Intraoperative and fluorescein angiographic findings of a secondary macular hole associated with age-related macular degeneration treated by pars plana vitrectomy.
Intraoperative and fluorescein angiographic findings of a secondary macular hole associated with age-related macular degeneration treated by pars plana vitrectomy.
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DOI：
10.1186/1471-2415-14-114
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发表时间：
2014-09-30
影响因子：
2
通讯作者：
Ozawa Y
中科院分区：
文献类型：
--
作者：
Okamoto T;Shinoda H;Kurihara T;Nagai N;Tsubota K;Ozawa Y
黄斑裂孔是由于玻璃体-视网膜界面处的牵引力引起的，该牵引力是由后皮质前玻璃体和内界膜（ILM）的改变和随后的变性而发展的。同时，湿性年龄相关性黄斑变性（AMD）是由黄斑下脉络膜新生血管（CNV）形成引起的。虽然CNV引起的渗出性改变可导致视网膜前膜（ERM）形成，这也可导致玻璃体-视网膜界面处的牵引力，但很少有AMD相关黄斑裂孔发展的报道，其中视网膜组织的全层被牵引力完全撕裂。此外，术中发现黄斑裂孔与AMD相关，可能涉及视网膜下病变尚未被描述。1例78岁男性，诊断为湿性AMD伴视网膜下积液和轻度白内障，接受了8次玻璃体内哌加他尼治疗。在AMD缓解后，他在同一只眼睛中出现了继发性黄斑裂孔。他接受了平坦部玻璃体切除术，成功地关闭了黄斑裂孔。术中，发现患者的玻璃体形成，并且ERM和ILM粘附，表明由于与AMD和/或玻璃体内注射的化合物相关的炎症反应，在玻璃体-视网膜界面处涉及牵引力，导致黄斑裂孔发展。在他的AMD和RPE的情况下的变化，观察到的荧光素血管造影（FA）和吲哚菁绿色血管造影（IA），黄斑裂孔的发展之前，表明视网膜下的变化也可能参与发病机制。这些临床数据，包括术中发现和血管造影片的时间变化，表明玻璃体视网膜界面的炎症反应和AMD相关的视网膜下病变有助于玻璃体内注射治疗AMD患者的黄斑裂孔发展。
Macular hole results from a tractional force at the vitreo-retinal interface which is developed by modification and subsequent degeneration of the posterior precortical vitreous and the internal limiting membrane (ILM). Meanwhile, the wet type of age-related macular degeneration (AMD) is caused by the submacular formation of choroidal neovascularization (CNV). Although exudative changes derived from CNV may cause epiretinal membrane (ERM) formation, which can also cause tractional force at the vitreo-retinal interface, there have been few reports of AMD-associated macular hole development in which the full thickness of the retinal tissue is completely torn by the tractional force. Moreover, intraoperative finding of macular hole associated with AMD with a possible involvement of subretinal lesion has not been described. A 78-year-old man diagnosed with wet AMD with subretinal fluid and mild cataract received 8 treatments with intravitreal pegaptanib. After AMD remission, he developed a secondary macular hole in the same eye. He underwent a pars plana vitrectomy that successfully closed the macular hole. Intraoperatively, it was found that the patient’s vitreous was formed and that the ERM and ILM were adherent, suggesting the involvement of a tractional force at the vitreo-retinal interface due to an inflammatory reaction related to AMD and/or intravitreally injected chemical compounds, resulting in macular hole development. Changes in the condition of his AMD and the RPE were observed on a fluorescein angiogram (FA) and an indocyanine green angiogram (IA) that preceded macular hole development, suggesting that subretinal changes may also have been involved in the pathogenesis. These clinical data, including the intraoperative findings and the temporal changes in the angiograms, suggest that an inflammatory reaction at the vitreo-retinal interface and subretinal lesion related to AMD contribute to the macular hole development in AMD patients treated with intravitreal injection.
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