Ishizaki Norihiko, Kida Teruyo, Fukumoto Masanori, Sato Takaki, Oku Hidehiro, Ikeda Tsunehiko
Department of Ophthalmology, Yao Tokushukai General Hospital, 1-17 Wakakusa-cho, Yao, Japan.
Department of Ophthalmology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
BMC Ophthalmol. 2018 Feb 27;18(1):59. doi: 10.1186/s12886-018-0730-5.
To describe a retrospective study of macular retinoschisis that developed long after the onset of retinal artery occlusion (RAO) using optical coherence tomography (OCT).
We describe changes in macular findings and visual acuity (VA) of 29 patients (21 males and 8 females, mean age: 66.1 ± 16.9 years) with RAO (18 branch RAOs [BRAOs] and 11 central RAOs [CRAOs] who visited Osaka Medical College Hospital over an 8-year period based on a medical chart review.
The mean VA (logMAR) increased from 1.06 ± 1.08 (CRAO: 2.04 ± 0.99; BRAO: 0.37 ± 0.40) at the first visit to 0.71 ± 0.87 (CRAO: 1.46 ± 0.86; BRAO: 0.18 ± 0.30) at the final visit. Macular OCT revealed swelling or hyper-reflectivity of the inner retina in the early phase of RAO and retinal thinning in the late phase. Among the 29 patients, two patients (a patient with BRAO and a patient with CRAO) developed macular retinoschisis about 1 year after RAO onset. The VA of the patient with BRAO was 20/300 at the first visit, and it improved to 20/25 two days after onset following eye massage and anterior chamber paracentesis. However, his VA worsened, declining from 20/25 to 20/50, and retinoschisis occurred 13 months after RAO onset. The patient with CRAO showed macular changes including small cystoids at the first follow-up visit more than 3 weeks after onset and developed retinoschisis 11 months after the first visit. In addition, two patients with BRAO and one patient with CRAO developed macular changes including small cystoids 3 weeks after onset, with the BRAO complicated by retinal vein occlusion. In the CRAO patient, the cystoid macular edema was resolved 1 month after the first visit.
Macular retinoschisis is unusual, but a possible complication of RAO that can develop long after the onset of the occlusion, potentially resulting in renewed VA deterioration.
采用光学相干断层扫描（OCT）对视网膜动脉阻塞（RAO）发病很久后出现的黄斑视网膜劈裂进行一项回顾性研究。
我们根据病历回顾，描述了8年间就诊于大阪医科大学医院的29例RAO患者（21例男性和8例女性，平均年龄：66.1±16.9岁）的黄斑病变及视力（VA）变化情况，其中18例为分支视网膜动脉阻塞（BRAO），11例为中央视网膜动脉阻塞（CRAO）。
初次就诊时平均视力（logMAR）为1.06±1.08（CRAO：2.04±0.99；BRAO：0.37±0.40），末次就诊时为0.71±0.87（CRAO：1.46±0.86；BRAO：0.18±0.30）。黄斑OCT显示，RAO早期内层视网膜肿胀或高反射，晚期视网膜变薄。29例患者中，2例（1例BRAO患者和1例CRAO患者）在RAO发病约1年后出现黄斑视网膜劈裂。BRAO患者初次就诊时视力为20/300，眼部按摩和前房穿刺术后发病2天视力改善至20/25。然而，其视力恶化，从20/25降至20/50，且在RAO发病13个月后发生视网膜劈裂。CRAO患者在发病3周多后的首次随访时出现包括小囊样变在内的黄斑改变，并在初次就诊11个月后发生视网膜劈裂。此外，2例BRAO患者和1例CRAO患者在发病3周后出现包括小囊样变在内的黄斑改变，其中BRAO患者并发视网膜静脉阻塞。CRAO患者在初次就诊1个月后囊样黄斑水肿消退。
黄斑视网膜劈裂不常见，但可能是RAO的一种并发症，可在阻塞发病很久后发生，可能导致视力再次恶化。
