背景:视网膜囊肿是罕见的眼底病变,基本上是位于或起源于视网膜的充满液体的腔,直径大于正常视网膜厚度。迄今为止,很少有巨大视网膜囊肿出血伴视网膜裂开的病例报道。
方法:一名没有其他病史的32岁女性患者在严重咳嗽后3天内出现视力下降。右眼的最佳矫正视力为0.5。全面的眼科检查,包括裂隙灯眼底镜检查,眼睛的超声扫描,光学相干层析成像扫描,并进行了眼眶磁共振成像。眼科检查显示右眼有III级前房血细胞和III级玻璃体出血,视网膜鼻侧有一个大疱疹囊肿。囊肿投射到玻璃体中,里面隐约可见大量出血。囊肿清晰可见,周围观察到浅表视网膜限制脱离。超声显示右眼视网膜囊肿伴视网膜脱离。实验室检测结果不显著。保守治疗3个月后,患者的囊内出血明显吸收,但是囊肿腔的大小没有任何明显的变化。巩膜外加压扣带术联合外引流囊内液体,手术后患者的视力逐渐恢复到正常的1.0,视网膜看起来变平了.该患者最终被诊断为右眼患有视网膜裂孔的巨大视网膜囊肿。推测原因是剧烈咳嗽导致视网膜囊肿破裂和出血,类似于动脉夹层破裂的机制。据我们所知,此病例因重度咳嗽引起的视网膜囊肿破裂出血,经手术治疗后恢复良好,以前从未报道过。
结论:伴有视网膜裂孔的巨大囊性视网膜出血非常罕见。眼眶磁共振成像和眼部B超对其诊断至关重要,和选择适当的外科手术是必要的,以最大限度地受益于受影响的患者。
BACKGROUND: Retinal cysts are rare lesions of the fundus that are essentially fluid-filled cavities located or originating in the retina, with a diameter larger than the normal retinal thickness. To date, there have been few case reports of giant retinal cyst hemorrhage with
retinoschisis.
METHODS: A 32-year-old woman with no other medical history complained of decreased vision for 3 days after a severe cough. The best-corrected visual acuity in the right eye was 0.5. A comprehensive ophthalmological examination including slit-lamp fundoscopy, ultrasound scan of the eye, optical coherence tomography scan, and orbital magnetic resonance imaging was performed. Ophthalmological examination revealed grade III anterior chamber blood cells and grade III vitreous hemorrhage in the right eye and a large herpetic cyst on the nasal side of the retina. The cyst projected into the vitreous, with a large amount of hemorrhage vaguely visible within it. The cyst was clearly visible, and a superficial retinal limiting detachment was observed around it. Ultrasound showed a retinal cyst with retinal detachment in the right eye. Laboratory test results were unremarkable. After 3 months of conservative treatment, the patient\'s intracystic hemorrhage was significantly absorbed, but the size of the cyst cavity did not show any significant change. Scleral buckling with external compression combined with external drainage of the intracystic fluid was performed, the patient\'s visual acuity was gradually restored to a normal 1.0 after the operation, and the retina appeared flattened. The patient was finally diagnosed with a giant retinal cyst with
retinoschisis in the right eye. The presumed cause was heavy coughing leading to rupture and hemorrhage of the retinal cyst, similar to the mechanism of rupture of an arterial dissection. To the best of our knowledge, this case of retinal cyst rupture and hemorrhage caused by heavy coughing with good recovery after external surgical treatment has never been reported before.
CONCLUSIONS: Giant cystic retinal hemorrhage with
retinoschisis is very rare. Orbital magnetic resonance imaging and ocular B-scan ultrasound are essential for its diagnosis, and the selection of an appropriate surgical procedure is necessary to maximize the benefit for affected patients.