Boldt H C, Munden P M, Folk J C, Mehaffey M G
Department of Ophthalmology, University of Iowa College of Medicine, Iowa City, USA.
Am J Ophthalmol. 1996 Sep;122(3):371-81. doi: 10.1016/s0002-9394(14)72064-1.
To describe a group of patients with dense visual field defects following macular hole surgery.
Nine (7%) of 125 patients reviewed noted onset of dense visual field defects following uncomplicated vitrectomy with gas-fluid exchange for the treatment of macular hole. Patient records were reviewed to investigate the etiology of these defects.
Eight (89%) of nine eyes that had surgery for macular hole developed dense, wedge-shaped visual field defects in the temporal periphery. One eye had an inferonasal wedge-shaped defect extending to fixation. Seven (78%) of nine eyes had generalized or focal narrowing of the retinal arteriole extending into the area of retina corresponding to the visual field defect, and five (56%) of nine eyes developed mild to moderate segmental nasal optic disk pallor. Postoperative fluorescein angiography disclosed one eye with delayed filling of the retinal arteriole extending into the area of retina corresponding to the visual field defect. Vitrectomy specimens showed no evidence of nerve fiber layer or internal limiting membrane in eight (89%) of nine eyes.
Visual field defects can occur following vitrectomy and gas-fluid exchange for macular hole. The most common visual field defect is dense and wedge-shaped and involves the temporal visual field. Although unclear, the etiology may involve trauma to the peripapillary retinal vasculature or nerve fiber layer during elevation of the posterior hyaloid or during aspiration at the time of air-fluid exchange, followed by compression and occlusion of the retinal peripapillary vessels during gas tamponade.
描述一组黄斑裂孔手术后出现致密视野缺损的患者。
在接受回顾的125例患者中，有9例（7%）在接受用于治疗黄斑裂孔的单纯玻璃体切除术及气液交换后出现了致密视野缺损。对患者记录进行回顾以调查这些缺损的病因。
9只接受黄斑裂孔手术的眼中，有8只（89%）在颞侧周边出现了致密的楔形视野缺损。1只眼有延伸至注视点的鼻下楔形缺损。9只眼中有7只（78%）出现视网膜小动脉普遍或局部变窄，延伸至与视野缺损相对应的视网膜区域，9只眼中有5只（56%）出现轻度至中度节段性鼻侧视盘苍白。术后荧光素血管造影显示1只眼视网膜小动脉延迟充盈，延伸至与视野缺损相对应的视网膜区域。玻璃体切除标本显示，9只眼中有8只（89%）未发现神经纤维层或内界膜。
黄斑裂孔玻璃体切除术及气液交换后可出现视野缺损。最常见的视野缺损是致密的楔形，累及颞侧视野。病因尚不清楚，可能与后玻璃体脱离抬起或气液交换时抽吸过程中视乳头周围视网膜血管或神经纤维层受到损伤有关，随后在气体填塞期间视乳头周围视网膜血管受压和闭塞。
