Lincoff H, Kreissig I
Department of Ophthalmology, New York Hospital-Cornell Medical Center, New York, USA.
Br J Ophthalmol. 1998 Apr;82(4):367-72. doi: 10.1136/bjo.82.4.367.
The authors have previously concluded that fluid from an optic disc pit creates an inner layer separation (ILS) of the retina. An outer layer detachment (OLD) centred on the macula is a secondary phenomenon that causes a dense central scotoma. Pneumatic displacement of the OLD effects an improvement in central vision. Pathology to confirm these conclusions is lacking. Intraretinal images obtained by optical coherence tomography (OCT), however, are confirmatory.
Three patients with optic disc pit maculopathy were studied with stereoscopic photographs, visual fields, and OCT before and after intravitreal gas was injected to displace the central retinal elevation to below the inferior temporal vascular arcade.
Preoperatively, OCT demonstrated an ILS that connected with the optic disc pit. External to it was an OLD that centred on the fovea and did not connect with the optic disc pit. Pneumatic displacement of the OLD was accompanied by an improvement in central vision. Long term follow up indicates that the effect of displacement may be temporary.
OCT confirmed the two layer structure of optic disc pit maculopathy and that the improvement in central vision after pneumatic displacement coincides with a reattachment of the OLD in the macula. It also supports the hypothesis that the ILS, which persists, provides a conduit for the continuous flow of fluid from the pit to the displaced retinal elevation.
作者之前得出结论，视盘小凹的液体可导致视网膜内层分离（ILS）。以黄斑为中心的外层脱离（OLD）是一种导致致密中央暗点的继发现象。OLD的气体置换可改善中心视力。然而，缺乏病理学证据来证实这些结论。不过，光学相干断层扫描（OCT）获得的视网膜内图像具有证实作用。
对3例视盘小凹黄斑病变患者在玻璃体腔内注入气体以将视网膜中央隆起移位至颞下血管弓下方之前和之后，进行了立体照片、视野和OCT检查。
术前，OCT显示ILS与视盘小凹相连。其外部是以黄斑为中心且不与视盘小凹相连的OLD。OLD的气体置换伴随着中心视力的改善。长期随访表明，置换效果可能是暂时的。
OCT证实了视盘小凹黄斑病变的两层结构，且气体置换后中心视力的改善与黄斑区OLD的复位相吻合。它还支持以下假说，即持续存在的ILS为液体从视盘小凹持续流向移位的视网膜隆起提供了一个通道。
