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外伤性睫状体脱离修复术后中心性浆液性脉络膜视网膜病变的消退

Central serous chorioretinopathy resolution after traumatic cyclodialysis repair.

作者信息

Imamachi Katsue, Ichioka Sho, Takayanagi Yuji, Tsutsui Aika, Shimizu Hiroshi, Tanito Masaki

机构信息

Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.

出版信息

Am J Ophthalmol Case Rep. 2022 Mar 25;26:101507. doi: 10.1016/j.ajoc.2022.101507. eCollection 2022 Jun.

Abstract

To report a rare case of central serous chorioretinopathy resolution after traumatic cyclodialysis repair. Observation: A 66-year-old Japanese woman was referred to our hospital with a visual disturbance in her right eye (OD). She had a history of blunt ocular injury when hit by a carton box 3 years previously, but the best-corrected visual acuity (BCVA) was 1.0. At the initial visit, the BCVA was 0.3 OD and 1.2 in the left eye (OS). Optical coherence tomography (OCT) showed a serous retinal detachment (SRD) in the macula; the submacular choroid was thicker OD (316 μm) than OS (246 μm). Fluorescent fundus angiography showed a subretinal macular leak. Gonioscopy and anterior-segment OCT showed angle recession and a cyclodialysis cleft at the temporal angle and cyclodialysis in the four quadrants. One month after focal photocoagulation was applied to the leakage point, the retinal detachment had not improved and the BCVA worsened to 0.2. After subsequent surgical repair of the cyclodialysis using an ab interno approach, the ciliochoroidal detachment resolved by 1 month with a simultaneous rapid decrease in the SRD and complete resolution by 2 months. At the final visit, 5 months postoperatively, the BCVA was 1.0 OD. During this period, the choroidal thickness decreased to 264 μm OD but was unchanged at 247 μm OS. Conclusion and Importance: Traumatic cyclodialysis, presumably via choroidal venous overload, can cause CSC. Since the presence of mild cyclodialysis and/or ciliochoroidal detachment may be difficult to find, post-traumatic CSC during the chronic phase of ocular trauma might be overlooked.

摘要

报告一例外伤性睫状体分离修复术后中心性浆液性脉络膜视网膜病变消退的罕见病例。观察:一名66岁日本女性因右眼视力障碍转诊至我院。她3年前曾被纸箱撞击,有钝性眼外伤史,但最佳矫正视力(BCVA)为1.0。初诊时,右眼BCVA为0.3,左眼为1.2。光学相干断层扫描(OCT)显示黄斑区浆液性视网膜脱离(SRD);右眼黄斑下脉络膜厚度(316μm)比左眼(246μm)厚。荧光素眼底血管造影显示黄斑区视网膜下渗漏。房角镜检查和眼前节OCT显示颞侧房角后退和睫状体分离裂孔,四个象限均有睫状体分离。对渗漏点进行局灶性光凝治疗1个月后,视网膜脱离未改善,BCVA恶化至0.2。随后采用内路手术修复睫状体分离,1个月时睫状脉络膜脱离消退,同时SRD迅速减轻,2个月时完全消退。术后5个月最后一次就诊时,右眼BCVA为1.0。在此期间,右眼脉络膜厚度降至264μm,但左眼脉络膜厚度无变化,仍为247μm。结论与重要性:外伤性睫状体分离可能通过脉络膜静脉过载导致中心性浆液性脉络膜视网膜病变。由于轻度睫状体分离和/或睫状脉络膜脱离可能难以发现,眼外伤慢性期的创伤后中心性浆液性脉络膜视网膜病变可能会被忽视。

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