Iwakawa Yumi, Imai Hisanori, Kaji Hiromi, Mori Yuki, Ono Chihiro, Otsuka Keiko, Miki Akiko, Oishi Mariko
Department of Ophthalmology, Mahoshi Hospital, Kobe, Japan.
Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan.
Case Rep Ophthalmol. 2018 Feb 1;9(1):113-119. doi: 10.1159/000485914. eCollection 2018 Jan-Apr.
To report a case of macular hole (MH) secondary to a retinal arterial macroaneurysm (RAMA) which was successfully treated with an autologous transplantation of internal limiting membrane (ILM).
An 87-year-old female presented with a sudden decrease in central vision in the right eye. A fundus examination revealed a RAMA in the superonasal macular region, a subretinal hemorrhage (SRH), involving the macula, and a sub-ILM hemorrhage. A pars plana vitrectomy (PPV) was performed. Intraoperatively, an MH filled with coagulum was detected. We tried to blow off and drain the SRH with a current of BSS and a gentle suction with a 27-gauge vitreous cutter from the MH, but some amount of SRH at the bottom of the MH remained. The ILM was peeled off for 2 disc diameters around the MH. The vitreous cavity was filled with air at the end of the operation. Two weeks after the surgery, the MH was not closed. One month following the initial PPV, a second PPV was performed to achieve closure of the MH.
An autologous transplantation of ILM was performed as second PPV. Six months after the final surgery, the MH was successfully closed and the best-corrected decimal visual acuity was 0.6.
Autologous ILM transplantation can be an effective treatment option for MH closure following RAMA rupture.
报告1例继发于视网膜动脉大动脉瘤（RAMA）的黄斑裂孔（MH）病例，该病例通过自体视网膜内界膜（ILM）移植成功治疗。
一名87岁女性因右眼中心视力突然下降就诊。眼底检查发现鼻上黄斑区有一个RAMA、黄斑区视网膜下出血（SRH）和ILM下出血。行玻璃体切割术（PPV）。术中发现一个充满凝血块的MH。我们试图用平衡盐溶液（BSS）冲洗并通过27G玻璃体切割器从MH轻柔抽吸来排出SRH，但MH底部仍残留一些SRH。在MH周围2个视盘直径范围内剥除ILM。手术结束时玻璃体腔填充空气。术后2周，MH未闭合。初次PPV术后1个月，再次行PPV以实现MH闭合。
第二次PPV时进行了自体ILM移植。最后一次手术后6个月，MH成功闭合，最佳矫正小数视力为0.6。
自体ILM移植可能是RAMA破裂后MH闭合的一种有效治疗选择。
