Lai Chun-Ting, Yang Chung-May
Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
Taiwan J Ophthalmol. 2015 Apr-Jun;5(2):85-89. doi: 10.1016/j.tjo.2015.03.002. Epub 2015 May 12.
There are yet no reports in the literature describing the mechanism of macular hole (MH) formation associated with fibrovascular proliferation in proliferative diabetic retinopathy. We report four cases of MHs in diabetic retinopathy with fibrovascular proliferation; formation of MHs were studied using sequential pre-MH optical coherence tomography (OCT). In Case 1, initial OCT revealed tractional schisis and cysts with fovea detachment. An MH with bowl-shaped detachment was noted within 6 weeks. In Case 2, initial OCT revealed thickened posterior hyaloid membrane with vitreomacular traction. Five and a half years later, OCT showed MH formation with possible vitreomacular separation. Some epiretinal membrane was also noted in the macula area. In Case 3, initial OCT revealed tractional retinal elevation from the superonasal area to the fovea with macular thinning. An MH with detachment developed 7 weeks later. In Case 4, initial OCT revealed macula-involved retinal detachment with traction. An MH was noted 4 weeks later. The analysis of sequential OCT findings in these four cases suggests that strong vitreoretinal adhesion and traction of fibrovascular proliferation may induce an MH without going through the same evolutionary phases as those characteristic of idiopathic MHs.
文献中尚无关于增生性糖尿病视网膜病变中与纤维血管增殖相关的黄斑裂孔（MH）形成机制的报道。我们报告了4例伴有纤维血管增殖的糖尿病视网膜病变患者的MH；使用MH形成前的连续光学相干断层扫描（OCT）对MH的形成进行了研究。病例1中，最初的OCT显示牵拉性视网膜劈裂和囊肿伴黄斑脱离。6周内发现了一个伴有碗状脱离的MH。病例2中，最初的OCT显示后玻璃体膜增厚伴玻璃体黄斑牵拉。五年半后，OCT显示MH形成且可能存在玻璃体黄斑分离。黄斑区还发现了一些视网膜前膜。病例3中，最初的OCT显示从鼻上区域到黄斑的牵拉性视网膜隆起伴黄斑变薄。7周后出现了一个伴有脱离的MH。病例4中，最初的OCT显示累及黄斑的视网膜脱离伴牵拉。4周后发现了一个MH。对这4例患者连续OCT结果的分析表明，强烈的玻璃体视网膜粘连和纤维血管增殖的牵拉可能导致MH的形成，而无需经历与特发性MH相同的演变阶段。
