Takeuchi Takashi, Hirai Hiromasa, Jimura Hironobu, Tsujinaka Hiroki, Ogata Nahoko, Ueda Tetsuo
Ophthalmology, Nara Medical University, Kashihara, JPN.
Cureus. 2023 Aug 30;15(8):e44406. doi: 10.7759/cureus.44406. eCollection 2023 Aug.
A macular hole (MH) is a widely known disease among ophthalmologists. Vitrectomy with internal limiting membrane (ILM) peeling is a standard technique for full-thickness MHs. However, the recurrence of MHs is sometimes seen. In addition, an eccentric MH is known to rarely occur after vitrectomy. An eccentric MH has been considered to require no therapeutic intervention because of its lack of increase in size. This study reports a case of two MHs (a recurrent MH and an enlarged eccentric MH) developed after laser photocoagulation around the injured retina caused by ILM peeling at the initial surgery. A 56-year-old woman presented with an idiopathic MH in her left eye and best-corrected visual acuity (BCVA) was decreased to 20/80. She underwent phacoemulsification and vitrectomy combined with posterior hyaloid removal, ILM peeling, and 20% sulfur hexafluoride gas tamponade. During the ILM peeling, we performed laser photocoagulation around the injured retina within the arcade. The MH was successfully closed and her BCVA was improved to 20/20 one month after surgery. Eight months after surgery, an eccentric MH occurred next to the photocoagulation spots. However, her BCVA remained 20/20; thus, we just followed up on her eye. Six years after surgery, her BCVA was decreased to 20/200. The eccentric MH increased in size and the original MH re-opened. The second vitrectomy was performed, but ILM had been already peeled within the arcade during the previous surgery and a usable sufficient size of ILM which could be auto-transplanted to the holes was not obtained. Thus, free flaps of the posterior lens capsule were harvested and placed within each hole. Two holes were successfully closed and her BCVA improved to 10/20 at three months after the surgery. Laser photocoagulation around the injured retina derived from ILM peeling may be a risk for recurrent MHs. .
黄斑裂孔（MH）是眼科医生熟知的一种疾病。玻璃体切割联合内界膜（ILM）剥除术是治疗全层MH的标准技术。然而，MH有时会复发。此外，已知玻璃体切割术后很少发生偏心性MH。由于偏心性MH大小不增加，一直被认为无需治疗干预。本研究报告了1例在初次手术时因ILM剥除导致视网膜损伤周围进行激光光凝后出现两个MH（一个复发性MH和一个扩大的偏心性MH）的病例。一名56岁女性左眼患有特发性MH，最佳矫正视力（BCVA）降至20/80。她接受了白内障超声乳化吸除术和玻璃体切割术，联合后玻璃体后皮质切除、ILM剥除及20%六氟化硫气体填充。在ILM剥除过程中，我们在视网膜弓状区内损伤的视网膜周围进行了激光光凝。术后1个月MH成功闭合，BCVA提高到20/20。术后8个月，在光凝斑旁出现一个偏心性MH。然而，她的BCVA仍为20/20，因此我们仅对其眼睛进行随访。术后6年，她的BCVA降至20/200。偏心性MH增大，原MH重新开放。进行了第二次玻璃体切割术，但在前一次手术中视网膜弓状区内的ILM已被剥除，未获得可用于自体移植到裂孔的足够大小的可用ILM。因此，取下后囊膜的游离瓣并放置在每个裂孔内。两个裂孔成功闭合，术后3个月她的BCVA提高到10/20。ILM剥除导致的视网膜损伤周围进行激光光凝可能是复发性MH的一个危险因素。
