52,末次随访时为20/31。
玻璃体切除术可能对治疗无视盘小凹的黄斑视网膜劈裂症有效。尽管在临床上除了没有视盘小凹外与视盘小凹黄斑病变相似,但我们对玻璃体后界膜的术中观察表明,无视盘小凹的黄斑病变有独特的发病机制。