Marquez Marilyn A, Fortun Jorge, Iyer Prashanth, Harbour J William, Haddock Luis J
Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
Am J Ophthalmol Case Rep. 2022 Jun 11;27:101614. doi: 10.1016/j.ajoc.2022.101614. eCollection 2022 Sep.
To describe a case of a chronic retinal detachment complicated by the development of pre and subretinal hemorrhage secondary to a large pseudoangiomatous retinal gliosis (PARG) that interfered with retinal reattachment. After the lesion was regressed following plaque radiotherapy retinal reattachment was successfully completed.
A 56y.o healthy man with known history of a chronic inferior rhegmatogenous retinal detachment (RD) of the left eye (OS) presented to the Bascom Palmer Eye Institute (BPEI) emergency department (ED) complaining of new floaters OS. On examination, the patient had a visual acuity of 20/30 right eye (OD) and 20/200 OS. Fundoscopic examination showed a treated tear in OD and dense vitreous hemorrhage OS. Initial B-scan ultrasonography OS showed an inferior RD with diffuse hyperechoic material in the vitreous cavity, preretinal and subretinal space most consistent with hemorrhage. Three days later the patient presented with further vision loss and a repeat B scan showed total RD and increasing subretinal hemorrhage with a solid mass like lesion. At this point, decision was made to proceed with retinal detachment repair, removal of the vitreous hemorrhage, and retina evaluation. During surgery, a total retinal detachment was encountered with poor view of the inferior retina due to a large round vascular lesion in the subretinal space with surrounding hemorrhage and clots. The retina was reattached during surgery, however, the postop was complicated by recurrence of VH, dense hyphema, increased IOP, recurrence of retinal detachment, and growth of the mass like lesion noted during surgery. Consultation with ocular oncology diagnosed the patient with secondary PARG lesion and plaque radiotherapy was given achieving remarkable regression of the lesion. After the lesion had regressed, successful retinal reattachment was achieved, and the patient had excellent visual recovery.
PARG lesions are uncommon in particular when associated to chronic retinal detachments. This case highlights the importance of having a high clinical suspicion for the development of these lesions to diagnose them correctly and treat them aggressively with plaque radiotherapy in order to be able to manage the underlying complex retinal detachment.
描述一例慢性视网膜脱离合并视网膜前和视网膜下出血的病例，该出血继发于大面积假性血管瘤样视网膜胶质增生（PARG），干扰了视网膜复位。在斑块放射治疗使病变消退后，成功完成了视网膜复位。
一名56岁健康男性，已知左眼（OS）患有慢性下方孔源性视网膜脱离（RD），因左眼出现新的飞蚊症就诊于巴斯科姆·帕尔默眼科研究所（BPEI）急诊科。检查发现，患者右眼（OD）视力为20/30，左眼视力为20/200。眼底检查显示右眼有一处已治疗的裂孔，左眼有致密的玻璃体积血。左眼初始B超检查显示下方视网膜脱离，玻璃体腔、视网膜前和视网膜下间隙有弥漫性高回声物质，最符合出血表现。三天后，患者视力进一步下降，复查B超显示完全性视网膜脱离，视网膜下出血增多，伴有一个实性肿块样病变。此时，决定进行视网膜脱离修复、清除玻璃体积血并评估视网膜。手术中，发现完全性视网膜脱离，由于视网膜下间隙有一个大的圆形血管病变，周围有出血和凝血块，下方视网膜视野不佳。手术中视网膜得以复位，但术后出现玻璃体积血复发、致密前房积血、眼压升高、视网膜脱离复发以及手术中发现的肿块样病变增大等并发症。眼科肿瘤会诊诊断该患者为继发性PARG病变，并给予斑块放射治疗，病变明显消退。病变消退后，成功实现了视网膜复位，患者视力恢复良好。
PARG病变并不常见，尤其是与慢性视网膜脱离相关时。该病例强调了对这些病变的发生保持高度临床怀疑的重要性，以便正确诊断并积极采用斑块放射治疗，从而能够处理潜在的复杂视网膜脱离。
