Tang Wenyi, Gu Ruiping, Zhang Ting, Xu Gezhi
Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, China.
BMC Ophthalmol. 2018 Mar 20;18(1):79. doi: 10.1186/s12886-018-0748-8.
Epiretinal membranes (ERMs), secondary to retinal cell proliferation on the retinal surface, usually affect patients over 50 years of age but occur rarely in children. Here we report the case of a 4-year-old patient with a unilateral sub-inner limiting membrane (sub-ILM) membrane mimicking epiretinal membrane with notable ultrastructural features indicating its possible origin from old sub-ILM hemorrhage.
A 4-year-old boy was admitted with the complaint of poor vision in his right eye, which had been detected at school vision screening performed 6 months earlier. Fundal examination showed a feather-shaped white membrane in the macula of the right eye, and optical coherence tomography (OCT) revealed a thickened retina with a hyper-reflective band on the retinal nerve fiber layer. We suspected epiretinal membrane in the right eye, and pars plana vitrectomy with membrane peeling was performed to improve the patient's vision. Surprisingly, the membrane was found intraoperatively to be located beneath the intact ILM; it was lifted carefully from the underlying retina as it was strongly adhered to a retinal artery of the superotemporal arcade. Postoperative scanning electron microscopy showed that the membrane consisted of hemosiderin, collagenous fibre and fibrinoid deposits. At follow-up visits, fundal examination and OCT revealed improvement in the retinal structure with disappearance of the hyper-reflective band and reduced retinal thickness. The patient's visual acuity in the right eye was stable at 20/100 at 1 year post operation.
The white membrane presented here was found to lie between the intact ILM and the rest of the retina, adhering firmly to the superotemporal vessel arch. Given the ultrastructural findings of the membrane and the medical history, we speculate that the sub-ILM membrane probably developed secondary to a sub-ILM hemorrhage.
视网膜前膜（ERM）继发于视网膜表面的视网膜细胞增殖，通常影响50岁以上的患者，但在儿童中很少见。在此，我们报告一例4岁患者，其单侧内界膜下（sub-ILM）膜类似视网膜前膜，具有显著的超微结构特征，提示其可能起源于陈旧性内界膜下出血。
一名4岁男孩因右眼视力差入院，该情况在6个月前学校视力筛查时被发现。眼底检查显示右眼黄斑区有羽毛状白色膜，光学相干断层扫描（OCT）显示视网膜增厚，视网膜神经纤维层有高反射带。我们怀疑右眼有视网膜前膜，并进行了玻璃体切割联合膜剥除术以改善患者视力。令人惊讶的是，术中发现该膜位于完整的内界膜下方；由于它与颞上弓形视网膜动脉紧密粘连，故小心地从下方视网膜提起。术后扫描电子显微镜检查显示该膜由含铁血黄素、胶原纤维和类纤维蛋白沉积物组成。随访时眼底检查和OCT显示视网膜结构改善，高反射带消失，视网膜厚度减小。术后1年，患者右眼视力稳定在20/100。
此处呈现的白色膜位于完整的内界膜与视网膜其余部分之间，紧紧附着于颞上血管弓。鉴于该膜的超微结构发现和病史，我们推测内界膜下膜可能继发于内界膜下出血。
