Smt. Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad India.
Rom J Ophthalmol. 2021 Jan-Mar;65(1):70-72. doi: 10.22336/rjo.2021.13.
A 53-year-old lady presented with inferior retinal detachment (RD) following focal laser for retinal artery macroaneurysm (RAM). She underwent focal laser with intravitreal gas injection elsewhere; however, no retinal break was localized on the examination. The patient was taken up for vitreoretinal surgery. Intraoperatively, it was noted that the retinal detachment was not extending to the retinal periphery and primary retinal break was not localized even during the scleral depression. Under high magnification, using a macular lens, a slit-like retinal break was noted at the area of previous focal laser. Focal laser for RAM probably caused this retinal break leading to RD. The clinician needs to be aware that during focal laser of ruptured RAM, haemorrhage may preclude the view of retinal structures leading to inadvertent use of excessive laser energy. Retinal breaks may form at the site of laser due to coagulative necrosis. During surgical management of RD in such cases, the area of focal laser should be thoroughly examined under high magnification to avoid missed breaks.
一位 53 岁女性因视网膜动脉大动脉瘤（RAM）局灶性激光治疗后出现下方视网膜脱离（RD）。她曾在其他地方接受过局灶性激光联合玻璃体腔气体注射，但检查时未发现视网膜裂孔。患者接受了玻璃体视网膜手术。术中注意到视网膜脱离并未延伸至视网膜周边，即使在巩膜压迫时也未定位到原发性视网膜裂孔。在高倍放大下，使用黄斑镜观察到之前局灶性激光治疗部位有一条缝状视网膜裂孔。可能是 RAM 的局灶性激光治疗导致了这条视网膜裂孔，进而引发 RD。临床医生需要注意，在 RAM 破裂的局灶性激光治疗过程中，出血可能会妨碍对视网膜结构的观察，导致无意中使用过多的激光能量。由于凝固性坏死，视网膜裂孔可能会在激光治疗部位形成。在这种情况下，进行 RD 的手术治疗时，应在高倍放大下彻底检查局灶性激光治疗区域，以避免遗漏裂孔。
