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LONG-TERM OBSERVATION OF TERSON SYNDROME WITH SPONTANEOUS DETACHMENT OF INTERNAL LIMITING MEMBRANE: A CASE REPORT
泰爾松氏症候群之長期追蹤伴隨自發性內界膜剝離：病例報告
摘要
目的：報告一位長期追蹤的泰爾松氏症候群個案，在自發性的內界膜剝離後觀察到視網膜厚度逐漸變薄的變化。方法：病例觀察報告。結果：一名剛出生的早產男嬰做的腦部超音波顯示兩側硬膜下積水和顱內囊腫，但是當時並沒有做眼科的檢查。在男嬰五個半月大的時候，發生了癲癇的症狀，在進一步安排了腦部核磁共振的檢查後，發現有硬膜下出血，蜘蛛膜下腔囊腫和腦室擴大的現象，並沒有外傷的病史。且在男嬰七個月大的時候，因為其追視的表現不如預期，經過眼科的檢查，發現左眼玻璃體下和內界膜下出血，並診斷為泰爾松氏症候群。他左眼眼內的出血大約在六個月後回診時消退了。在他十歲左右，間接眼底鏡檢查出左眼內界膜發生自發性的剝離和破裂，內界膜向黃斑部的顳側捲曲，使得黃斑部失去內界膜的覆蓋。從十二歲開始，我們使用光學相干斷層掃描記錄其視網膜的變化大約有四年的時間，發現左眼的視網膜比起右眼，在這四年來有逐漸變薄的趨勢並有統計上的意義(p=0.0369)。且患者的電腦驗光在這四年之內並無顯著的變化。結論：我們記錄了泰爾松氏症候群的個案，在自發性的失去內界膜的覆蓋下，視網膜有逐漸變薄的趨勢，失去內界膜和內界膜下的出血可能是使視網膜變薄的其中兩項因素，因此內界膜在正常視網膜上，有可能扮演著保護的角色。此後會需要更多的研究來決定或證明，視網膜在長期失去內界膜的覆蓋下，是否會改變網膜原本代謝功能，而導致視網膜厚度變薄，甚至影響到視網膜的功能。
關鍵字
無資料並列摘要
Purpose: To present a case of progressive retinal thinning after a spontaneous internal limiting membrane (ILM) tear following Terson syndrome-related sub-ILM hemorrhage. Methods: An observational case report. Results: This male infant was born prematurely. Brain echography showed subdural effusion and an intracranial cyst at 2 weeks of age. However, he did not receive an ophthalmic examination at that time. Subdural hemorrhage and ventriculomegaly were also detected and related to a seizure episode at 5.5 months of age. There was no history of trauma. At 7 months of age, poor visual tracking was noted. A dome-shaped sub-ILM and subhyaloid hemorrhage over the posterior pole of the left eye were noted, and Terson syndrome was impressed. Both the sub-ILM and subhyaloid hemorrhage eventually regressed completely after 6 months of observation. A spontaneous ILM tear rolled up to the temporal side of the macula with nerve fiber exposure developed in his left eye when he was 10 years old. Gradual retina thinning was evident during 4 years of follow-up (193.6 um to 174.8 um) compared to the fellow eye (259 um to 256.4 um) from 12 to 15 years of age using optical coherence tomography, and the difference was statistically significant (p=0.0369). There was no significant difference in auto-refraction during the follow-up period. Conclusion: Gradual retinal thinning was noted in a case of spontaneous ILM tear secondary to Terson syndrome. ILM loss and blood toxicity may have contributed to the retinal thinning. ILM may play a protective role in the normal physiology of the retina. Furthermore, whether progressive thinning can lead to adverse effects on retinal function should be studied further.