Notomi Shoji, Kubo Yuki, Ishikawa Keijiro, Shiose Satomi, Koh-Hei Sonoda
Ophthalmology, Kyushu University, Fukuoka, JPN.
Cureus. 2024 Aug 5;16(8):e66232. doi: 10.7759/cureus.66232. eCollection 2024 Aug.
Epiretinal proliferation (EP) is thought to be glial cell proliferation arising from the inner retina, seen in cases of lamellar or full-thickness macular holes (FTMH). Embedding EP within the macular hole is considered supportive for FTMH closure and functional recovery. We report a recurrent case of FTMH that was successfully closed after primary vitrectomy with the EP embedding technique. In the primary surgery, internal limiting membrane (ILM) peeling was avoided to reduce the potential risk of retinal nerve fiber layer damage associated with glaucoma. The FTMH was successfully closed, with complete recovery of macular layer structures. However, over one year later, the FTMH reopened, slightly dislocated from the position of the embedded EP scar. The reopened FTMH was closed again after the second surgery using the ILM inverted flap technique. This case indicates that macular hole closure with EP might not sufficiently support the tissue repair of FTMH as a new hole can form if tangential traction of the ILM remains.
视网膜前增殖（EP）被认为是源于视网膜内层的胶质细胞增殖，见于板层或全层黄斑裂孔（FTMH）病例。将EP嵌入黄斑裂孔内被认为有助于FTMH闭合和功能恢复。我们报告一例复发性FTMH病例，在初次玻璃体切除术中采用EP嵌入技术后成功闭合。在初次手术中，避免了内界膜（ILM）剥离，以降低与青光眼相关的视网膜神经纤维层损伤的潜在风险。FTMH成功闭合，黄斑层结构完全恢复。然而，一年多后，FTMH重新开放，与嵌入的EP瘢痕位置略有错位。在第二次手术中使用ILM翻转瓣技术后，重新开放的FTMH再次闭合。该病例表明，EP封闭黄斑裂孔可能不足以支持FTMH的组织修复，因为如果ILM的切线牵引力仍然存在，可能会形成新的裂孔。
