Department of Ophthalmology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
Sci Rep. 2022 Sep 29;12(1):16321. doi: 10.1038/s41598-022-20949-3.
Ruptured retinal arterial macroaneurysm (RAM) can cause sub-inner limiting membrane (ILM) hemorrhage, leading to acute vision loss in the elderly. Vitrectomy has been established as an effective treatment to remove hemorrhage and facilitate visual recovery. Although optical coherence tomography (OCT) is useful for the diagnosis of sub-ILM hemorrhage before surgery, little is known about the postoperative OCT findings. Here, we retrospectively investigated the records of nine eyes of nine patients who underwent surgery for sub-ILM hemorrhage due to RAM rupture. On postoperative OCT, hyperreflectivity throughout the full thickness of the central fovea was observed in eight eyes (88.9%), and disruption of the ellipsoid/interdigitation zone (EZ/IZ) was observed in seven out of eight eyes (87.5%). The widths of the hyperreflectivity and EZ disruption gradually decreased. Visual recovery was least favorable in two eyes, in which the EZ line continuation did not recover until the final follow-up. The OCT findings corresponded to the hemorrhagic staining identified on fundus photographs in at least four eyes; as per the fundus photographs the findings persisted even after the hemorrhage was absorbed. In contrast, the OCT findings resembled the appearance before the development of a full-thickness macular hole, suggesting fragility caused by the RAM rupture.
视网膜动脉大动脉瘤破裂（RAM）可导致内界膜下（ILM）出血，导致老年人视力急性丧失。玻璃体切除术已被确立为一种有效治疗方法，可清除出血并促进视力恢复。尽管光学相干断层扫描（OCT）有助于术前诊断 ILM 下出血，但对术后 OCT 发现知之甚少。在此，我们回顾性调查了 9 例因 RAM 破裂导致 ILM 下出血而接受手术的 9 只眼的记录。术后 OCT 显示，8 只眼（88.9%）的中央凹全层均可见高反射，7 只眼（87.5%）的椭圆体/交织带（EZ/IZ）中断。高反射和 EZ 中断的宽度逐渐减小。2 只眼的视力恢复最差，其中 EZ 线连续性直到最终随访才恢复。在至少 4 只眼中，OCT 发现与眼底照片上的出血染色相对应；根据眼底照片，即使出血吸收后，发现仍持续存在。相比之下，OCT 发现类似于全层黄斑裂孔形成前的外观，表明 RAM 破裂导致的脆弱性。
