以黄斑裂孔首诊的渗出性玻璃体视网膜病变1例  

Exudative vitreoretinopathy initially misdiagnosed with macular hole:A case report

作　　者：郑杏杏[1] 王玉萍[1] 张文芳[1] 杨义[1] ZHENG Xingxing;WANG Yuping;ZHANG Wenfang;YANG Yi(Department of Ophthalmology,Lanzhou University Second Hospital,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院眼科,兰州730030

出　　处：《眼科学报》2020年第3期210-216,共7页Eye Science

摘　　要：患者因“左眼视物不清50 d”就诊。裸眼视力:右眼0.15,左眼0.06;眼压:OD 11 mmHg,OS 11 mmHg,双侧眼位正,眼球运动如常,眼表及眼前节检查未见明显异常,眼底:左眼黄斑部见一小圆形裂孔,颞侧周边网膜可见变性区。左眼黄斑光学相干断层扫描(optical coherence tomography,OCT)提示黄斑部神经上皮层反射中断,孔径388μm。入院诊断:1)左眼黄斑裂孔;2)左眼玻璃体黄斑牵拉综合征;3)双眼高度近视。在局部麻醉强化下行“左眼玻切+黄斑裂孔修复术”,术中切除玻璃体后见黄斑区颞侧网膜前纵行增殖膜与网膜粘连紧密,无法完全剥除,颞下方周边网膜血管中断,颞侧网膜面血管呈直线状,术后行双眼FFA检查进一步明确诊断为渗出性玻璃体视网膜病变,此病例为以黄斑裂孔首诊的渗出性玻璃体视网膜病变,术前因颞侧网膜增殖,在一定程度上影响眼底检查,导致首诊时渗出性玻璃体视网膜病变这一诊断漏诊。The patient was admitted to our hospital due to“blurred vision of the left eye for 50 d”.Uncorrected visual acuity:OD 0.15,OS 0.06.Intraocular pressure(IOP):OD 11 mmHg,OS 11 mmHg,normal bilateral eye position,normal eye movement,no obvious abnormalities were found in the ocular surface and anterior segment examination.Fundus examination a small round hole was found in the macular area of the left eye,and degeneration areas were seen in the peripheral retinal membrane on the temporal side.Optical coherence tomography(OCT)in the left macular area indicated the disruption of neurocutaneous reflex in macular area,with an aperture of 388μm.Diagnosis upon admission:1)macular hole of the left eye;2)vitreous macular traction syndromes of the left eye;3)high myopia in both eyes.Left eye vitrectomy combined with macular hole repair were performed under local anesthesia.After vitrectomy,it was found that the anterior longitudinal proliferative membrane of temporal retina in the macular area was closely adhered to the retina,which could not be completely excised.Peripheral retinal vessels in the inferior temporal area were blocked,and the retinal vessels on the temporal side were arranged in a straight line.Postoperative FFA examination confirmed the diagnosis of exudative vitreoretinopathy.The patient was initially diagnosed with macular hole.Preoperative proliferation of the temporal retina affected the results of fundus examination,leading to the initial misdiagnosis of macular hole.

关 键 词：视网膜疾病 视网膜穿孔 视网膜脱离 

分 类 号：R774.1[医药卫生—眼科]