Haustein M, Babatz J, Sommer F, Radke J, Hoffmann C, Pillunat L E, Sandner D
Klinik und Poliklinik für Augenheilkunde, Universitätsklinik, TU Dresden, Dresden, Deutschland.
Ophthalmologe. 2011 Nov;108(11):1039-44. doi: 10.1007/s00347-011-2352-7.
This case report describes the unilateral acute reduction of vision in the right eye of a 48-year-old woman. The patient was otherwise healthy but 2 days previously had suffered from dizziness and blurred vision. Secondary to this, the patient had already been under dental treatment for 1 week due to gingival swelling. At the first examination a macular branch retinal vein occlusion and Roth spots were found in the right eye by indirect ophthalmoscopy. The immediate diagnostic procedure identified aute amyeloid leukemia (AML) as the cause of the vascular pathology. The AML can be manifested in different ways and the retina is involved in approximately 50% of cases. Due to a secondary hyperviscosity syndrome, which is found in approx. 20% of acute leukaemias, symptomatic central vein occlusion or macular branch vein occlusion can occur. Ophthalmic symptoms can be the first and only signs to be detected. Therefore, ophthalmologists should also consider a systemic disease and initiate a clarification. A differential blood count is indispensable. The results usually improve by a rapidly arranged and suitable therapy. Ophthalmological follow-up examinations are imperative as an initiated chemotherapy can also produce ophthalmological side-effects.
本病例报告描述了一名48岁女性右眼视力急性单侧下降的情况。该患者其他方面健康，但两天前出现头晕和视力模糊。继发于此，患者因牙龈肿胀已接受牙科治疗1周。首次检查时，通过间接检眼镜在右眼发现黄斑分支视网膜静脉阻塞和 Roth 斑。立即进行的诊断程序确定急性髓细胞白血病（AML）是血管病变的原因。AML 可表现为不同形式，约50%的病例累及视网膜。由于约20%的急性白血病会出现继发性高粘滞综合征，可发生有症状的中央静脉阻塞或黄斑分支静脉阻塞。眼科症状可能是最早且唯一可检测到的体征。因此，眼科医生也应考虑全身性疾病并启动排查。血常规检查必不可少。通过迅速安排的适当治疗，结果通常会改善。眼科随访检查至关重要，因为开始化疗也可能产生眼科副作用。
