Padrón-Pérez Noel, Aronés Janny Rosario, Muñoz Silvia, Arias-Barquet Luis, Arruga Jorge
Department of Ophthalmology, Hospital Universitari de Bellvitge, Barcelona, Spain.
Hospital de l'Esperança - Parc de Salut Mar, Barcelona, Spain.
Clin Ophthalmol. 2014 Apr 11;8:733-8. doi: 10.2147/OPTH.S56568. eCollection 2014.
An 86 year old woman experienced a sequential bilateral loss of vision over a period of less than 24 hours. Clinical findings and complementary studies suggested a bilateral atherogenic embolic event. Initially, she presented a superior branch retinal artery occlusion in her right eye followed by a central retinal artery occlusion with cilioretinal artery sparing in her left eye. Some conservative maneuvers performed did not improve visual acuity in the left eye. Supra-aortic Doppler ultrasonography revealed mild right internal carotid artery stenosis and moderate left internal carotid artery stenosis with a small, smooth, and homogeneous plaque. The transthoracic echocardiography showed a severe calcification of the mitral valve with a mild-moderate rim of stenosis. Central retinal artery occlusion and branch retinal artery occlusion are characterized by painless monocular loss of vision. Clinical approach and management attempt to treat the acute event, find the source of the vascular occlusion, and prevent further vascular events from occurring. Giant cell arteritis is a potentially treatable cause of central retinal artery occlusion and should be excluded in every single patient over 50 years old.
一名86岁女性在不到24小时的时间内先后出现双侧视力丧失。临床检查结果及辅助检查提示双侧动脉粥样硬化栓塞事件。最初，她右眼出现视网膜上支动脉阻塞，随后左眼发生视网膜中央动脉阻塞，睫状视网膜动脉未受累。所采取的一些保守措施未能改善左眼视力。主动脉弓上多普勒超声检查显示右侧颈内动脉轻度狭窄，左侧颈内动脉中度狭窄，伴有小的、光滑且均匀的斑块。经胸超声心动图显示二尖瓣严重钙化，伴有轻度至中度狭窄边缘。视网膜中央动脉阻塞和视网膜分支动脉阻塞的特点是无痛性单眼视力丧失。临床处理和治疗旨在治疗急性事件，找到血管阻塞的源头，并防止进一步的血管事件发生。巨细胞动脉炎是视网膜中央动脉阻塞的一种潜在可治疗病因，每一位50岁以上的患者均应排除该病因。
