Yoshida Miyo, Hosoda Yoshikatsu, Akimoto Masayuki
Department of Ophthalmology, Japanese Red Cross Osaka Hospital, Osaka, Japan.
Am J Ophthalmol Case Rep. 2022 Jul 13;27:101663. doi: 10.1016/j.ajoc.2022.101663. eCollection 2022 Sep.
To report a case of retinal pigment epithelial (RPE) tear after trabeculectomy combined with pars plana vitrectomy (PPV).
A 65-year-old man with neovascular glaucoma due to proliferative diabetic retinopathy presented with visual impairment and elevated intraocular pressure (IOP) in the right eye and underwent trabeculectomy combined with PPV. Three weeks after surgery, the best-corrected visual acuity (logarithm of minimal angle of resolution) improved from 3.0 to 0.30, and the IOP was controlled within normal limits. Four weeks after the surgery, he noticed visual impairment and ocular pain in the right eye after continuous coughing associated with asthma. Fundus examination revealed bullous retinal detachment, choroidal detachment, and submacular hemorrhage (SMH) due to a giant RPE tear at the posterior pole. Visual acuity worsened considerably to 1.7, while IOP was not elevated (6 mmHg). The patient received PPV with recombinant tissue plasminogen activator (rt-PA) and fluid/air exchange for internal tamponade and achieved anatomic retinal and choroidal attachments.
The acute increase in hydrostatic pressure in the choroidal interstitium due to continuous coughing induces an RPE tear. Vitrectomy with rt-PA and fluid/air exchange may be a favorable treatment for exudative retinal detachment and SMH due to RPE tears.
报告一例小梁切除术联合玻璃体切除术（PPV）后发生视网膜色素上皮（RPE）撕裂的病例。
一名65岁男性，因增殖性糖尿病视网膜病变导致新生血管性青光眼，右眼出现视力障碍和眼压升高，接受了小梁切除术联合PPV。术后三周，最佳矫正视力（最小分辨角对数）从3.0提高到0.30，眼压控制在正常范围内。术后四周，他在哮喘发作持续咳嗽后，右眼出现视力障碍和眼痛。眼底检查发现后极部巨大RPE撕裂导致视网膜大泡性脱离、脉络膜脱离和黄斑下出血（SMH）。视力显著恶化至1.7，而眼压未升高（6 mmHg）。患者接受了玻璃体切除术联合重组组织型纤溶酶原激活剂（rt-PA）及液/气交换进行眼内填充，视网膜和脉络膜实现了解剖复位。
持续咳嗽导致脉络膜间质静水压急性升高，诱发RPE撕裂。玻璃体切除术联合rt-PA及液/气交换可能是治疗RPE撕裂所致渗出性视网膜脱离和SMH的有效方法。
