中心凹旁玻璃体视网膜牵引与慢性黄斑水肿(英文)

Chronic macular edema associated with extrafoveal vitreoretinal traction

目的:使用OCT研究中心凹旁玻璃体视网膜牵引与慢性弥漫性黄斑水肿或囊样黄斑水肿的关系。方法:分析2例与中心凹旁玻璃体牵引膜相关的持续性弥漫黄斑水肿或持续性弥漫黄斑水肿伴黄斑囊样水肿患者的病历及OCT表现。患有其它玻璃体视网膜病变可能影响分析的,玻璃体切除术后的,或者经玻璃体腔内注射药物治疗的患者除外。年龄相匹配的正常对照组(n=12)的OCT用作正常黄斑厚度的定量标准。结果:患者1例1眼为眼球穿通伤后,另1例患者(1眼)为特发性慢性黄斑,常规治疗无效,经检查发现与中心凹旁玻璃体视网膜牵引有关。每只眼牵引位置下的视网膜水肿与黄斑中心水肿相连,因而表现为弥漫性黄斑水肿。OCT自动中心6条辐射线程序发现1眼的牵引位置,另1眼的诊断需要借助附加的线条组程序。结论:慢性弥漫性黄斑水肿可能与中心凹旁玻璃体视网膜牵引相关。为了发现中心凹旁牵引位置,应该使用不同的OCT程序仔细查找。为了比较早期玻璃体切除或药物玻璃体溶解术与现有的治疗方法的疗效还需要进一步的研究和大样本队列研究。

AIM： To describe an association between extrafoveal vitreoretinal traction and chronic macular edema, either diffuse （DiME） or cystoid （CME）, by the use of optical coherence tomography （OCT）. METHODS： Charts and OCT findings of two patients with persistent DiME or persistent DiME accompanied by CME, both associated with extrafoveal vitreous traction membranes were analyzed. Excluded were eyes that either had another vitreoretinopathy that could affect the analysis, had undergone pars plana vitrectomy or that had been treated by intravitreal medications. An agematched normal control group for OCT （n=12） allowed for the quantification of the normal macular thicknesses. RESULTS： One patient （one eye） following perforating ocular injury and one patient （one eye） of idiopathic origin, both with chronic macular edema refractive to conventional treatment, were found to be associated with extrafoveal vitreoretinal traction in each eye. Retinal edema that was underlying the traction site in each eye was in continuum with the central macular edema, thus manifesting as diffuse macular edema. The automatic central 6-radial lines program in the OCT enabled the detection of the traction site in one eye, while in the other eye the diagnosis was achieved only with the additional use of the Line group program. CONCLUSION： Chronic diffuse macular edema might be related to extrafoveal vitreoretinal traction. Careful search with the diverse OCT programs should be made in order to detect extrafoveal traction sites. Further studies and a larger cohort are required to compare the efficacy of early vitrectomy or pharmacologic vitreolysis versus the current therapeutic approaches in these situations.