METHODS: A 16-year-old asymptomatic female presented with a unilateral atypical peripapillary lesion of the retinal pigment epithelium (RPE) in the left eye. At baseline, best corrected visual acuity (BCVA) was 20/20 and anterior segment examination was unremarkable. Fundus examination revealed an irregularly shaped atrophy of the RPE adjacent to the optic disc with scalloped border of RPE hyperplasia and a fibroglial proliferation in the overlying retina. Optical coherence tomography demonstrated mild changes of the RPE and the outer retina layers. Three years after initial diagnosis, the patient was referred to our clinic due to blurry vision. Complete ophthalmological evaluation revealed tractional retinal detachment with full thickness macular hole formation. Pars plana vitrectomy with epiretinal membrane removal and internal limiting membrane peeling led to anatomical recovery of the macular area with BCVA of 20/32 at four-months postoperatively.
CONCLUSIONS: This is the first report of tractional retinal detachment and macular hole as rare complications of URPED. Systematic follow-up examinations seem to be essential for the prevention of permanent visual loss, whereas prompt surgical intervention can contribute to visual acuity restoration in complicated cases.
■一名16岁无症状女性,在左眼表现为单侧视网膜色素上皮(RPE)的非典型乳头状周围病变。在基线,最佳矫正视力(BCVA)为20/20,眼前节检查无明显变化。眼底检查显示,与视盘相邻的RPE不规则形状的萎缩,RPE增生的扇形边界和上覆视网膜的纤维胶质增生。光学相干断层扫描显示RPE和外视网膜层的轻度变化。初步诊断三年后,由于视力模糊,患者被转诊到我们的诊所。完整的眼科评估显示牵引性视网膜脱离并形成全厚度黄斑孔。平坦部玻璃体切除术伴视网膜前膜去除和内界膜剥离导致黄斑区的解剖恢复,术后4个月BCVA为20/32。
■这是首次报道牵引性视网膜脱离和黄斑裂孔作为URPED的罕见并发症。系统的随访检查似乎对于预防永久性视力丧失至关重要,而及时的手术干预有助于复杂病例的视力恢复。