Sowka Joseph W, Vollmer Lori A, Au Michael
*OD, FAAO †OD Nova Southeastern University, College of Optometry, Ft. Lauderdale, Florida (all authors).
Optom Vis Sci. 2015 Jan;92(1):e6-11. doi: 10.1097/OPX.0000000000000446.
The purpose is to report a patient with primary open-angle glaucoma that developed sudden painless unilateral vision loss, a sequential ophthalmoscopic appearance with features of both central retinal artery and later central retinal vein occlusion, and objective visual system dysfunction in the form of a relative afferent pupil defect, who spontaneously recovered vision along with complete resolution of the pupillary defect over several weeks.
A 50-year-old woman with a long-standing history of glaucoma presented with acute, painless vision loss in one eye, a pallid retina with a cherry red macula, diffuse retinal hemorrhages, and a relative afferent pupil defect. Spectral domain optical coherence tomography and fluorescein angiography were essentially normal with neither retinal edema nor retinal ischemia to account for the visual dysfunction. Over the course of 2 months, the patient regained vision and the relative afferent pupil defect, typically a permanent manifestation of retinal destruction, resolved.
Not all retinal vaso-occlusive phenomena can be completely attributed to a central retinal vein or artery occlusion. In the patient presented, there was no objective diagnostic testing that revealed a cause for the patient's vision loss or relative afferent pupillary defect. This combined with the complete recovery of vision and resolution of the relative afferent pupillary defect underscores a lack of comprehensive understanding of retinal vaso-occlusive disease.
报告一例原发性开角型青光眼患者，该患者出现突然无痛性单眼视力丧失，眼底镜检查呈现出中央视网膜动脉阻塞和随后中央视网膜静脉阻塞的特征，以及以相对性传入瞳孔障碍形式存在的客观视觉系统功能障碍，且在数周内视力自发恢复，瞳孔障碍完全消失。
一名有长期青光眼病史的50岁女性，出现一只眼睛急性无痛性视力丧失，视网膜苍白伴黄斑樱桃红，弥漫性视网膜出血，以及相对性传入瞳孔障碍。光谱域光学相干断层扫描和荧光素血管造影基本正常，既无视网膜水肿也无视网膜缺血来解释视觉功能障碍。在2个月的病程中，患者视力恢复，相对性传入瞳孔障碍（通常是视网膜破坏的永久性表现）消失。
并非所有视网膜血管阻塞现象都可完全归因于中央视网膜静脉或动脉阻塞。在本病例中，没有客观诊断检查能揭示患者视力丧失或相对性传入瞳孔障碍的原因。这与视力的完全恢复和相对性传入瞳孔障碍的消失相结合，凸显了对视网膜血管阻塞性疾病缺乏全面的了解。
