Hashimoto Yuto, Arai Yusuke, Makino Shinji, Inoue Yuji, Takahashi Hidenori, Kawashima Hidetoshi
Department of Ophthalmology, Jichi Medical University, Shimotsuke-shi, Japan.
Case Rep Ophthalmol. 2020 Jul 14;11(2):342-347. doi: 10.1159/000508821. eCollection 2020 May-Aug.
We report a case of full-thickness macular hole (FTMH) which developed during follow-up for Coats disease. To our knowledge, this is the first report on a case of FTMH which developed during follow-up for Coats disease. A 17-year-old boy was referred to our institution with blurred vision in his left eye. Fundus examination showed yellowish subretinal exudates with overlying telangiectatic retinal vessels in the temporal periphery in the left eye; the right eye was normal. Fluorescein angiography revealed diffusion indicative of temporal peripheral vascular leakage. We made a diagnosis of stage 2A Coats disease and performed argon laser photocoagulation (PC). Moreover, he received intravitreal injection of anti-vascular endothelial growth factor. At 30 months after the first visit, the best-corrected visual acuity (BCVA) of the left eye worsened to 20/50. We observed tensioned internal limiting membrane (ILM), serous macular detachment (SMD) and retinal thinning; the intraretinal exudate remained. We performed PC and at 36 months after the first visit, BCVA further declined to 20/63 in his left eye and FTMH was observed. We then performed a 27-gauge pars plana vitrectomy and ILM peeling following which the FTMH was found to have closed by 4 days after vitrectomy. SMD gradually decreased, and BCVA improved to 20/20. Chronic inflammation by peripheral vascular leakage and PC application might have caused FTMH. In this case, the vitrectomy for FTMH with Coats disease provided good visual and anatomic outcomes.
我们报告了1例在Coats病随访期间发生的全层黄斑裂孔（FTMH）。据我们所知，这是首例关于在Coats病随访期间发生FTMH的病例报告。一名17岁男孩因左眼视力模糊转诊至我院。眼底检查显示左眼颞侧周边视网膜下有淡黄色渗出物，上方有扩张的视网膜血管；右眼正常。荧光素血管造影显示有颞侧周边血管渗漏的扩散迹象。我们诊断为2A期Coats病并进行了氩激光光凝（PC）。此外，他接受了玻璃体腔内抗血管内皮生长因子注射。首次就诊后30个月，左眼最佳矫正视力（BCVA）恶化为20/50。我们观察到内界膜（ILM）紧张、浆液性黄斑脱离（SMD）和视网膜变薄；视网膜内渗出物仍然存在。我们进行了PC，在首次就诊后36个月，他的左眼BCVA进一步降至20/63，并观察到FTMH。然后我们进行了27G经睫状体平坦部玻璃体切除术并剥除ILM，玻璃体切除术后4天发现FTMH已闭合。SMD逐渐减轻，BCVA提高到20/20。周边血管渗漏和PC应用引起的慢性炎症可能导致了FTMH。在该病例中，针对Coats病合并FTMH的玻璃体切除术取得了良好的视力和解剖学效果。
