Kumar Atul, Kakkar Prateek, Ravani Raghav Dinesh, Markan Ashish
Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India.
BMJ Case Rep. 2017 Jul 14;2017:bcr-2016-217671. doi: 10.1136/bcr-2016-217671.
Macular hole-associated retinal detachment in high myopia is described as a final stage in progression of myopic traction maculopathy (MTM). Shimada described the progressive stages of MTM from macular retinoschisis to serous retinal detachment in high myopia. Stage 4 MTM is characterised as disappearance of retinoschisis with progression to retinal detachment due to macular hole formation. It is hypothesised that vitreoschisis and abnormal vitreo-retinal interface create the premacular tangential traction. Intraoperative triamcinolone acetonide is used to visualise the residual posterior vitreous cortex (PVC). We hereby describe the utility of microscope-integrated optical coherence tomography (MIOCT) in assisting complete removal of PVC and internal limiting membrane (ILM) peeling with multilayered inverted ILM flap in the treatment of myopic macular hole retinal detachment. MIOCT helped identify vitreoschisis and confirm the position of ILM flaps over the macular hole intraoperatively.
高度近视性黄斑裂孔性视网膜脱离被描述为近视性牵引性黄斑病变（MTM）进展的终末阶段。岛田描述了高度近视性MTM从黄斑视网膜劈裂到浆液性视网膜脱离的进展阶段。MTM 4期的特征是视网膜劈裂消失，由于黄斑裂孔形成而进展为视网膜脱离。据推测，玻璃体劈裂和异常的玻璃体视网膜界面产生黄斑前切线牵引。术中使用曲安奈德来显示残留的玻璃体后皮质（PVC）。我们在此描述显微镜集成光学相干断层扫描（MIOCT）在治疗近视性黄斑裂孔视网膜脱离中辅助完全去除PVC和进行多层倒置内界膜（ILM）瓣剥离的作用。MIOCT有助于术中识别玻璃体劈裂并确认黄斑裂孔上方ILM瓣的位置。
