Lytvynchuk Lyubomyr M, Glittenberg Carl G, Ansari-Shahrezaei Siamak, Binder Susanne
Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Campus Giessen, Friedrichstrasse 18, 35392, Giessen, Germany.
Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, A-1030, Vienna, Austria.
BMC Ophthalmol. 2017 Aug 1;17(1):134. doi: 10.1186/s12886-017-0533-0.
The pathogenesis of non-rhegmatogenous retinal detachment (non-RRD) associated with morning glory syndrome (MGS) is not established, as well as best surgical approach to treat RD. Our purpose was to analyse intraoperative optical coherence tomography data (iOCT) in all steps of pars plana vitrectomy (PPV) for non-RRD in MGS, in order to follow pathophysiological aspects of the disease and to understand the tissues behaviour during surgical workflow.
Intraoperative spectral domain optical coherent tomography (iSD-OCT) assisted PPV using Rescan 700 (Carl Zeiss Meditech, Jena, Germany) with epiretinal membrane (ERM) and internal retinal membrane (ILM) peeling, and air endotamponade was performed on the only eye of a 21 years old female with non-RRD associated with MGS. BCVA, pre-, intra- and postoperative OCT were performed along with standard ocular examination. iOCT video and snapshots were analysed intra- and postoperatively using post-processing approach using graphic software. The progression of non-RRD resulted in best corrected visual acuity (BCVA) decrease from 0.8 to 0.2. Triamcinolone enhanced iOCT imaging revealed strong vitreous traction and adhesion above the macula and optic disc. Internal limiting membrane was peeled under iOCT control to prevent the peeling of inner layers of the retinal schisis. No retinal break was detected, and only air endotamponade was performed. The retina reattached during first 4 weeks of follow-up with gradual resolution of intraretinal- and subretinal fluid, and remained stable in 12 months. BCVA improved to 0.8.
Based on iSD-OCT findings we assume that non-RRD in this case of MGS is caused primarily by the vitreous traction with further possible formation of the retinal breaks. Retinal reattachment reached only with air endotamponade strongly advocates the tractional component of non-RRD and retinal schisis assotiated with MGS. Early PPV for central non-RRD and retinal schisis with the use of iOCT can be performed in more safe and controlled manner and has to be considered to reduce the risk of retinal break formation and to prevent the central vision loss.
与牵牛花综合征（MGS）相关的非孔源性视网膜脱离（non-RRD）的发病机制尚未明确，治疗视网膜脱离的最佳手术方法也未确定。我们的目的是分析在MGS患者非RRD的玻璃体切割术（PPV）各步骤中的术中光学相干断层扫描数据（iOCT），以追踪该疾病的病理生理方面，并了解手术过程中组织的行为。
对一名21岁患有与MGS相关的非RRD的女性单眼进行了术中光谱域光学相干断层扫描（iSD-OCT）辅助的PPV，使用Rescan 700（德国耶拿卡尔蔡司医疗技术公司）进行视网膜前膜（ERM）和视网膜内界膜（ILM）剥除，并进行了空气内填充。在进行标准眼科检查的同时，还进行了最佳矫正视力（BCVA）检查以及术前、术中和术后的OCT检查。术中及术后使用图形软件的后处理方法对iOCT视频和快照进行了分析。非RRD的进展导致最佳矫正视力（BCVA）从0.8降至0.2。曲安奈德增强的iOCT成像显示黄斑和视盘上方有强烈的玻璃体牵引和粘连。在iOCT控制下剥除内界膜以防止视网膜劈裂内层的剥除。未检测到视网膜裂孔，仅进行了空气内填充。在随访的前4周内视网膜复位，视网膜内液和视网膜下液逐渐消退，并在12个月内保持稳定。BCVA提高到了0.8。
基于iSD-OCT的结果，我们推测该MGS病例中的非RRD主要是由玻璃体牵引引起的，进一步可能形成视网膜裂孔。仅通过空气内填充实现视网膜复位强烈支持了与MGS相关的非RRD和视网膜劈裂的牵引成分。对于中央性非RRD和视网膜劈裂，早期使用iOCT进行PPV可以更安全、可控地进行，并且必须考虑以降低视网膜裂孔形成的风险并防止中央视力丧失。
