Ornek Nurgül, Onaran Zafer, Ornek Kemal, Büyüktortop Nesrin
Department of Ophthalmology, Kırıkkale University, Kırıkkale, Turkey.
BMJ Case Rep. 2013 Jun 13;2013:bcr2013009389. doi: 10.1136/bcr-2013-009389.
A 39-year-old man was admitted with a sudden visual loss in the left eye. Visual acuities were 10/10 on the right and 1/10 on the left. Fundus examination did not show any abnormalities. Visual acuity improved to 10/10 and visual field defect regressed in the following 2 weeks. Three years later, the patient returned with acute visual loss in the right eye. Visual acuities were 2/10 on the right and 10/10 on the left. Right optic disc had blurred margins with mild oedema. The tests revealed methylenetetrahydrofolate reductase A1298C mutation with positive lupus anticoagulant and hyperhomocysteinaemia. Enoxaparin was initialised with vitamin B12 supplementation. Complete visual recovery occurred in the following 3 weeks in both eyes. Thrombophilic screening seems to be important in the treatment and prevention of an attack in the second eye of patients with non-arteritic anterior ischaemic optic neuropathy.
一名39岁男性因左眼突然视力丧失入院。右眼视力为10/10，左眼为1/10。眼底检查未发现任何异常。在接下来的2周内，视力提高到10/10，视野缺损消退。三年后，该患者因右眼急性视力丧失再次就诊。右眼视力为2/10，左眼为10/10。右侧视盘边缘模糊，有轻度水肿。检查发现亚甲基四氢叶酸还原酶A1298C突变，狼疮抗凝物阳性和高同型半胱氨酸血症。开始使用依诺肝素并补充维生素B12。在接下来的3周内，双眼视力完全恢复。对于非动脉性前部缺血性视神经病变患者，进行血栓形成倾向筛查对于治疗和预防第二眼发作似乎很重要。
