Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India.
University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA.
BMC Ophthalmol. 2024 May 28;24(1):224. doi: 10.1186/s12886-024-03497-4.
Macular retinoschisis (MRS) and myopic macular neovascularization (mMNV) are both potentially blinding complications of high myopia. In this case report, we highlight the progression of MRS after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment for mMNV, as well as an extensive review of the literature on this topic.
A 49-year-old woman presented with two weeks of recent onset blurring and metamorphopsia in her right eye. She had high myopia in both eyes (right eye - 20/60 with - 16D, left eye - 20/20 with - 13D). Slit-lamp ophthalmoscopy found a normal anterior segment in both eyes. On fundus examination, features of pathological myopia with posterior staphyloma and peripapillary atrophy were observed in both eyes. An active mMNV, as well as intraretinal fluid, minimal perifoveal inner and outer MRS, and focal posterior vitreous traction along the inferotemporal retinal arcade, were detected on optical coherence tomography (OCT) of the right eye. The patient received an intravitreal injection of Aflibercept (2 mg/0.05 ml).
OCT scans at two- and four-month follow-up visits revealed regressed mMNV with a taut epiretinal membrane, progressive worsening of outer MRS, and the development of multiple perifoveal retinal detachment inferior to the fovea. Pars plana vitrectomy surgery was performed for the progressive MRS with good anatomical (resolved MRS) and functional outcome (maintained visual acuity at 20/60) at the last one-month post-surgery visit.
Intravitreal anti-VEGF injections for mMNV can cause vitreoretinal interface changes, exacerbating MRS and causing visual deterioration. Vitrectomy for MRS could be one of several treatment options.
黄斑视网膜劈裂症（MRS）和近视性黄斑新生血管（mMNV）都是高度近视潜在的致盲并发症。在本病例报告中，我们重点介绍了 MRS 在抗血管内皮生长因子（抗-VEGF）治疗 mMNV 后进展的情况，并对该主题的文献进行了广泛回顾。
一名 49 岁女性，因右眼出现两周的新发视力模糊和变形前来就诊。她双眼高度近视（右眼 - 20/60，伴- 16D；左眼 - 20/20，伴- 13D）。裂隙灯检查发现双眼眼前段正常。眼底检查发现双眼存在病理性近视的特征，包括后葡萄肿和视盘周围萎缩。右眼光学相干断层扫描（OCT）发现存在活动性 mMNV，以及视网膜内液、最小性黄斑区全层劈裂和局限性后玻璃体沿下方颞侧视网膜血管鞘牵引。患者接受了玻璃体内注射 Aflibercept（2mg/0.05ml）。
两次和四次随访的 OCT 扫描显示，mMNV 消退，伴视网膜前膜紧张，外层 MRS 逐渐加重，黄斑下出现多发性视网膜脱离。由于进展性 MRS，行玻璃体切割手术，最后一次手术后一个月的随访显示解剖结构（MRS 已解决）和功能（视力保持在 20/60）均良好。
抗-VEGF 玻璃体内注射治疗 mMNV 可能导致玻璃体视网膜界面改变，加重 MRS 并导致视力恶化。对于 MRS，玻璃体切割术可能是几种治疗选择之一。
