Usami Yuta, Kimura Masayo, Matsumoto Atsuki, Kominami Aoi, Morita Hiroshi, Yasukawa Tsutomu
Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
Department of Ophthalmology, Gamagori City Hospital, Aichi, Japan.
Am J Ophthalmol Case Rep. 2025 Aug 26;39:102414. doi: 10.1016/j.ajoc.2025.102414. eCollection 2025 Sep.
To report two cases of macular exudations resulting from retinal arterial macroaneurysms (MaAs) refractory to focal photocoagulations that were treated with a new surgical technique including subretinal balanced saline solution (BSS) injection to dilute lipid-rich subretinal fluid (SRF) and facilitate absorption of the SRF, intentional retinal hole formation to direct SRF into the vitreous cavity, and laser photocoagulation posterior to the MaAs to prevent intraretinal fluid and SRF from reaching the fovea.
A 70-year-old man with macular edema (ME) refractory to anti-vascular endothelial growth factor (VEGF) therapy was referred to our hospital. Fundus examination showed retinal arterial MaAs and hard exudations. He underwent laser photocoagulation, sub-Tenon injections of triamcinolone acetonide (STTA), and anti-VEGF therapies; the ME recured despite all treatments. Subretinal lipid-rich exudatoins from retinal arterial MaAs involved the macula, which led to severe vision loss. Therefore, vitrectomy with the new technique was planned to flush out the lipid-rich SRF and prevent new exudations from reaching the macula. Postoperatively, the SRF resolved completely and the ME has not reccured until 59 months postoperatively at his latest visit. The second patient was a 77-year-old woman with an epiretinal membrane and ME with sarcoidosis. She underwent anti-VEGF therapy, STTA injection, and focal laser photocoagulation. The vision-threatening ME persisted. She underwent vitrectomy with the new technique, and the macular exudation resolved promptly. The ME has not recurred 27 months postoperatively.
Vitrectomy with this technique may be considered in cases with vision-threatening ME due to retinal MaAs resistant to combined multiple conventional treatments.
报告两例因视网膜动脉大动脉瘤（MaA）导致的黄斑渗出病例，这些病例对局部光凝治疗无效，采用了一种新的手术技术进行治疗，该技术包括视网膜下注射平衡盐溶液（BSS）以稀释富含脂质的视网膜下液（SRF）并促进其吸收，有意制造视网膜裂孔以将SRF引流至玻璃体腔，以及在MaA后方进行激光光凝以防止视网膜内液和SRF到达黄斑。
一名70岁男性，抗血管内皮生长因子（VEGF）治疗无效的黄斑水肿（ME）患者被转诊至我院。眼底检查显示视网膜动脉MaA和硬性渗出。他接受了激光光凝、曲安奈德球周注射（STTA）和抗VEGF治疗；尽管进行了所有治疗，ME仍复发。视网膜动脉MaA导致的视网膜下富含脂质的渗出累及黄斑，导致严重视力丧失。因此，计划采用新技术进行玻璃体切除术以清除富含脂质的SRF并防止新的渗出到达黄斑。术后，SRF完全消退，直至最近一次随访术后59个月ME未复发。第二例患者是一名77岁女性，患有视网膜前膜和结节病相关的ME。她接受了抗VEGF治疗、STTA注射和局部激光光凝。威胁视力的ME持续存在。她采用新技术进行了玻璃体切除术，黄斑渗出迅速消退。术后27个月ME未复发。
对于因视网膜MaA导致的威胁视力的ME，经多种传统治疗联合无效的病例，可考虑采用该技术进行玻璃体切除术。
