不典型慢性中心性浆液性脉络膜视网膜病变误诊分析
Misdiagnosis of Atypical Chronic Central Serous Chorioretinopathy
黄丽娟 1彭素银 1刘彬泉 2邓智祥 1王秀琴 1张秋丽1
作者信息
- 1. 524013 广东湛江,广东医科大学附属医院眼科
- 2. 516007 广东惠州,惠州爱尔眼科医院眼科
- 折叠
摘要
目的 分析库欣综合征并慢性中心性浆液性脉络膜视网膜病变(CSCR)的临床特点及误诊原因.方法 对2022 年10 月诊治的1 例库欣综合征并慢性CSCR误诊脉络膜炎患者的临床资料进行回顾性分析.结果 36 岁女性,肥胖体型,有抑郁症、高血压病史,因左眼视力下降1 年,加重2 个月就诊,经专科查体、激光眼底扫描、光学相干断层成像、眼底自发荧光照相及荧光素眼底血管造影检查诊断为左眼脉络膜炎,予曲安奈德左眼球后注射、七叶洋地黄双苷滴眼液滴左眼和血明目片口服,症状无明显改善,后于某眼科中心经吲哚菁绿眼底血管造影确诊为双眼慢性CSCR,行双眼视网膜激光光凝术.经相关检查确诊为库欣综合征并右侧肾上腺皮质腺瘤.肾上腺皮质腺瘤切除术后随访10 个月,视力有所恢复.结论 库欣综合征并非典型慢性CSCR较少见,若仅重视局部眼部症状而忽视全身症状,极易导致误诊;加强对慢性CSCR的认识,及时更新并巩固相关理论知识,提高各眼底疾病之间的鉴别能力,尽可能做到早发现、早诊断、早治疗.
Abstract
Objective To discuss the clinical features of Cushing's syndrome complicated with chronic central serous chorioretinopathy(CSCR)and the causes of misdiagnosis.Methods The clinical data of a patient with Cushing's syndrome and chronic CSCR misdiagnosed as choroiditis were retrospectively analyzed.Results A 36-year-old obese female,with a history of depression and hypertension,was diagnosed with left choroiditis by specialized physical examination,laser fundus scanning,optical coherence tomography,fundus autofluorescence and fluorescein fundus angiography due to decreased visual acuity in her left eye for 1 year and aggravation for 2 months.After the injection of triamcinolone acetonide in the left eye,ad-ministration of Esculin and Digitalisglycosides Eye Drops into the left eye and the oral administration of Xuemingmu tablets,the symptoms did not improve significantly.After indocyanine green angiography(ICGA),the patient was diagnosed as chro-nic CSCR in both eyes in January 2023 at an ophthalmic center,and underwent bilateral retinal laser photocoagulation.She was diagnosed with Cushing's syndrome and right adrenal cortical adenoma(ACA)by relevant examinations.At 10-month fol-low-up after adrenalectomy for ACA the visual acuity showed certain improvement.Conclusion Cushing's syndrome compli-cated with atypical chronic CSCR is rare,and it is prone to misdiagnosis if merely local ocular symptoms are emphasized and systemic symptoms are ignored.It is necessary to strengthen the understanding of chronic CSCR,timely update and consoli-date the relevant theoretical knowledge,and improve the ability to distinguish between various fundus diseases,so as to ensure early detection,early diagnosis,and early diagnosis.
关键词
中心性浆液性脉络膜视网膜病变/库欣综合征/误诊/脉络膜炎/鉴别诊断Key words
Central serous chorioretinopathy/Cushing's syndrome/Misdiagnosis/Choroiditis/Differential diagnosis引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据