背景:报道一例增殖性糖尿病性视网膜病变(PDR),在激光光凝后,在玻璃体腔内出现推测为晶状体蛋白的闪烁颗粒。
方法:一名56岁的男性患者在意识到右眼视力下降后出现在我们的门诊诊所。患者初次就诊时进行的眼部检查显示,由于右眼PDR导致大量视网膜前黄斑出血。荧光素眼底血管造影显示,双眼均存在广泛的视网膜非灌注区域和新生血管形成。然而,在他的左眼玻璃体腔中未观察到混浊.超声乳化白内障吸出及人工晶状体植入术后,对患者右眼行玻璃体手术。手术后,该眼的校正VA从0.1提高到1.0。与患者右眼的治疗相关,我们开始对他的左眼进行全视网膜光凝.在患者第三次全视网膜光凝术之前进行的检查显示,视网膜前的后部玻璃体凝胶中存在大量闪烁颗粒。通过裂隙灯显微镜检查发现颗粒具有不同的色调,非常像“圣诞树”的白内障。未观察到玻璃体后脱离,由于这些颗粒的位置就像捕获在后部玻璃体凝胶中一样,未观察到与眼球运动相关的颗粒移动性.由于浑浊不足以干扰光凝,进行了额外的光凝,患者目前正在观察中。自进行第四次光凝手术以来,已经过去了六个月,粒子的状态没有变化。光学相干断层扫描成像显示全视网膜光凝前后均无变化。在术后随访期间,左眼的校正VA保持在1.0。
结论:我们推测,在这种情况下,视网膜中结晶蛋白的产生是由糖尿病性视网膜病变的光凝程序触发的。
BACKGROUND: To report a
case of proliferative diabetic retinopathy (PDR) exhibiting the appearance of scintillating particles presumed to be
crystallin inside the intravitreal cavity after laser photocoagulation.
METHODS: A 56-year-old male patient presented at our outpatient clinic after becoming aware of decreased vision in his right eye. Ocular examination performed at the patient\'s initial visit revealed a massive preretinal macular hemorrhage due to PDR in his right eye. Fundus fluorescein angiography revealed extensive retinal non-perfusion areas and neovascularization in both eyes. However, no opacity was observed in the intravitreal cavity of his left eye. Vitreous surgery was performed on the patient\'s right eye after ultrasonic phacoemulsification aspiration and intraocular lens implantation. Post surgery, the corrected VA in that eye improved from 0.1 to 1.0. In correlation with the treatment performed on the patient\'s right eye, we began panretinal photocoagulation on his left eye. Examination performed prior to the patient\'s third session of panretinal photocoagulation revealed a large number of scintillating particles in the posterior vitreous gel in front of the retina. Examination via slit-lamp microscopy revealed that the particles were of varied hues, and closely resembled a \'Christmas tree\' cataract. No posterior vitreous detachment was observed, and since these particles were situated as if captured in the posterior vitreous gel, no eye-movement-associated mobility of the particles was observed. Since the cloudiness was not severe enough to interfere with photocoagulation, additional photocoagulation was performed, and the patient is currently under observation. Six months have now passed since the fourth photocoagulation procedure was performed, and there has been no change in the state of the particles. Optical coherence tomography imaging revealed no change before and after the panretinal photocoagulation. The corrected VA in his left eye has remained at 1.0 during the postoperative follow-up period.
CONCLUSIONS: We speculate that the production of
crystallin in the retina in this
case was triggered by the photocoagulation procedure performed for diabetic retinopathy.