Bravetti Giacomo Edoardo, Mandrioli Matteo, Cappuccini Luca, Bravetti Giorgio Enrico
Department of Ophthalmology, University Hospital Modena, Italy.
Department of Ophthalmology, DSC Multimedical Center, Bologna, Italy.
Klin Monbl Augenheilkd. 2025 Apr;242(4):451-454. doi: 10.1055/a-2511-6405. Epub 2025 Feb 10.
The aim of this report is to describe the visual symptoms and spectral-domain optical coherence tomography (SD-OCT) findings associated with foveal herniation with epiretinal membrane and to evaluate the postoperative visual, anatomical, and surgical outcomes.
Foveal herniation occurs when neuroretinal tissue protrudes through and above the level of an epiretinal membrane. The pathogenesis of foveal herniation is still unknown, though it is likely attributable to the centripetal contraction of the epiretinal membrane (ERM). Moreover, thinning of the prefoveolar internal limiting membrane (ILM) may further exacerbate this process by reducing the structural support for the retina in that area. In the literature, foveal herniation with ERM is rare and usually described as unilateral. Most cases present a good visual outcome after surgical intervention.
We describe the case of a 37-year-old Caucasian male patient, without any previous ocular history, who presented with metamorphopsia and a sustained reduction visual acuity to his left eye that had persisted for several months. The baseline best-corrected visual acuity (BCVA) was recorded as 0.05 decimals. Anterior segment examination was unremarkable, while dilated fundoscopy revealed an ERM with a concentric ring of foveal tissue prolapse. SD-OCT showed the foveal tissue protruding through and above the ERM, demonstrating the severe foveal herniation. A diagnosis of idiopathic ERM with foveal herniation was established based on these findings. Subsequently, the patient was scheduled for surgical intervention to undergo pars-plana vitrectomy with ERM peeling. After the surgery, the patient experienced progressive restoration of the foveal anatomy and an improvement of vision to 0.6 decimals from baseline at 3 months.
This case report shows a rare finding of foveal herniation with ERM. This atypical presentation is of important clinical relevance in drawing clinicians' attention to the possibility of these findings, with the goal to prevent erroneous diagnosis and unnecessary treatments. We demonstrate the visual improvement and gradual resolution of foveal herniation with SD-OCT images after ERM removal, and the images show that it may take a few months for the foveal bulge to decrease in height. When the outer retinal layers are normal, visual recovery, though delayed, is appreciable.
本报告旨在描述与黄斑疝合并视网膜前膜相关的视觉症状和频域光学相干断层扫描（SD-OCT）表现，并评估术后的视觉、解剖学和手术效果。
当神经视网膜组织穿过视网膜前膜并突出到其上方时，就会发生黄斑疝。黄斑疝的发病机制尚不清楚，尽管可能归因于视网膜前膜（ERM）的向心性收缩。此外，黄斑前内界膜（ILM）变薄可能会通过减少该区域视网膜的结构支撑而进一步加剧这一过程。在文献中，黄斑疝合并ERM的情况很少见，通常描述为单侧。大多数病例在手术干预后视力恢复良好。
我们描述了一名37岁的白种男性患者，既往无眼部病史，出现视物变形，左眼视力持续下降数月。基线最佳矫正视力（BCVA）记录为小数视力0.05。眼前节检查无异常，散瞳眼底检查发现一个伴有同心环形黄斑组织脱垂的ERM。SD-OCT显示黄斑组织穿过ERM并突出到其上方，证实存在严重的黄斑疝。根据这些发现，诊断为特发性ERM合并黄斑疝。随后，该患者计划接受手术干预，进行玻璃体切割联合ERM剥除术。术后，患者黄斑部解剖结构逐渐恢复，3个月时视力从基线的小数视力0.05提高到0.6。
本病例报告显示了黄斑疝合并ERM这一罕见发现。这种非典型表现具有重要的临床意义，可引起临床医生对这些发现可能性的关注，以防止误诊和不必要的治疗。我们通过SD-OCT图像展示了ERM切除后黄斑疝的视力改善和逐渐消退情况，图像显示黄斑隆起高度可能需要数月才能降低。当视网膜外层正常时，视力恢复虽有延迟，但较为明显。
