快速视网膜前骨化表现为慢性视网膜脱离区域上的血管化病变。

Rapid pre-retinal ossification presenting as a vascularized lesion over an area of chronic retinal detachment.

作者信息

Ma Chu Jian, Pekmezci Melike, Stewart Jay M

机构信息

University of California San Francisco, Department of Ophthalmology, San Francisco, CA, USA.

Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, USA.

出版信息

Am J Ophthalmol Case Rep. 2022 Dec 31;29:101791. doi: 10.1016/j.ajoc.2022.101791. eCollection 2023 Mar.

DOI:10.1016/j.ajoc.2022.101791

PMID:36686266

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9850056/

Abstract

PURPOSE

To describe the clinical, optical coherence tomography (OCT), and histopathological findings of a patient who was found to have ossification of a pre-retinal membrane after multiple surgical repairs for retinal detachment.

METHODS

The patient had comprehensive ophthalmic examinations during seven years of follow-up and underwent surgical removal of her pre-retinal membrane.

RESULTS

A 24-year-old woman with a history of retinal detachment and multiple retina surgeries presented with baseline vision of 20/200 and refractory glaucoma in the left eye (right eye with no light perception due to prior failed retinal detachment repair). OCT showed a thick epiretinal membrane with hypo-reflective intraretinal spaces in the macula, and exam revealed a chronic retinal detachment superotemporally surrounded by laser barricade. She was stable for six years and then experienced vision loss and decreasing eye pressure, concurrent with rapid evolution of pre-retinal fibrosis, leading to a vascularized consolidation in the mid-periphery, for which she underwent vitrectomy and membrane peel. The vascularized lesion over the area of detachment in the superotemporal retina was removed en bloc through the anterior chamber. Pathological findings revealed woven bone formation anterior to the internal limiting membrane, and the tissue was GFAP negative.

CONCLUSIONS

Our case adds to the limited knowledge of the chronology, presentation, and surgical management of intraocular ossification, especially of the rarer pre-retinal type. Our patient highlights that development of ossification can happen more quickly than previously thought (year or years rather than decades), can be hidden under vascularized lesions, and is dynamic, with simultaneous release of traction in one area and increased traction in another. Diligent follow-up is indicated even in cases of vitreous membranes from retinal detachment that otherwise appear to have been stable for years.

摘要

目的

描述一名在视网膜脱离多次手术修复后出现视网膜前膜骨化患者的临床、光学相干断层扫描（OCT）及组织病理学检查结果。

方法

该患者在七年随访期间接受了全面的眼科检查，并接受了视网膜前膜手术切除。

结果

一名有视网膜脱离和多次视网膜手术史的24岁女性，左眼基线视力为20/200，伴有难治性青光眼（右眼因先前视网膜脱离修复失败无光感）。OCT显示黄斑区有增厚的视网膜前膜，视网膜内间隙低反射，检查发现颞上象限存在慢性视网膜脱离，周围有激光光凝瘢痕。她稳定了六年，然后出现视力丧失和眼压下降，同时视网膜前纤维化迅速发展，导致中周边部血管化机化，为此她接受了玻璃体切除术和膜剥除术。通过前房整块切除颞上视网膜脱离区域的血管化病变。病理检查结果显示在内界膜前方有编织骨形成，组织GFAP阴性。

结论

我们的病例增加了对眼内骨化的病程、表现及手术治疗的有限认识，尤其是罕见的视网膜前型。我们的患者强调骨化的发展可能比以前认为的更快（数年而非数十年），可能隐藏在血管化病变之下，并且是动态的，一个区域的牵引同时释放，而另一个区域的牵引增加。即使是视网膜脱离的玻璃体膜病例，即使在其他方面似乎已经稳定多年，也需要进行密切随访。