PDF(Pubmed)
Abstract：
BACKGROUND: Macular retinoschisis (MRS) and myopic macular neovascularization (mMNV) are both potentially blinding complications of high myopia. In this case report, we highlight the progression of MRS after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment for mMNV, as well as an extensive review of the literature on this topic.
METHODS: A 49-year-old woman presented with two weeks of recent onset blurring and metamorphopsia in her right eye. She had high myopia in both eyes (right eye - 20/60 with - 16D, left eye - 20/20 with - 13D). Slit-lamp ophthalmoscopy found a normal anterior segment in both eyes. On fundus examination, features of pathological myopia with posterior staphyloma and peripapillary atrophy were observed in both eyes. An active mMNV, as well as intraretinal fluid, minimal perifoveal inner and outer MRS, and focal posterior vitreous traction along the inferotemporal retinal arcade, were detected on optical coherence tomography (OCT) of the right eye. The patient received an intravitreal injection of Aflibercept (2 mg/0.05 ml).
RESULTS: OCT scans at two- and four-month follow-up visits revealed regressed mMNV with a taut epiretinal membrane, progressive worsening of outer MRS, and the development of multiple perifoveal retinal detachment inferior to the fovea. Pars plana vitrectomy surgery was performed for the progressive MRS with good anatomical (resolved MRS) and functional outcome (maintained visual acuity at 20/60) at the last one-month post-surgery visit.
CONCLUSIONS: Intravitreal anti-VEGF injections for mMNV can cause vitreoretinal interface changes, exacerbating MRS and causing visual deterioration. Vitrectomy for MRS could be one of several treatment options.
METHODS: A 49-year-old woman presented with two weeks of recent onset blurring and metamorphopsia in her right eye. She had high myopia in both eyes (right eye - 20/60 with - 16D, left eye - 20/20 with - 13D). Slit-lamp ophthalmoscopy found a normal anterior segment in both eyes. On fundus examination, features of pathological myopia with posterior staphyloma and peripapillary atrophy were observed in both eyes. An active mMNV, as well as intraretinal fluid, minimal perifoveal inner and outer MRS, and focal posterior vitreous traction along the inferotemporal retinal arcade, were detected on optical coherence tomography (OCT) of the right eye. The patient received an intravitreal injection of Aflibercept (2 mg/0.05 ml).
RESULTS: OCT scans at two- and four-month follow-up visits revealed regressed mMNV with a taut epiretinal membrane, progressive worsening of outer MRS, and the development of multiple perifoveal retinal detachment inferior to the fovea. Pars plana vitrectomy surgery was performed for the progressive MRS with good anatomical (resolved MRS) and functional outcome (maintained visual acuity at 20/60) at the last one-month post-surgery visit.
CONCLUSIONS: Intravitreal anti-VEGF injections for mMNV can cause vitreoretinal interface changes, exacerbating MRS and causing visual deterioration. Vitrectomy for MRS could be one of several treatment options.
摘要：
背景：黄斑视网膜裂孔（MRS）和近视黄斑新生血管（mMNV）都是高度近视的潜在致盲并发症。在这个案例报告中,我们强调了玻璃体内抗血管内皮生长因子（抗VEGF）治疗mMNV后MRS的进展，以及对有关该主题的文献的广泛评论。
方法：一名49岁的女性近期出现了两周的右眼模糊和变形。她双眼高度近视（右眼-20/60与-16D，左眼-20/20与-13D）。裂隙灯检眼镜在双眼中发现正常的眼前段。眼底检查，双眼均观察到病理性近视伴后葡萄肿和乳头周围萎缩的特征。活跃的mMNV，以及视网膜内液体，最小中央凹内部和外部MRS，和沿着下颞区视网膜拱廊的局灶性玻璃体后部牵引，在右眼的光学相干断层扫描（OCT）上检测到。患者接受玻璃体内注射阿柏西普(2mg/0.05ml)。
结果：两个月和四个月随访时的OCT扫描显示mMNV消退，视网膜前膜拉紧，外MRS逐渐恶化，以及位于中央凹下方的多个中央凹视网膜脱离的发展。在手术后的最后一个月就诊时，对进行性MRS进行了平坦部玻璃体切除术，具有良好的解剖学（已解决的MRS）和功能结果（维持视力为20/60）。
结论：玻璃体内注射抗VEGF治疗mMNV可引起玻璃体视网膜界面改变，加剧MRS并导致视力下降。MRS的玻璃体切除术可能是几种治疗选择之一。
方法：一名49岁的女性近期出现了两周的右眼模糊和变形。她双眼高度近视（右眼-20/60与-16D，左眼-20/20与-13D）。裂隙灯检眼镜在双眼中发现正常的眼前段。眼底检查，双眼均观察到病理性近视伴后葡萄肿和乳头周围萎缩的特征。活跃的mMNV，以及视网膜内液体，最小中央凹内部和外部MRS，和沿着下颞区视网膜拱廊的局灶性玻璃体后部牵引，在右眼的光学相干断层扫描（OCT）上检测到。患者接受玻璃体内注射阿柏西普(2mg/0.05ml)。
结果：两个月和四个月随访时的OCT扫描显示mMNV消退，视网膜前膜拉紧，外MRS逐渐恶化，以及位于中央凹下方的多个中央凹视网膜脱离的发展。在手术后的最后一个月就诊时，对进行性MRS进行了平坦部玻璃体切除术，具有良好的解剖学（已解决的MRS）和功能结果（维持视力为20/60）。
结论：玻璃体内注射抗VEGF治疗mMNV可引起玻璃体视网膜界面改变，加剧MRS并导致视力下降。MRS的玻璃体切除术可能是几种治疗选择之一。
