Jaafar Juanarita, Hitam Wan Hazabbah Wan, Noor Raja Azmi Mohd
Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
Asian Pac J Trop Biomed. 2012 Jul;2(7):586-8. doi: 10.1016/S2221-1691(12)60102-6.
A 27 year-old lady, presented with sudden loss of vision in the right eye for a week. It was followed by poor vision in the left eye after 3 days. It involved the whole entire visual field and was associated with pain on eye movement. She was diagnosed to have miliary tuberculosis and retroviral disease 4 months ago. She was started on anti-TB since then but defaulted highly active anti-retroviral therapy (HAART). On examination, her visual acuity was no perception of light in the right eye and 6/120 (pinhole 3/60) in the left eye. Anterior segment in both eyes was unremarkable. Funduscopy showed bilateral optic disc swelling with presence of multiple foci of choroiditis in the peripheral retina. The vitreous and retinal vessels were normal. Chest radiography was normal. CT scan of orbit and brain revealed bilateral enhancement of the optic nerve sheath that suggest the diagnosis of bilateral atypical optic neuritis. This patient was managed with infectious disease team. She was started on HAART and anti-TB treatment was continued. She completed anti-TB treatment after 9 months without any serious side effects. During follow up the visual acuity in both eyes was not improved. However, funduscopy showed resolving of disc swelling and choroiditis following treatment.
一名27岁女性，右眼突然失明一周。3天后左眼视力也下降。整个视野受累，并伴有眼球运动时疼痛。4个月前她被诊断为粟粒性肺结核和逆转录病毒病。自那时起她开始接受抗结核治疗，但停用了高效抗逆转录病毒治疗（HAART）。检查时，她右眼无光感，左眼视力为6/120（针孔视力3/60）。双眼眼前节无异常。眼底检查显示双侧视盘肿胀，周边视网膜有多个脉络膜炎病灶。玻璃体和视网膜血管正常。胸部X线检查正常。眼眶和脑部CT扫描显示双侧视神经鞘强化，提示双侧非典型视神经炎诊断。该患者由感染病团队管理。她开始接受HAART治疗，并继续抗结核治疗。9个月后她完成了抗结核治疗，无任何严重副作用。随访期间，双眼视力未改善。然而，眼底检查显示治疗后视盘肿胀和脉络膜炎消退。
