Shimokawa Sakurako, Nakao Shintaro, Murakami Yusuke, Ikeda Yasuhiro, Sonoda Koh-Hei
Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Am J Ophthalmol Case Rep. 2020 Mar 31;18:100682. doi: 10.1016/j.ajoc.2020.100682. eCollection 2020 Jun.
Two diabetic case reports of serous retinal detachment (SRD) accompanied by pachychoroid in hypotony maculopathy after trabeculectomy for neovascular glaucoma (NVG).
Case 1: A 66-year-old female with stage 3 NVG and decreased vision acuity in the left eye. After trabeculectomy, postoperative laser suture lysis (LSL) resulted in development of hypotony maculopathy, followed by pachychoroid and SRD. Injection of C3F8 gas in the anterior chamber was unsuccessful and transconjunctival scleral re-suturing was performed. Intraocular pressure (IOP) consequently increased and SRD improved. Case 2: A 60-year-old man with stage 2 NVG and decreased vision acuity in the right eye. Trabeculectomy was uneventful, but postoperative LSL also resulted in development of hypotony maculopathy followed by pachychroid and SRD. Intravitreal bevacizumab injection had no effect and transconjunctival flap re-suturing was performed. IOP consequently increased and SRD improved.
SRD accompanied by pachychoroid was observed in hypotony maculopathy in diabetic cases. VEGF-independent exudative change in hypotony maculopathy may be due to hydrostatic pressure elevation in choroidal blood vessels based on Starling's hypothesis with the consequent breakdown of retinal pigment epithelium barrier in diabetic patients.
报告两例糖尿病患者行新生血管性青光眼（NVG）小梁切除术后发生浆液性视网膜脱离（SRD）并伴有黄斑部低眼压性脉络膜增厚的病例。
病例1：一名66岁女性，患有3期NVG，左眼视力下降。小梁切除术后，术后激光缝线松解术（LSL）导致黄斑部低眼压性病变，随后出现脉络膜增厚和SRD。前房注射C3F8气体未成功，遂行结膜下巩膜重新缝合。眼压（IOP）因此升高，SRD有所改善。病例2：一名60岁男性，患有2期NVG，右眼视力下降。小梁切除术过程顺利，但术后LSL也导致黄斑部低眼压性病变，随后出现脉络膜增厚和SRD。玻璃体内注射贝伐单抗无效，遂行结膜瓣重新缝合。眼压因此升高，SRD有所改善。
在糖尿病患者的黄斑部低眼压性病变中观察到伴有脉络膜增厚的SRD。黄斑部低眼压性病变中不依赖血管内皮生长因子（VEGF）的渗出性改变可能是基于Starling假说，脉络膜血管静水压升高，从而导致糖尿病患者视网膜色素上皮屏障破坏所致。
