Kimura Daisaku, Kida Teruyo, Sato Takaki, Fukumoto Masanori, Kohmoto Ryohsuke, Kojima Shota, Mizuno Hiroshi, Sakaguchi Hitoshi, Sugasawa Jun, Ikeda Tsunehiko
Department of Ophthalmology, Osaka Medical College, Takatsuki, Japan.
Department of Ophthalmology, Takatsuki Red Cross Hospital, Takatsuki, Japan.
Case Rep Ophthalmol. 2018 Jan 5;9(1):17-23. doi: 10.1159/000485317. eCollection 2018 Jan-Apr.
To report a case of retinal detachment with unique optical coherence tomography (OCT) findings after Gamma Knife® (GK; Elekta Instrument AB, Stockholm, Sweden) treatment for choroidal melanoma (CM).
A 48-year-old woman underwent GK therapy for CM in her right eye from the macula to the temporal side. While the tumor subsequently shrank, the patient developed radiation retinopathy, which was treated with laser photocoagulation. The tumor lesions later subsided; however, her visual acuity (VA) decreased 8 years after the initial treatment. Although the tumor lesions in the right eye had become scarred, a bullous retinal detachment with fixed folds occurred in the superior-nasal quadrants. OCT examination revealed a preretinal membrane, vitreoretinal traction, and an inner retinal break; however, no outer retinal break was clearly detectable. MRI scans showed no increase in tumorous lesions, and I-IMP SPECT imaging showed no photon accumulation. Thus, it was determined that there was no tumor activity. The corrected VA in her right eye was light perception, and it was determined that there was no indication for vitreous surgery.
In this case, an inner retinal break was formed by the vitreoretinal traction around the scarred tumor and radiation retinopathy, thus suggesting the possibility of the development of a rhegmatogenous retinal detachment presumably complicated with an outer retinal break.
报告1例脉络膜黑色素瘤（CM）经伽玛刀（GK；瑞典斯德哥尔摩Elekta Instrument AB公司）治疗后出现独特光学相干断层扫描（OCT）表现的视网膜脱离病例。
一名48岁女性右眼黄斑至颞侧的CM接受了GK治疗。肿瘤随后缩小，但患者出现放射性视网膜病变，接受了激光光凝治疗。肿瘤病变后来消退；然而，初次治疗8年后她的视力（VA）下降。尽管右眼的肿瘤病变已形成瘢痕，但在鼻上象限出现了伴有固定皱襞的大泡性视网膜脱离。OCT检查显示视网膜前膜、玻璃体视网膜牵拉和视网膜内层裂孔；然而，未明确检测到视网膜外层裂孔。MRI扫描显示肿瘤病变无增加，I-IMP SPECT成像显示无光子聚集。因此，确定无肿瘤活动。她右眼的矫正视力为光感，确定无玻璃体手术指征。
在本病例中，瘢痕化肿瘤周围的玻璃体视网膜牵拉和放射性视网膜病变导致视网膜内层裂孔形成，提示可能发生孔源性视网膜脱离，可能合并视网膜外层裂孔。
