Sayanagi Kaori, Hara Chikako, Fukushima Yoko, Sato Shigeru, Kawasaki Ryo, Nishida Kohji
Department of Ophthalmology, Osaka University Medical School, Osaka, Japan.
Am J Ophthalmol Case Rep. 2023 Jul 20;32:101899. doi: 10.1016/j.ajoc.2023.101899. eCollection 2023 Dec.
Myopic choroidal neovascularization (CNV) and myopic traction maculopathy are major complications of pathologic myopia, and myopic foveoschisis (MF) is one of several symptoms that can be included under the general term "myopic traction maculopathy"; however, only a few cases will have MF around the myopic CNV. We report three cases with MF around myopic CNV that followed different clinical courses observed using swept-source optical coherence tomography.
Case 1 was a 69-year-old woman with an axial length of 29.71 mm, myopic CNV, and MF in the left eye. One month after intravitreal injection of ranibizumab (IVR), a macular retinal detachment (RD) expanded. Vitrectomy and gas tamponade were performed during month 2; the macular RD and MF resolved gradually thereafter. Case 2 was a 54-year-old man with an axial length of 30.59 mm, myopic CNV, and MF in the right eye; after IVR, a macular RD developed and gradually expanded until month 4; the RD and MF resolved spontaneously and resolved during month 8. Case 3 was a 66-year-old woman with an axial length of 28.63 mm, myopic CNV, and MF in the left eye. A macular RD expanded 1 month after a previous vitrectomy for MF; after intravitreal injection of aflibercept, the macular RD and MF resolved gradually in month 12. In all cases, the CNV was accompanied by subretinal fluid, and two of the three cases had outer lamellar holes.
The MF around the myopic CNV may lead to exacerbated MF and RD during follow-up, and the subretinal fluid caused by the CNV might facilitate MF progression. Since this condition is rare, further investigation of this entity is needed to determine appropriate management.
近视性脉络膜新生血管（CNV）和近视性牵引性黄斑病变是病理性近视的主要并发症，近视性黄斑劈裂（MF）是可归入“近视性牵引性黄斑病变”这一统称的几种症状之一；然而，仅有少数病例在近视性CNV周围会出现MF。我们报告3例近视性CNV周围出现MF的病例，其遵循不同的临床病程，通过扫频光学相干断层扫描进行观察。
病例1为一名69岁女性，眼轴长度为29.71mm，左眼患有近视性CNV和MF。玻璃体内注射雷珠单抗（IVR）1个月后，黄斑视网膜脱离（RD）扩大。在第2个月进行了玻璃体切除术和气体填塞；此后黄斑RD和MF逐渐消退。病例2为一名54岁男性，眼轴长度为30.59mm，右眼患有近视性CNV和MF；IVR后，黄斑RD出现并逐渐扩大直至第4个月；RD和MF在第8个月时自发消退。病例3为一名66岁女性，眼轴长度为28.63mm，左眼患有近视性CNV和MF。在先前因MF进行玻璃体切除术后1个月，黄斑RD扩大；玻璃体内注射阿柏西普后，黄斑RD和MF在第12个月时逐渐消退。在所有病例中，CNV均伴有视网膜下液，3例中有2例存在外层板层孔。
近视性CNV周围的MF在随访期间可能导致MF和RD加重，CNV引起的视网膜下液可能促进MF进展。由于这种情况罕见，需要对该实体进行进一步研究以确定合适的治疗方法。
