Manayath George J, Amar Sreelakshmi P, Vidhate Swapnil Shivaji, Kumarswamy Karan A, Venkatapathy Narendran
Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India.
Oman J Ophthalmol. 2023 Jun 27;16(2):336-341. doi: 10.4103/ojo.ojo_261_22. eCollection 2023 May-Aug.
We describe the diagnostic and therapeutic strategies employed in the management of a patient with subfoveal pigment epithelial detachments (PEDs) combined with full-thickness macular hole (FTMH) and discuss the possible pathophysiology of these diseases occurring concurrently. A 38-year-old patient with a history of central serous chorioretinopathy (CSC) presented with FTMH overlying a large subfoveal serous PED. Multimodal imaging confirmed the same and intravitreal anti-vascular endothelial growth factor (VEGF) injections and eplerenone failed to resolve the PED. Spontaneous resolution of the large PED was observed later and pars plana vitrectomy with internal limiting membrane peeling closed the macular hole successfully. However, the PED with fibrinous CSC recurred postoperatively and low fluence photodynamic therapy (PDT) was done to tackle the same. At 10 months' follow-up, the final vision was 6/9, the macular hole remained closed, and the PED had not recurred. Macular hole formation may be the result of choroidal hyperpermeability and leakage in the backdrop of CSC which gives rise to an exudative component causing mechanical stretching and disruption of the overlying sensory retina. Spontaneous uncomplicated resolution of large subfoveal PED in CSCR is rare. This case was managed with a combination of intravitreal anti-VEGF injections, surgery, and PDT. The therapeutic challenge here was the timing of surgery.
我们描述了在治疗一名伴有黄斑中心凹下色素上皮脱离（PED）合并全层黄斑裂孔（FTMH）患者时所采用的诊断和治疗策略，并讨论了这些疾病同时发生的可能病理生理学机制。一名有中心性浆液性脉络膜视网膜病变（CSC）病史的38岁患者，其黄斑中心凹下有一个大的浆液性PED，上方出现了FTMH。多模态成像证实了这一情况，玻璃体内注射抗血管内皮生长因子（VEGF）及依普利酮均未能使PED消退。后来观察到这个大的PED自发消退，经玻璃体视网膜手术联合内界膜剥除成功封闭了黄斑裂孔。然而，术后伴有纤维蛋白渗出的CSC导致PED复发，于是进行了低能量光动力疗法（PDT）来处理。在10个月的随访中，最终视力为6/9，黄斑裂孔保持封闭，PED未复发。黄斑裂孔的形成可能是CSC背景下脉络膜高通透性和渗漏的结果，这会产生一个渗出成分，导致机械性拉伸并破坏上方的感觉视网膜。CSCR患者黄斑中心凹下大的PED自发且无并发症消退的情况很少见。该病例采用了玻璃体内注射抗VEGF、手术及PDT联合治疗。这里的治疗挑战在于手术时机。
