Osigian Carla J, Gologorsky Daniel, Cavuoto Kara M, Berrocal Audina, Villegas Victor
Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA.
Am J Ophthalmol Case Rep. 2020 Jan 16;17:100599. doi: 10.1016/j.ajoc.2020.100599. eCollection 2020 Mar.
To describe a novel combination of surgical and medical management for the treatment of optic disc pit maculopathy.
A 12-year-old obese girl with bilateral optic disc pits presented with decreased vision in the left eye (20/400). On dilated fundus examination, she was found to have a macula-involving serous retinal detachment. Pars plana vitrectomy, posterior hyaloid peel, internal limiting membrane peel, fluid-air exchange, temporal juxtapapillary endolaser, and CF tamponade were performed. Postoperatively, there was persistence of subretinal fluid, so oral acetazolamide and a weight loss regimen were started. After 3 months of medical treatment, the subretinal fluid decreased significantly and visual acuity improved to 20/60.
Currently, the mechanisms leading to optic disc pit maculopathy remain a topic of debate. As optic disc pits may provide a conduit between the subarachnoid and subretinal spaces, the reduction of intracranial pressure with the use of systemic carbonic anhydrase inhibitors may play a role in decreasing the subretinal fluid associated with select cases of optic disc pit maculopathy.
描述一种用于治疗视盘小凹黄斑病变的手术与药物联合治疗新方法。
一名12岁双侧视盘小凹的肥胖女孩，左眼视力下降（20/400）。散瞳眼底检查发现其存在累及黄斑的浆液性视网膜脱离。进行了玻璃体切割术、后玻璃体膜剥除术、内界膜剥除术、液气交换、颞侧视乳头旁视网膜激光光凝术及全氟丙烷气体填塞。术后，视网膜下液持续存在，因此开始口服乙酰唑胺并实施减肥方案。经过3个月的药物治疗，视网膜下液显著减少，视力提高到20/60。
目前，导致视盘小凹黄斑病变的机制仍是一个有争议的话题。由于视盘小凹可能在蛛网膜下腔和视网膜下腔之间提供一个通道，使用全身性碳酸酐酶抑制剂降低颅内压可能在减少与某些视盘小凹黄斑病变相关的视网膜下液方面发挥作用。
