Gasparian Suzie A, Barrett Dianne, Sierpina David, Chalam K V
Department of Ophthalmology, Loma Linda University, Loma Linda, CA, USA.
J Surg Case Rep. 2020 Nov 30;2020(11):rjaa468. doi: 10.1093/jscr/rjaa468. eCollection 2020 Nov.
Behçet's disease (BD) is a multisystemic, immune-mediated occlusive vasculitis of unknown etiology with a chronic, relapsing remitting course. Ocular involvement is characterized by recurrent nongranulomatous uveitis with necrotizing obliterative vasculitis affecting both the anterior and posterior segments of the eye and often leads to blindness. We describe successful surgical management of a rare case of combined rhegmatogenous retinal detachment (RRD) and tractional retinal detachment (TRD) in a patient with Behçet's disease. A 28-year-old Hispanic women with known Behcet's disease presented with loss of vision of both eyes. She was found to have extensive bilateral necrotizing vasculitis with severe ischemia. Despite aggressive antivascular endothelial growth factor (VEGF) therapy and pan retinal photocoagulation, patient progressed to total blindness from development of combined rhegmatogenous and tractional funnel retinal detachment. Small gauge pars plana vitrectomy (PPV) with silicone oil tamponade was performed for retinal detachment repair (without scleral buckle). Combined RRD and TRD was successfully treated with standard PPV with silicone oil placement without use of scleral buckle. Visual acuity 1 year postoperatively improved from ability to perceive light to 20/400. Combined forms of retinal detachment, a rare development in Behçet's disease may be effectively treated with PPV (without scleral buckling) with favorable visual and anatomic outcomes.
白塞病（BD）是一种病因不明的多系统免疫介导的闭塞性血管炎，病程呈慢性、复发缓解型。眼部受累的特征是复发性非肉芽肿性葡萄膜炎，并伴有坏死性闭塞性血管炎，累及眼球的前段和后段，常导致失明。我们描述了1例白塞病患者合并孔源性视网膜脱离（RRD）和牵拉性视网膜脱离（TRD）的罕见病例的成功手术治疗。一名患有白塞病的28岁西班牙裔女性双眼视力丧失。检查发现其双眼存在广泛的坏死性血管炎并伴有严重缺血。尽管积极进行抗血管内皮生长因子（VEGF）治疗和全视网膜光凝，但患者仍因合并孔源性和牵拉性漏斗状视网膜脱离而发展为完全失明。遂行小切口玻璃体切除术（PPV）并硅油填充以修复视网膜脱离（未行巩膜扣带术）。采用标准PPV联合硅油填充，未使用巩膜扣带术，成功治疗了合并RRD和TRD的病例。术后1年视力从仅能感知光线提高到20/400。白塞病中罕见的视网膜脱离合并形式，可通过PPV（未行巩膜扣带术）得到有效治疗，视觉和解剖学预后良好。
