Macular hole and serous pigment epithelial detachment in bilateral acquired vitelliform lesions
Macular hole and serous pigment epithelial detachment in bilateral acquired vitelliform lesions
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双侧获得性卵黄样病变中的黄斑裂孔和浆液性色素上皮脱离
DOI：
10.1016/j.ajoc.2020.100628
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发表时间：
2020
影响因子：
--
通讯作者：
Ogura Yuichiro
中科院分区：
文献类型：
--
作者：
Yata Nana;Yasukawa Tsutomu;Kawamura Mihoko;Hirano Yoshio;Ogura Yuichiro
目的获得性卵黄样病变（avl）与年龄相关性黄斑变性和其他黄斑病变相关。avl常导致视网膜外萎缩，有时伴有黄斑孔和脉络膜新生血管。本研究的目的是报告一例罕见的双侧avl病例，其中一只眼睛伴黄斑孔，另一只眼睛伴浆液色素上皮脱离（sPED）。66岁女性主诉双侧变形。右眼呈avl，左眼呈平速。双眼最佳矫正视力（BCVA）为20/17。荧光素血管造影显示右眼局部渗漏，双眼呈营养不良样低荧光。经玻璃体内注射afliberceept、亚tenon注射曲安奈德、光动力治疗（IVA/STTA/PDT）联合治疗后，裸眼伴avl进展，成功使裸眼裸眼变平并维持良好视力4年。右眼采用玻璃体内注射雷尼珠单抗和组织型纤溶酶原激活剂，增强卵泡状物质的吸收。然而，14个月后，在卵黄期，在视网膜下纤维化瘢痕上方形成典型变形的黄斑孔。虽然睫状体部玻璃体切除术关闭了黄斑孔，但外视网膜萎缩的扩大使BCVA恶化至20/100。结论及重要性：我们采用IVA/STTA/PDT联合治疗方法成功治疗了一只伴avl的快速视网膜病变眼，而另一只继发于avl的黄斑孔眼最终发生了视网膜外萎缩并视力丧失。
PurposeAcquired vitelliform lesions (AVLs) are associated with age-related macular degeneration and other variable macular disorders. AVLs often lead to outer retinal atrophy, sometimes accompanying a macular hole and choroidal neovascularization. The purpose of this study was to report a rare case with bilateral AVLs, in which one eye had accompanied a macular hole and the second eye a serous pigment epithelial detachment (sPED).ObservationsA 66-year-old woman complained of bilateral metamorphopsia. AVLs were observed in the right eye and a flat sPED in the left eye. The best-corrected visual acuity (BCVA) was 20/17 in both eyes. Fluorescein angiography revealed local leakage in the right eye and pattern dystrophy-like hypofluorescence in both eyes. The sPED progressed with AVLs in the left eye and was treated with a combination therapy of intravitreal aflibercept, a sub-Tenon's injection of triamcinolone acetonide, and photodynamic therapy (IVA/STTA/PDT), which successfully flattened the sPED and sustained good vision for 4 years. The right eye was treated with intravitreal ranibizumab and tissue plasminogen activator, which enhanced absorption of the vitelliform material. However, 14 months later, a macular hole with typical metamorphopsia formed above a subretinal fibrotic scar at the vitelliruptive stage. Although pars plana vitrectomy closed the macular hole, enlargement of the outer retinal atrophy worsened the BCVA to 20/100.Conclusions and importanceWe successfully treated one eye with a sPED with AVLs using the combination therapy of IVA/STTA/PDT, while the second eye with a macular hole secondary to AVLs ultimately developed outer retinal atrophy with visual loss.