老年性盤狀黃斑部變性併發巨大出血性網膜剝離及隅角閉鎖性青光眼－病例報告

One eye developed angle-closure glaucoma secondary to total hemorrhagic retinal detachment that occurred as a rare complication of senile disciform macular degeneration. The patient was a 65-year-old man. He had no history of eye surgery and experienced sudden loss of vision and pain in the left eye. Visual acuity was 20/40 in the right eye and hand motion at 20 centimeters in the left eye. Intraocular tension was 13mm of mercury in the right eye and 48mm of mercury in the left eye. The anterior chamber was deep in the right eye and very shallow in the left eye. There were drusen, serous detachment of pigment epithelium in the right eye. Two extensive solid-like, dark masses with overlying retinal detachment involving both of lower guadrants and retinal, subretinal hemorrhage in the macular area were, noted in the left eye. Systemic evaluation revealed primary lung cancer. Visual acuity of the left eye decreased to no light perception ten days later. The eye was enucleated and sent to pathological laboratory for examination. Pathological examination revealed massive subretinal, sub R.P.E. hemorrhage, R.P.E. break and hemorrhagic retinal detachment. Balloons of retinal detachment were pushed tightly against the lens in a characteristic ”Y suture” appearance causing shallowing of the anterior chamber and glaucoma. Sheets of avulsed retinal outer segments were seen incarcerated in subretinal blood but neovascular tissue in macular disciform lesion which was the probable source of hemorrhage was not found. We presented the clinical course, treatment and pathological finding of the case. The differential diagnosis was also discussed.

並列關鍵字

senile disciform macular degeneration massive hemorrhagic retinal detachment angle closure glaucoma

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