Ong Charles Jit Teng, Cheung Chui Ming Gemmy
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
Ophthalmology and Visual Sciences Academic Clinical Program (EYE ACP), Duke-NUS Medical School, Singapore.
Taiwan J Ophthalmol. 2024 Oct 29;14(4):614-618. doi: 10.4103/tjo.TJO-D-24-00051. eCollection 2024 Oct-Dec.
This report describes a patient with polypoidal choroidal vasculopathy (PCV) with fovea-involving retinal pigment epithelium (RPE) tear that showed tissue remodeling with a good visual outcome. Imaging over the patient's clinical course from 2019 was reviewed. A 74-year-old female presented with left submacular hemorrhage and a large multi-lobular pigment epithelial detachment. Left eye vision was 6/19 at the presentation. Indocyanine green angiography (ICGA) revealed underlying PCV. One month after initiation of intravitreal aflibercept (IVA, Bayer), she developed fresh subretinal hemorrhage. An RPE tear of 1 disc area in size, centered over the fovea was diagnosed. The torn RPE edge was scrolled up temporal to the fovea on spectral-domain optical coherence tomography (SD-OCT), with hypertransmission into the choroid observed over the area of RPE loss. Left eye vision after the RPE tear was 6/15. Over the next 2 months, the subretinal hemorrhage resolved following further IVA. At month 3, fundus autofluorescence (FAF) demonstrated hypo-autofluorescence while fundus fluorescein angiography (FFA) and ICGA showed a window defect corresponding to the area of RPE tear. On SD-OCT, there was a faint hyper-reflective layer where one might expect the RPE layer to be. Serial SD-OCT scans over 5 years revealed increasing prominence of the hyperreflective layer between the ellipsoid zone and Bruch's membrane. FAF remained hypo-autofluorescent. At the last review, the patient retained 6/9 vision. We report a case of fovea-involving RPE tear documented with multimodal imaging with good visual outcome, which is atypical. Serial OCT suggests tissue remodeling may explain the functional preservation.
本报告描述了一名患有息肉样脉络膜血管病变（PCV）且累及黄斑中心凹的视网膜色素上皮（RPE）撕裂的患者，该患者显示出组织重塑且视觉预后良好。回顾了该患者2019年以来临床病程中的影像学检查。一名74岁女性因左眼黄斑下出血和一个大的多叶状色素上皮脱离就诊。初诊时左眼视力为6/19。吲哚菁绿血管造影（ICGA）显示存在潜在的PCV。玻璃体内注射阿柏西普（IVA，拜耳公司生产）1个月后，她出现了新的视网膜下出血。诊断为一个视盘面积大小、以黄斑中心凹为中心的RPE撕裂。在光谱域光学相干断层扫描（SD - OCT）上，撕裂的RPE边缘在黄斑中心凹颞侧向上卷曲，在RPE缺失区域观察到脉络膜高透过。RPE撕裂后左眼视力为6/15。在接下来的2个月里，进一步注射IVA后视网膜下出血消退。在第3个月时，眼底自发荧光（FAF）显示低自发荧光，而眼底荧光血管造影（FFA）和ICGA显示与RPE撕裂区域相对应的窗样缺损。在SD - OCT上，在预期RPE层所在位置有一个微弱的高反射层。5年的连续SD - OCT扫描显示，椭圆体带和布鲁赫膜之间的高反射层越来越明显。FAF仍为低自发荧光。在最后一次复查时，患者保留了6/9的视力。我们报告了一例通过多模态成像记录的累及黄斑中心凹的RPE撕裂病例，其视觉预后良好，这是非典型的。连续OCT提示组织重塑可能解释了功能的保留。
