一名有弥漫性大B细胞淋巴瘤病史的患者发生双侧同时性非动脉炎性前部缺血性视神经病变。
Simultaneous bilateral nonarteritic anterior ischemic optic neuropathy in a patient with a history of diffuse large B-cell lymphoma.
作者信息
Lazar David B, Lemor Daniel, Brown Archie, Nussdorf Jonathan D
机构信息
Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, LA.
Department of Ophthalmology, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
出版信息
Ochsner J. 2015 Spring;15(1):106-9.
BACKGROUND
Nonarteritic anterior ischemic optic neuropathy (NAAION) has a poorly understood etiology, and the onset of simultaneous bilateral NAAION in a patient <50 years without identifiable systemic risk factors is rare.
CASE REPORT
We present the case of a patient with acute painless monocular vision loss and bilateral optic disc edema who subsequently developed painless vision loss in the fellow eye. The patient's history was significant for diffuse large B-cell lymphoma, and our pressing diagnostic concern was to determine if his vision loss and bilateral optic disc changes represented lymphomatous infiltrates. A complete ocular exam demonstrated findings consistent with simultaneous bilateral NAAION. After an extensive systemic workup for malignancy with central nervous system involvement, vasculitis, and other entities associated with NAAION, we determined that the patient's primary risk factor for developing bilateral ischemic optic neuropathies was his crowded optic discs.
CONCLUSION
This case supports the hypothesis that a crowded optic disc is a sufficient primary risk factor for developing NAAION.
背景
非动脉炎性前部缺血性视神经病变（NAAION）的病因尚不清楚，在50岁以下且无明确全身危险因素的患者中，同时发生双侧NAAION的情况很少见。
病例报告
我们报告了一例患者，该患者最初出现急性无痛性单眼视力丧失和双侧视盘水肿，随后对侧眼也出现无痛性视力丧失。患者有弥漫性大B细胞淋巴瘤病史，我们迫切需要诊断的是确定其视力丧失和双侧视盘改变是否代表淋巴瘤浸润。全面的眼部检查结果与同时发生的双侧NAAION一致。在对伴有中枢神经系统受累的恶性肿瘤、血管炎及其他与NAAION相关的疾病进行广泛的全身检查后，我们确定该患者发生双侧缺血性视神经病变的主要危险因素是其拥挤的视盘。
结论
该病例支持视盘拥挤是发生NAAION的充分主要危险因素这一假说。
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