视网膜和视网膜色素上皮联合错构瘤
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摘要
视网膜和视网膜色素上皮联合错构瘤是少见的良性视网膜肿瘤。好发于儿童,单眼患病。表现为后极眼底单个灰黑色扁平隆起的病变,伴紊乱增生及受牵拉的血管及视网膜前膜。光学相干层析成像(OCT)示病变视网膜增厚,结构紊乱,呈高反射,其后则为低反射影,几乎都伴视网膜前膜。临床上需与黄斑前膜、犬弓蛔虫病、永存胚胎性血管等疾病相鉴别。年幼儿童给予遮盖治疗防止弱视。该类患者应定期观察,如出现视力持续下降,见前膜收缩及血管渗漏加重,并经OCT及荧光素眼底血管造影(FFA)证实,且前膜与视网膜间存在间隙的可考虑玻璃体手术。
Combined hamartoma of the retina and retinal pigment epithelium is a rare benign retinal tumor,common in children with unilateral occurrence. It manifests as solitary black grayish slightly elevated lesion located at posterior pole of fundus,associating with irregular proliferation of blood vessels and preretinal membrane. Optical coherence tomography( OCT) shows localized thickened and disorganized retina,with high reflectivity and shadow posterior to it,almost always accompanied by preretinal membrane. Differential diagnosis includes idiopathic preretinal membrane,ocular toxocariasis and persistent fetal vasculature. For treatment,occlusion treatment to prevent amblyopia may improve visual acuity in children. Regular follow-up is needed. When progressive deterioration of vision with increasing contraction of preretinal membrane and vascular leakage are seen and confirmed by OCT and fundus fluorescein angiography( FFA),especially a potential space is present between preretinal membrane and retina,vitrectomy could be considered.
Combined hamartoma of the retina and retinal pigment epithelium is a rare benign retinal tumor,common in children with unilateral occurrence. It manifests as solitary black grayish slightly elevated lesion located at posterior pole of fundus,associating with irregular proliferation of blood vessels and preretinal membrane. Optical coherence tomography( OCT) shows localized thickened and disorganized retina,with high reflectivity and shadow posterior to it,almost always accompanied by preretinal membrane. Differential diagnosis includes idiopathic preretinal membrane,ocular toxocariasis and persistent fetal vasculature. For treatment,occlusion treatment to prevent amblyopia may improve visual acuity in children. Regular follow-up is needed. When progressive deterioration of vision with increasing contraction of preretinal membrane and vascular leakage are seen and confirmed by OCT and fundus fluorescein angiography( FFA),especially a potential space is present between preretinal membrane and retina,vitrectomy could be considered.
引文
[1]Gass JD.An unusual hamartoma of the pigment epithelium and retina simulating choroidal melanoma and retinoblastoma[J].Trans Am Ophthalmol Soc,1973,71:171-183.
[2]Font RL,Moura RA,Shetlar DJ,et al.Combined hamartoma of sensory retina and retinal pigment epithelium[J].Retina,1989,9(4):302-311.
[3]Vianna RN,Pacheco DF,Vasconcelos MM,et al.Combined hamartoma of the retina and retinal pigment epithelium associated with neurofibromatosis type-1[J].Int Ophthalmol,2001,24(2):63-66.
[4]Yassin SA,Al-Tamimi ER.Familial bilateral combined hamartoma of retina and retinal pigment epithelium associated with neurofibromatosis 1[J].Saudi J Ophthalmol,2012,26(2):229-234.
[5]Shields CL,Thangappan A,Hartzell K,et al.Combined hamartoma of the retina and retinal pigment epithelium in 77 consecutive patients.Visual outcome based on macular versus extramacular tumor location[J].Ophthalmology,2008,115(12):2246-2252.
[6]Mason JO 3rd,Kleiner R.Combined hamartoma of the retina and retinal pigment epithelium associated with epiretinal membrane and macular hole[J].Retina,1997,17(2):160-162.
[7]Schachat AP,Shields JA,Fine SL,et al.Combined hamartoma of the retina and retinal pigment epithelium[J].Ophthalmology,1984,91(12):1609-1615.
[8]Helbig H,Niederberger H.Presumed combined hamartoma of the retina and retinal pigment epithelium with preretinal neovascularization[J].Am J Ophthalmol,2003,136(6):1157-1159.
[9]Echevarría L,Villena O,Nievas T,et al.Combined hamartoma of the retina and retinal pigment epithelium.Anti-VEGF treatment of the associated choroidal neovascular membranes[J].Arch Soc Esp Oftalmol,2015,90(2):87-93.
[10]Chae B,Dhrami-Gavazi E,Dansingani KK,et al.Multimodal imaging of combined hamartoma of the retina and retinal pigment epithelium associated with an acquired vitelliform lesion[J].Int J Retina Vitreous,2015,1:23.
[11]俞笳,黎蕾,徐格致,等.视网膜和视网膜色素上皮联合错构瘤二例[J].中华眼底病杂志,2008,24(2):140-141.
[12]Shields CL,Mashayekhi A,Dai VV,et al.Optical coherence tomographic findings of combined hamartoma of the retina and retinal pigment epithelium in 11 patients[J].Arch Ophthalmol,2005,123(12):1746-1750.
[13]Khaja HA,Mc Cannel CA,Diehl NN,et al.Incidence and clinical characteristics of epiretinal membranes in children[J].Arch Ophthalmol,2008,126(5):632-636.
[14]Stewart JM,Cubillan LD,Cunningham ET Jr.Prevalence,clinical features,and causes of vision loss among patients with ocular toxocariasis[J].Retina,2005,25(8):1005-1013.
[15]Zhou M,Chang Q,Gonzales JA,et al.Clinical characteristics of ocular toxocariasis in Eastern China[J].Graefes Arch Clin Exp Ophthalmol,2012,250(9):1373-1378.
[16]Wang ZJ,Zhou M,Cao WJ,et al.Evaluation of the GoldmannWitmer coefficient in the immunologic diagnosis of ocular toxocariasis[J].Acta Trop,2016,158:20-23.
[17]Shields CL,Mashayekhi A,Materin MA,et al.Optical coherence tomography of choroidal nevus in 120 patients[J].Retina,2005,25:243-252.
[18]Sappenfeld DL,Gitter KA.Surgical intervention for combined retinal-retinal pigment epithelial hamartoma[J].Retina,1990,10(2):119-124.
[19]Stallman JB.Visual improvement after pars plana vitrectomy and membrane peeling for vitreoretinal traction associated with combined hamartoma of the retina and retinal pigment epithelium[J].Retina,2002,22(1):101-104.
[20]Cohn AD,Quiram PA,Drenser KA,et al.Surgical outcomes of epiretinal membranes associated with combined hamartoma of the retina and retinal pigment epithelium[J].Retina,2009,29(6):825-830.
[21]Schachat AP,Shields JA,Fine SL,et al.Combined hamartoma of the retina and retinal pigment epithelium[J].Ophthalmology,1984,91(12):1609-1615.
[22]Mc Donald HR,Abrams GW,Burke JM,et al.Clinicopathologic results of vitreous surgery for epiretinal membranes in patients with combined retinal and retinal pigment epithelial hamartomas[J].Am J Ophthalmol,1985,100(6):806-813.
[23]Zhang X,Dong F,Dai R,et al.Surgical management of epiretinal membrane in combined hamartomas of the retina and retinal pigment epithelium[J].Retina,2010,30(2):305-309.
[24]Bonnin S,Metge F,Guez A,et al.Long-term outcome of epiretinal membrane surgery in young children[J].Retina,2016,36(3):558-564.
[2]Font RL,Moura RA,Shetlar DJ,et al.Combined hamartoma of sensory retina and retinal pigment epithelium[J].Retina,1989,9(4):302-311.
[3]Vianna RN,Pacheco DF,Vasconcelos MM,et al.Combined hamartoma of the retina and retinal pigment epithelium associated with neurofibromatosis type-1[J].Int Ophthalmol,2001,24(2):63-66.
[4]Yassin SA,Al-Tamimi ER.Familial bilateral combined hamartoma of retina and retinal pigment epithelium associated with neurofibromatosis 1[J].Saudi J Ophthalmol,2012,26(2):229-234.
[5]Shields CL,Thangappan A,Hartzell K,et al.Combined hamartoma of the retina and retinal pigment epithelium in 77 consecutive patients.Visual outcome based on macular versus extramacular tumor location[J].Ophthalmology,2008,115(12):2246-2252.
[6]Mason JO 3rd,Kleiner R.Combined hamartoma of the retina and retinal pigment epithelium associated with epiretinal membrane and macular hole[J].Retina,1997,17(2):160-162.
[7]Schachat AP,Shields JA,Fine SL,et al.Combined hamartoma of the retina and retinal pigment epithelium[J].Ophthalmology,1984,91(12):1609-1615.
[8]Helbig H,Niederberger H.Presumed combined hamartoma of the retina and retinal pigment epithelium with preretinal neovascularization[J].Am J Ophthalmol,2003,136(6):1157-1159.
[9]Echevarría L,Villena O,Nievas T,et al.Combined hamartoma of the retina and retinal pigment epithelium.Anti-VEGF treatment of the associated choroidal neovascular membranes[J].Arch Soc Esp Oftalmol,2015,90(2):87-93.
[10]Chae B,Dhrami-Gavazi E,Dansingani KK,et al.Multimodal imaging of combined hamartoma of the retina and retinal pigment epithelium associated with an acquired vitelliform lesion[J].Int J Retina Vitreous,2015,1:23.
[11]俞笳,黎蕾,徐格致,等.视网膜和视网膜色素上皮联合错构瘤二例[J].中华眼底病杂志,2008,24(2):140-141.
[12]Shields CL,Mashayekhi A,Dai VV,et al.Optical coherence tomographic findings of combined hamartoma of the retina and retinal pigment epithelium in 11 patients[J].Arch Ophthalmol,2005,123(12):1746-1750.
[13]Khaja HA,Mc Cannel CA,Diehl NN,et al.Incidence and clinical characteristics of epiretinal membranes in children[J].Arch Ophthalmol,2008,126(5):632-636.
[14]Stewart JM,Cubillan LD,Cunningham ET Jr.Prevalence,clinical features,and causes of vision loss among patients with ocular toxocariasis[J].Retina,2005,25(8):1005-1013.
[15]Zhou M,Chang Q,Gonzales JA,et al.Clinical characteristics of ocular toxocariasis in Eastern China[J].Graefes Arch Clin Exp Ophthalmol,2012,250(9):1373-1378.
[16]Wang ZJ,Zhou M,Cao WJ,et al.Evaluation of the GoldmannWitmer coefficient in the immunologic diagnosis of ocular toxocariasis[J].Acta Trop,2016,158:20-23.
[17]Shields CL,Mashayekhi A,Materin MA,et al.Optical coherence tomography of choroidal nevus in 120 patients[J].Retina,2005,25:243-252.
[18]Sappenfeld DL,Gitter KA.Surgical intervention for combined retinal-retinal pigment epithelial hamartoma[J].Retina,1990,10(2):119-124.
[19]Stallman JB.Visual improvement after pars plana vitrectomy and membrane peeling for vitreoretinal traction associated with combined hamartoma of the retina and retinal pigment epithelium[J].Retina,2002,22(1):101-104.
[20]Cohn AD,Quiram PA,Drenser KA,et al.Surgical outcomes of epiretinal membranes associated with combined hamartoma of the retina and retinal pigment epithelium[J].Retina,2009,29(6):825-830.
[21]Schachat AP,Shields JA,Fine SL,et al.Combined hamartoma of the retina and retinal pigment epithelium[J].Ophthalmology,1984,91(12):1609-1615.
[22]Mc Donald HR,Abrams GW,Burke JM,et al.Clinicopathologic results of vitreous surgery for epiretinal membranes in patients with combined retinal and retinal pigment epithelial hamartomas[J].Am J Ophthalmol,1985,100(6):806-813.
[23]Zhang X,Dong F,Dai R,et al.Surgical management of epiretinal membrane in combined hamartomas of the retina and retinal pigment epithelium[J].Retina,2010,30(2):305-309.
[24]Bonnin S,Metge F,Guez A,et al.Long-term outcome of epiretinal membrane surgery in young children[J].Retina,2016,36(3):558-564.