Department of Ophthalmology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki-City, Osaka, 569-8686, Japan.
BMC Ophthalmol. 2020 Apr 29;20(1):171. doi: 10.1186/s12886-020-01444-7.
Here we report two patients who developed an atypical macular hole (MH) during the treatment course for diabetic macular edema (DME).
Patient 1 was a 73-year-old male. Optical coherence tomography (OCT) revealed perifoveal retinoschisis (RS) in addition to cystoid macular edema and serous retinal detachment (SRD) in his left eye, and that an MH had developed during the clinical course. A convex surface was formed at the MH margin toward the vitreous cavity, and granular shadows were observed in the fluid cuff. Intraoperative findings revealed a thin epiretinal macular membrane (ERM) around the MH. Patient 2 was a 79-year-old male. Although the patient underwent pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) in both eyes, RS and a thin ERM in addition to SRD was observed in his left eye after surgery, and an MH developed during the clinical course. As in Patient 1, a convex surface was formed at the fluid cuff margin toward the vitreous cavity.
Both patients had persistent DME, SRD, RS, and a thin ERM before the development of the MH. OCT revealed the formation of a convex surface at the MH margin toward the vitreous cavity, suggesting that the fragility of the layered structure of the retina combined with tangential retinal traction may have been involved in the atypical MH form.
我们在此报告两例在糖尿病性黄斑水肿（DME）治疗过程中出现非典型黄斑裂孔（MH）的患者。
患者 1 为 73 岁男性。光学相干断层扫描（OCT）显示左眼除了囊样黄斑水肿和浆液性视网膜脱离（SRD）外，还存在周边性视网膜劈裂（RS），并且在临床病程中出现 MH。MH 边缘朝向玻璃体腔形成凸面，在液性袖套中观察到颗粒状阴影。术中发现 MH 周围有一层薄的视网膜内表面膜（ERM）。患者 2 为 79 岁男性。尽管该患者双眼均因增生性糖尿病性视网膜病变（PDR）接受了经睫状体平坦部玻璃体切除术（PPV），但左眼在手术后仍存在 RS 和薄的 ERM 以及 SRD，并在临床病程中出现 MH。与患者 1 一样，在朝向玻璃体腔的液性袖套边缘形成凸面。
在 MH 形成之前，这两例患者均存在持续的 DME、SRD、RS 和薄的 ERM。OCT 显示 MH 边缘朝向玻璃体腔形成凸面，表明视网膜分层结构的脆弱性以及切线性视网膜牵引可能与非典型 MH 形式有关。
