vitreomacular traction

玻璃体黄斑牵引
  • 文章类型: Case Reports
    我们介绍了一例玻璃体黄斑牵引(VMT)患者,他在第六次玻璃体内注射阿柏西普治疗年龄相关性黄斑变性后出现了全厚度黄斑裂孔(FTMH),并回顾了有关该不良事件的危险因素和发病机制的文献。
    FTMH可在玻璃体黄斑粘连或VMT恶化的情况下重复多次玻璃体内注射后发生。该患者的FTMH及时手术治疗成功,并安全恢复额外的注射.
    玻璃体内注射后视力意外下降的患者,应该用光学相干断层扫描重新评估,以排除包括玻璃体黄斑界面异常在内的替代病理。FTMH,如果存在,应及时治疗,以便根据需要恢复治疗和视觉优化。
    UNASSIGNED: We present a case of a patient with preceding vitreomacular traction (VMT) who developed a full-thickness macular hole (FTMH) following his sixth intravitreal aflibercept injection for the treatment of age-related macular degeneration and review the literature on risk factors and pathogenesis of this adverse event.
    UNASSIGNED: FTMH can occur after an extended number of repeat intravitreal injections in the setting of worsening vitreomacular adhesion or VMT. This patient\'s FTMH was successfully treated surgically in a timely manner, and additional injections were resumed safely.
    UNASSIGNED: Patients with an unexpected decrease in vision after intravitreal injections should be reevaluated with optical coherence tomography to rule out alternative pathology including vitreomacular interface abnormalities. FTMH, if present, should be treated promptly to allow for resumption of therapy as needed and visual optimization.
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  • 文章类型: Case Reports
    背景:激光皮肤表面修复术是一种流行的非侵入性皮肤恢复美容程序。由于健康保险计划通常不涵盖这些类型的程序,病人经常自掏腰包。因此,有出国的动机,价格更实惠。然而,目的地国家的从业者可能缺乏严格的激光安全培训,监管监督,或许可,特别是在用于“美容”程序的设备上。在某些情况下,这会导致悲剧性的结果,尤其是当不合格的从业者操作医疗级激光设备时。
    方法:一名29岁的妇女因手持调Q掺钕钇铝石榴石(Nd:YAG)激光脉冲装置在越南一家医疗水疗中心进行皮肤表面修复治疗而遭受视网膜烧伤。患者没有充分了解其视力的潜在风险,也没有提供任何眼睛保护。短暂的,由于黄斑烧伤,患者右眼意外激光照射导致不可逆的视力丧失。这一事件立即引起了痛苦,接着突然出现了漂浮物,还有视网膜和玻璃体出血.尽管使用非标签贝伐单抗治疗脉络膜新生血管膜的发展,由于黄斑瘢痕的存在,视力保持在计数手指的水平。
    结论:使用基于激光的设备时,采取安全措施至关重要,例如佩戴安全护目镜或使用眼罩来保护眼部组织免受潜在损害。美容激光设备的日益普及带来了巨大的公共卫生风险,因为许多操作员缺乏基本安全标准的足够培训,或者他们忽视了跟随他们。此外,在国外寻求服务的患者必须遵守目的地国家的监管规定,这可能并不总是执行必要的安全标准。需要进一步的研究来确定区域和全球激光相关损伤的发生率,以帮助指导教育和监管工作。
    BACKGROUND: Laser skin resurfacing is a popular cosmetic procedure for noninvasive skin rejuvenation. Since health insurance plans often do not cover these types of procedures, patients often pay out of pocket. Consequently, there is an incentive to go abroad, where prices are more affordable. However, practitioners in destination countries may lack rigorous training on laser safety, regulatory oversight, or licensing, especially on devices used for \"cosmetic\" procedures. In certain cases, this can lead to tragic outcomes, especially when underqualified practitioners operate medical-grade laser devices.
    METHODS: A 29-year-old woman suffered a retinal burn from a handheld Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser pulse device used to perform skin resurfacing treatment at a medical spa in Vietnam. The patient was not adequately informed about the potential risk to her vision and was not provided with any eye protection. A momentary, unintended laser exposure to the patient\'s right eye led to irreversible vision loss due to a macular burn. This incident caused immediate pain, followed by the sudden appearance of floaters, along with a retinal and vitreous hemorrhage. Despite treatment with off-label bevacizumab for the development of a choroidal neovascular membrane, vision remained at the level of counting fingers because of the presence of the macular scar.
    CONCLUSIONS: When utilizing laser-based devices, it is crucial to employ safety measures, such as the wearing of safety goggles or the use of eye shields to protect ocular tissues from potential damage. The growing availability of cosmetic laser devices presents a substantial public health risk, because numerous operators lack adequate training in essential safety standards, or they neglect to follow them. Furthermore, patients seeking services abroad are subject to the regulatory practices of the destination country, which may not always enforce the requisite safety standards. Further research is needed to determine regional and global incidence of laser-related injuries to help direct educational and regulatory efforts.
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  • 文章类型: Case Reports
    目的:描述一例因玻璃体黄斑牵引(VMT)综合征而在平坦部玻璃体切除术(PPV)后出现的术后持续性视网膜下液(SRF)。方法:对1例病例进行分析,并进行文献复习。结果:一名健康的64岁男性,没有明显的眼部病史,有症状的VMT。联合超声乳化和PPV,视网膜前膜和内界膜剥离,进行气体-流体交换。术后谱域光学相干断层扫描成像显示中央凹SRF。SRF持续了8个月,尺寸变化最小,最佳矫正视力改善很小。结论:尽管在高度近视的孔源性视网膜脱离(RD)和糖尿病的牵张性RD的玻璃体切除术后,已经报道了持续的局部SRF,在VMT的PPV术后尚未有报道.需要对VMTPPV后持续性SRF的病理生理学和长期过程进行研究,以告知这种罕见并发症的管理决策。
    Purpose: To describe a case of postoperative persistent loculated subretinal fluid (SRF) that developed after pars plana vitrectomy (PPV) for vitreomacular traction (VMT) syndrome. Methods: A case was analyzed and a literature review performed. Results: A healthy 64-year-old man with no significant ocular history presented with persistent, symptomatic VMT. Combined phacoemulsification and PPV, epiretinal membrane and internal limiting membrane peeling, and gas-fluid exchange were performed. Postoperative spectral-domain optical coherence tomography imaging showed loculated foveal SRF. The SRF persisted for 8 months, with minimal change in size and little best-corrected visual acuity improvement. Conclusions: Although persistent loculated SRF has been reported after vitrectomy for rhegmatogenous retinal detachment (RD) in high myopia and tractional RD in diabetes, it has not yet been reported postoperatively after PPV for VMT. Studies of the pathophysiology and long-term course of persistent SRF after PPV for VMT are needed to inform management decisions for this rare complication.
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  • 文章类型: Case Reports
    视网膜膜(ERM)通常保持稳定或逐渐恶化。这里,我们报告了2例罕见的自发性ERM消退和1例ERM分离。这是三个病人的系列病例。收集患者的临床数据,并使用系列光学相干断层扫描(OCT)评估ERM。病例1和2是出现漂浮物的女性患者。诊断为轻度至中度特发性ERM,在随后的几年中自发消退,没有干预和分离的证据。患者视力略有下降或保持稳定,分别。病例3是一名女性患者,视力模糊。轻度ERM被诊断为玻璃体黄斑牵引(VMT)和小黄斑孔。在接下来的三个月里,OCT证实ERM分离以及VMT释放。黄斑裂孔同时愈合。她的视力从20/70提高到20/30。特发性ERM自发消退的可能性应该是管理中需要考虑的因素。必须进行进一步的研究以确定这种现象的机理。
    Epiretinal membranes (ERMs) typically remain stable or progressively worsen. Here, we report two rare cases of spontaneous ERM regression and one case of ERM separation. This is a case series of three patients. The patients\' clinical data were collected and ERMs were evaluated with serial optical coherence tomographies (OCTs). Cases one and two were female patients presenting with floaters. Mild-to-moderate idiopathic ERM was diagnosed which spontaneously regressed over the following years without intervention and evidence of separation. Patients\' vision was slightly decreased or remained stable, respectively. Case three was a female patient presenting with blurry vision. A mild ERM was diagnosed with vitreomacular traction (VMT) and a tiny macular hole. Over the following three months, ERM separation along with VMT release was evidenced on OCT. The macular hole healed simultaneously. Her vision improved from 20/70 to 20/30. The possibility of spontaneous regression of idiopathic ERMs should be a factor to consider in management. Further research must be done to determine the mechanism of this phenomenon.
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  • 文章类型: Journal Article
    玻璃体是解剖学和生物化学上的复杂结构。由于它与视网膜的距离和牢固的粘附,研究人员研究了这两种结构之间的联系,以及它们各自的病理是如何联系起来的。一些实验和临床研究已经证明玻璃体在视网膜疾病的发病机理中的重要作用。这篇叙述性综述强调了玻璃体在视网膜疾病中的作用以及自引入光学相干断层扫描以来所取得的进步。这导致对玻璃体视网膜疾病的更好理解,并证明其在其他视网膜病变中的决定性作用。如糖尿病视网膜病变或年龄相关性黄斑变性。当我们加深对玻璃体结构的了解时,函数,和异常情况,我们可以更好地联系疾病的变化,并确定有效的治疗方法。
    The vitreous body is an anatomically and biochemically complex structure. Because of its proximity and firm adherence to the retina, researchers have examined the link between these two structures and how their individual pathologies might be connected. Several experimental and clinical studies have already demonstrated the important role of vitreous in the pathogenesis of retinal disorders. This narrative review highlights the role of the vitreous in retinal diseases and the improvements that have been made since the introduction of optical coherence tomography. This leads to a better understanding of vitreoretinal diseases and demonstrates its determinant role in other retinal pathologies, such as diabetic retinopathy or age-related macular degeneration. As we deepen our knowledge of the vitreous\'s structure, function, and abnormal conditions, we can better link the changes in diseases and identify effective treatments.
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  • 文章类型: Case Reports
    报告一例在充气玻璃体溶解(PV)结合头部摆动运动后立即出现全厚度黄斑裂孔(FTMH)的患者释放玻璃体黄斑牵引(VMT)的病例。
    一名患有VMT和FTMH的71岁女性,视力模糊2个月,达到20/400的水平。在她为期一个月的随访中,使用C3F8气体进行PV,并指示她进行10分钟的饮水鸟技术。
    在头部摆动的PV后十分钟进行光学相干断层扫描,显示VMT释放和较小的FTMH。视敏度立即提高到20/150,两个月后提高到20/80。
    在PV后立即连续使用饮鸟技术可能会鼓励VMT快速释放。对于不希望手术的VMT和FTMH患者,PV可能是可行的选择。
    UNASSIGNED: To report a case of release of vitreomacular traction (VMT) in a patient with a full thickness macular hole (FTMH) immediately following pneumatic vitreolysis (PV) combined with head bobbing movements.
    UNASSIGNED: A 71-year-old female with VMT and an FTMH presented with blurred vision for 2 months to the level of 20/400. At her 1-month follow-up visit, PV was performed using C3F8 gas and she was instructed to perform the drinking bird technique for ten minutes.
    UNASSIGNED: Optical coherence tomography performed ten minutes after PV with head bobbing showed VMT release and a smaller FTMH. Visual acuity improved to 20/150 immediately afterwards and to 20/80 two months later.
    UNASSIGNED: Using the drinking bird technique for a continuous period of time immediately following PV may encourage rapid VMT release. PV may be a feasible option for patients with VMT and FTMH who do not want surgery.
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  • 文章类型: Case Reports
    本报告描述了成人卵黄样黄斑营养不良(AVMD)的双侧黄斑裂孔(MHs)。
    提供了一例AVMD患者的回顾性病例报告,该病例报告为双侧MHs的序贯发作。
    在光学相干断层扫描上确定玻璃体牵引后观察到双侧MHs。用C3F8(全氟丙烷)气体填塞法进行平坦部玻璃体切除术(PPV)修复双眼的孔;只有右眼进行了内界膜剥离。在右眼,孔闭合需要2个PPV。在两只眼睛里,观察到视网膜和视网膜色素上皮的长期萎缩。
    AVMD中的MHs可以先于玻璃体牵引。PPV和气体填塞的手术修复是成功的。术后视网膜和视网膜色素上皮萎缩,但患者的视力仍在改善。
    UNASSIGNED: This report describes a case of bilateral macular holes (MHs) in adult vitelliform macular dystrophy (AVMD).
    UNASSIGNED: A retrospective case report of a patient with AVMD and sequential onset of bilateral MHs is presented.
    UNASSIGNED: Bilateral MHs were observed after vitreomacular traction was identified on optical coherence tomography. Holes in both eyes were repaired with pars plana vitrectomy (PPV) with C3F8 (perfluoropropane) gas tamponade; only the right eye underwent internal limiting membrane peeling. In the right eye, 2 PPVs were required for hole closure. In both eyes, long-term atrophy of the retina and retinal pigment epithelium was observed.
    UNASSIGNED: MHs in AVMD may be preceded by vitreomacular traction. Surgical repair with PPV and gas tamponade was successful. Retinal and retinal pigment epithelium atrophy developed postoperatively, but the patient\'s vision still improved.
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  • 文章类型: Journal Article
    扫描源光学相干断层扫描血管造影(SS-OCTA)分析玻璃体黄斑牵引(VMT)手术前后的脉管系统以及15个月的“观察等待”随访数据。
    38只眼的回顾性分析。患者分为第1组:未经治疗(20只眼);第2组:未经治疗,自发释放牵引(4只眼);第3组:玻璃体切除术(14只眼)。
    在所有情况下,脉络膜毛细血管的SS-OCTA显示了一个低反射区,牵引力释放后消失了。在第1组中,所分析的因素均无明显变化。在第2组中,视力(VA)从0.3logMAR提高到0.1logMAR。以下参数均无明显变化:中央脉络膜厚度,浅凹无血管区(sFAZ),深中央凹无血管区(dFAZ),和血管密度。在1只眼中形成层状黄斑孔。增加牵引自发释放机会的因素是牵引宽度和中央视网膜厚度(P<0.05)。在第3组中,VA从0.27Snellen(0.6logMAR)提高到0.44Snellen(0.4logMAR)(P<0.05)。术后OCTA显示中央视网膜厚度显著降低(P<.001),参数sFAZ,和dFAZ(P<0.05)。
    玻璃体切除术后sFAZ和dFAZ下降,但自发释放牵引后没有下降。自发释放牵引的眼睛中的VA更好。玻璃体切除术组的VA改善程度更大。在所有情况下,在SS-OCTA的脉络膜毛细血管层中都可以看到反射不足的区域。当牵引力被释放时它消失。早期治疗,至少在低VA患者中,可能是有益的。
    UNASSIGNED: A swept-source optical coherence tomography angiography (SS-OCTA) analysis of vasculature in vitreomacular traction (VMT) before and after surgery as well as 15 months\' \"watchful waiting\" follow-up data.
    UNASSIGNED: A retrospective analysis of 38 eyes. Patients were divided into group 1: untreated (20 eyes); group 2: untreated, spontaneous release of traction (4 eyes); and group 3: vitrectomy (14 eyes).
    UNASSIGNED: In all cases, SS-OCTA of the choriocapillaris revealed a hyporeflective area, which disappeared after traction release. In group 1, none of the analyzed factors significantly changed. In group 2, visual acuity (VA) improved from 0.3 logMAR to 0.1 logMAR. None of the following parameters significantly changed: central choroidal thickness, superficial fovea avascular zone (sFAZ), deep fovea avascular zone (dFAZ), and vessel densities. In 1 eye a lamellar macular hole formed. Factors increasing the chances of spontaneous release of traction were width of traction and central retinal thickness (P < .05). In group 3, VA improved from 0.27 Snellen (0.6 logMAR) to 0.44 Snellen (0.4 logMAR) (P < .05). Postoperative OCTA revealed significant decreases in central retinal thickness (P < .001), the parameters sFAZ, and dFAZ (P < .05).
    UNASSIGNED: sFAZ and dFAZ decreased after vitrectomy but not after spontaneous release of traction. VA was better in eyes with spontaneous release of traction. The degree of improvement in VA was greater in the vitrectomy group. In all cases a hyporeflective area is visible in the choriocapillaris layer in SS-OCTA. It disappears when traction is released. Early treatment, at least in patients with lower VA, might be beneficial.
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  • 文章类型: Case Reports
    确定用玻璃体内空气进行的气压式玻璃体溶解对局灶性玻璃体牵引(VMT)是否有效。
    我们进行了回顾性连续病例系列,包括19例局灶性VMT患者的20只眼,这些患者接受了玻璃体内空气充气玻璃体溶解术(2017年1月至2018年11月)。我们在玻璃体内空气注射前和1个月时通过谱域光学相干断层扫描对患者进行了分析。主要结果指标是VMT的释放。
    我们观察到55%的个体释放VMT。仅限于有晶状体眼的分析显示,VMT的释放率为69%,65%的人改善了最佳矫正视力。持续VMT和视力改善的个体玻璃体视网膜插入角度显著降低(P<0.01),VMT下的面积(P<.05),和中央凹下囊肿面积(P<0.05)。
    玻璃体内空气是治疗局灶性VMT的有效方法。在具有持久性VMT的个体中,视力改善与整体VMT减少相关.
    UNASSIGNED: To determine whether pneumatic vitreolysis with intravitreal air is effective for focal vitreomacular traction (VMT).
    UNASSIGNED: We conducted a retrospective consecutive case series of 20 eyes from 19 individuals with focal VMT who underwent pneumatic vitreolysis with intravitreal air (January 2017 to November 2018). We analyzed patients via spectral-domain optical coherence tomography before intravitreal air injection and at 1 month. The primary outcome measure was release of VMT.
    UNASSIGNED: We observed release of VMT in 55% of individuals. An analysis limited to phakic eyes demonstrated release of VMT in 69%, and 65% developed improved best-corrected visual acuity. Individuals with persistent VMT and visual improvement had a significant reduction in angle of vitreoretinal insertion (P < .01), area under VMT (P < .05), and subfoveal cyst area (P < .05).
    UNASSIGNED: Intravitreal air is an effective treatment for focal VMT. In individuals with persistent VMT, visual-acuity improvement was associated with a reduction in overall VMT.
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  • 文章类型: Case Reports
    我们报告了一例62岁的男子,双眼视力模糊和扭曲。眼底检查显示从椎间盘到右眼中央凹中心的纤维带状膜,双眼的动脉瘤灰色旁凹病变,和右眼下颞叶周围血管肿瘤.该患者存在视网膜前膜并伴有玻璃体牵引,导致诊断为偶然的外周血管肿瘤。据我们所知,没有报道描述2型黄斑毛细血管扩张症和视网膜前膜形成与血管增生性肿瘤引起的玻璃体牵引之间的关联。
    We report a case of a 62-year-old man who presented with blurred and distorted vision in both eyes. Fundus examination revealed a fibrous band-like membrane emanating from the disc to the foveal center in the right eye, aneurysmal gray parafoveal lesions in both eyes, and an inferotemporal peripheral vascular tumor in the right eye. The presence of an epiretinal membrane with vitreomacular traction in this patient has led to the diagnosis of an incidental peripheral vascular tumor. To our knowledge, there are no reports describing an association between macular telangiectasia type 2 and epiretinal membrane formation with vitreomacular traction due to a vasoproliferative tumor.
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