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急性酒精性胰腺炎中的类Purtscher视网膜病变:荧光素血管造影和光学相干断层扫描结果

[Purtscher-like retinopathy in acute alcoholic pancreatitis: fluorescein angiography and optical coherence tomography findings].

作者信息

Stefanicková J, Hasa J, Hlinstáková S, Pesko K, Krahulec B, Strmen P

机构信息

Klinika Oftalmológie LFUK a FNsP, Bratislava.

出版信息

Cesk Slov Oftalmol. 2010 Oct;66(4):165-9.

Abstract

27 year old patient with a history of alcohol abuse after consumption of fat meal and wine following epigastric pain noticed sudden bilateral visual loss: right eye logMAR 0, 94, left eye logMAR 1, 22. Retinal examination revealed massive edema in the central part of the retina, multiple cotton wool spots in the posterior pole peripapillary and flame-shaped hemorrhages. On the OCT, there was edema most of all in the inner part of the retina, but also subretinal, hyperreflectivity in the nerve fibre layers corresponding to massive cotton wool spots. Fluorescein angiography in the early phases showed hypofluorescent ischemic areas of the retina subsequently leakage developed in the late phases. Immediately after antibiotic and spasmoanalgetic treatment of the pancreatitis visual acuity improved and 2 months after beginning of the therapy visual acuity is logMAR 0 bilateraly. We proposed that the most suspected cause of Purtscher-like retinopathy in this case is fat embolism.

摘要

一名27岁有酗酒史的患者,在食用油腻食物和饮酒后出现上腹部疼痛,随后突然双侧视力丧失:右眼logMAR 0.94,左眼logMAR 1.22。视网膜检查发现视网膜中央部分有大量水肿,视盘周围后极部有多个棉絮斑和火焰状出血。光学相干断层扫描(OCT)显示视网膜内层水肿最明显,但也有视网膜下水肿,神经纤维层的高反射对应大量棉絮斑。荧光素血管造影早期显示视网膜缺血性低荧光区,后期出现渗漏。胰腺炎经抗生素和解痉镇痛治疗后视力立即改善,治疗开始2个月后双侧视力logMAR均为0。我们认为该病例中最可疑的类Purtscher视网膜病变原因是脂肪栓塞。

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