视神经脊髓炎相关视神经炎合并中心性浆液性脉络膜视网膜病变1例
A case of concurrent neuromyelitis optica-associated optic neuritis and central serous chorioretinopathy
缪金鑫 1袁松涛 1刘庆淮 1胡仔仲1
作者信息
- 1. 南京医科大学第一附属医院眼科 南京 210029
- 折叠
摘要
40 岁男性,因"左眼突发视力下降 1 周"入院.患者 3 个月前因"左视神经脊髓炎相关视神经炎"行激素冲击及序贯减量治疗,1 周前感染新型冠状病毒后自觉左眼视力下降.体格检查:左眼最佳矫正视力为FC/5cm,前节未见明显异常,左眼相对性瞳孔传入障碍(RAPD)(+),眼底见视盘边界清晰,杯盘比(C/D)约0.5,A:V约 2:3,视网膜平伏、色泽正常;右眼未见异常.入院后光学相干层析成像(OCT)检查提示左眼颞下血管弓位置一约2 PD直径的视网膜神经上皮层脱离区域.完善感染相关检查、血清脱髓鞘抗体检测、眼眶磁共振成像(MRI)平扫+增强后,患者确诊:①左眼复发性抗体双阴性视神经脊髓炎相关视神经炎;② 双眼中心性浆液性脉络膜视网膜病变(CSC).仍予以激素冲击及序贯减量治疗视神经炎,随访观察CSC.治疗 6 个月后,患者右眼BCVA 为 0.6,双眼CSC病变消退.讨论体会:视神经脊髓炎相关视神经炎合并未累及中心凹的CSC,仍应该给予规范性的激素冲击治疗及序贯减量.
Abstract
A 40-year-old man presented with 1 week of blurred vision in the left eye.The patient was previously diagnosed with neuromyelitis optica-associated optic neuritis in the left eye 3 months ago and had been treated with high-dose intravenous methylprednisolone in acute phase and low-dose corticosteroid therapy in chronic phase.One week ago,the patient was attacked by Covid-19 coronavirus,and then complained of vision loss in the left eye.The Ocular examination of the left eye showed that the best corrected visual acuity was FC/5cm,no specific abnormality was detected in the anterior segment except for a positive relative afferent pupillary defect.Fundus examination showed the edge of optic disc was clear,and the C/D ratio was 0.5.OCT indicated a detached retinal neuroepithelial layer(approximately 2PD)in the inferotemporal retina.Serum tests of infection and demyelination anti-bodies were negative,while MRI showed remarkable demyelination sign in the left optic nerve.The patient was diagnosed with 1.left recurrent serum-negative neuromyelitis optica-associated optic neuritis,and 2.bilateral central serous chorioretinopathy(CSC).High-dose intravenous methylprednisolone and sequential tapering was still administered for his optic neuritis,with follow-up suggested for CSC.After 6 months of treatment,the BCVA of the left eye was 0.6,and the CSC have resolved in both eyes.Summary:Neuromyelitis optica-related optic neuritis combined with foveal-spare CSC is rare and we still suggest to standardize the treatment of steroid and sequential tapering.
关键词
视神经脊髓炎/中心性浆液性脉络膜视网膜病变/视网膜下液/激素Key words
Neuromyelitis optica/Central serous chorioretinopathy/Subretinal fluid/Corticosteroid引用本文复制引用
出版年
2024
NETL
NSTL
万方数据