Ayalon Anfisa, Okrent Lily, Rubowitz Alexander
Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.
Am J Ophthalmol Case Rep. 2020 Feb 29;18:100642. doi: 10.1016/j.ajoc.2020.100642. eCollection 2020 Jun.
Posterior pole retinal tears occur rarely following blunt trauma. We describe a case of traumatic macular tears, without concurrent peripheral retinal tears or holes.
A 17-year-old patient presented to our emergency unit with blunt ocular trauma and multiple maxillofacial fractures after being assaulted. On examination visual acuity was 20/200 in the left eye with scant vitreous and preretinal hemorrhages. Funduscopic examination revealed multiple choroidal ruptures running concentrically to the optic disc, a subretinal macular hemorrhage, and a large macular tear in the area of the inferior vascular arcade just temporal to the macula. Optical coherence tomography revealed subretinal fluid in the foveal area, choroidal ruptures and a slight elevation of the macular retinal tear margins without subretinal fluid. Laser retinopexy was performed around the macular tear nasally. On follow-up, the retina in the lasered area remained flat, while a shallow retinal detachment had developed temporal to the tear, with a second tear appearing supero-temporally to the macula. Laser retinopexy was not possible due to surrounding subretinal hemorrhage. The clinical course was later complicated by macular detachment, necessitating pars plana vitrectomy with endolaser around the posterior tears and the retinal periphery, and silicone oil injection.
While traumatic macular holes and traumatic macular choroidal ruptures have both been extensively described, posterior pole and macular retinal tears following blunt trauma have rarely been reported. This case illustrates this unusual finding, discussing the possible pathogenic mechanisms and the importance of close follow-up of patients after blunt trauma with appropriate imaging.
钝性外伤后很少发生后极部视网膜裂孔。我们描述了一例外伤性黄斑裂孔病例，未并发周边视网膜裂孔或破孔。
一名17岁患者在遭受袭击后因钝性眼外伤和多处颌面骨折被送至我们的急诊科。检查发现左眼视力为20/200，玻璃体及视网膜前少量出血。眼底检查发现多个脉络膜破裂，与视盘同心，黄斑下出血，黄斑区颞侧下方血管弓区域有一个大的黄斑裂孔。光学相干断层扫描显示黄斑中心凹区域有视网膜下液，脉络膜破裂，黄斑视网膜裂孔边缘轻度隆起且无视网膜下液。在黄斑裂孔鼻侧周围进行了激光视网膜光凝术。随访时，激光治疗区域的视网膜保持平坦，而裂孔颞侧出现了浅视网膜脱离，黄斑区颞上方出现了第二个裂孔。由于周围视网膜下出血，无法进行激光视网膜光凝术。临床病程后来因黄斑脱离而复杂化，需要进行玻璃体切除联合后极部裂孔及视网膜周边部的眼内激光光凝术，并注入硅油。
虽然外伤性黄斑孔和外伤性黄斑脉络膜破裂都已有广泛描述，但钝性外伤后后极部和黄斑视网膜裂孔很少被报道。本病例说明了这一不寻常的发现，讨论了可能的致病机制以及钝性外伤患者进行适当影像学检查后密切随访的重要性。
