Kanda Keisuke, Nakashima Hiroshi, Emi Kazuyuki
Department of Ophthalmology, Osaka Rosai Hospital Clinical Research Center for Optical Sensory Organ Disability, Osaka, Japan.
Am J Ophthalmol Case Rep. 2022 Jan 20;25:101282. doi: 10.1016/j.ajoc.2022.101282. eCollection 2022 Mar.
The inverted internal limiting membrane (ILM) flap technique is generally used to treat refractory macular holes (MHs). Recently, a case of macular pucker formation outside the ILM flap after using silicone oil was reported. Although the pucker formation was attributed to the silicone oil use in that case, here we report two cases of macular pucker that occurred after the inverted ILM flap technique was performed without silicone oil. In one case, the ILM flap and proliferated tissue was removed, followed by their histopathological examination.
Two patients with MH underwent vitrectomies using the inverted ILM flap technique. In both patients, the visual acuity worsened postoperatively, and macular pucker formation, associated with the ILM flap, was observed. In one patient, visual acuity improved after ILM flap removal, and histopathological examination of the specimen indicated strong cellular proliferation between the ILMs.
Following the inverted ILM flap technique, macular pucker may occur even without the use of silicone oil. Removal of the flap and associated proliferative tissue was effective and resulted in no recurrence of MH or pucker. Ophthalmologists should consider the possibility that tissues on the ILM may lead to macular pucker formation especially inside the flap, in the area between the ILMs.
内界膜（ILM）翻转瓣技术通常用于治疗难治性黄斑裂孔（MH）。最近，有报道称在使用硅油后ILM瓣外出现黄斑皱襞形成的病例。尽管在该病例中皱襞形成归因于硅油的使用，但在此我们报告两例在未使用硅油的情况下进行ILM翻转瓣技术后发生黄斑皱襞的病例。其中一例切除了ILM瓣和增殖组织，随后进行了组织病理学检查。
两名MH患者接受了使用ILM翻转瓣技术的玻璃体切除术。两名患者术后视力均恶化，且观察到与ILM瓣相关的黄斑皱襞形成。在一名患者中，切除ILM瓣后视力改善，标本的组织病理学检查表明ILM之间有强烈的细胞增殖。
在采用ILM翻转瓣技术后，即使不使用硅油也可能发生黄斑皱襞。切除瓣和相关的增殖组织是有效的，且未出现MH或皱襞复发。眼科医生应考虑ILM上的组织可能导致黄斑皱襞形成的可能性，尤其是在瓣内、ILM之间的区域。
