Beňová A, Kuthan P, Kousal B, Diblík P, Meliška M
Cesk Slov Oftalmol. 2015 Apr;71(2):116-21.
To present a case report with "unclear" and sudden decrease of left eye visual acuity and bilateral visual fields defects.
A case report.
A 66-year-old woman was referred to our Center of Neuroophthalmology and Orbitology by a neurologist for a history of sudden decrease of visual acuity of her left eye 3 years ago. From September 2009, she was examined at various and not only ophthalmology departments. One by one the optic nerve neuritis, traumatic, compressive or toxic neuropathy and also nutritive neuropathy because of vitamin B(12) deficiency were excluded. The patient underwent also a genetic examination for Lebers hereditary optic nerve neuropathy, but this diagnosis was not confirmed. On magnetic resonance imaging, an atrophy of both optic nerves was described, with no further progression found during the follow-up examination after one year. In available patients medical records we found out that on optical coherence tomography scans optic disc drusen of the both eyes are visible, but this wasnt described in the records. Also, an examination of Visual Evoked Potential was performed - this confirmed the diagnosis of optic disc drusen. However, our patient was further examined for visual lost of the left eye. At the time of presentation (January, 2014), her best-corrected visual acuity of the right eye was 0.5, and counting fingers at 50 cm distance with correct light projection in the left eye. Static perimetric examination demonstrated bilateral and concentric narrowing of visual fields. The eyes were parallel, with no limitation of their movements in any direction. The patient was without diplopia, the direct pupil reactions to the light were sluggish bilaterally, and anterior segments of both eyes were with no pathologies. Examination of the fundus revealed bilateral findings of pale optic disc with absent optic cup and indistinct "lumpy" margins. Waxy pearl-like irregularities of the papila of both eyes were visible even without pupil dilatation. Bilateral optic disc drusen were confirmed by ultrasonography, fundus autofluorescence and spectral-domain optical coherence tomography.
Optic disc drusen are often asymptomatic, frequently it is an accidental finding during the biomicroscopy of fundus due to ordinary eye examination. Rarely, optic disc drusen can cause blood circulation failure on the optic disc with typical defects of the visual field. Thats why we shouldnt forget the optic disc drusen in the differential diagnosis considerations.
呈现一例左眼视力“不明”且突然下降以及双侧视野缺损的病例报告。
病例报告。
一名66岁女性因3年前左眼视力突然下降的病史被神经科医生转诊至我们的神经眼科与眼眶病中心。自2009年9月起，她在多个科室（不仅是眼科）接受了检查。逐一排除了视神经炎、外伤性、压迫性或中毒性神经病变以及因维生素B12缺乏导致的营养性神经病变。患者还接受了莱伯遗传性视神经病变的基因检测，但该诊断未得到证实。磁共振成像显示双侧视神经萎缩，在一年后的随访检查中未发现进一步进展。在现有的患者病历中，我们发现光学相干断层扫描显示双眼视盘玻璃疣可见，但病历中未对此进行描述。此外，还进行了视觉诱发电位检查——这证实了视盘玻璃疣的诊断。然而，我们对该患者左眼视力丧失的情况进行了进一步检查。在就诊时（2014年1月），她右眼的最佳矫正视力为0.5，左眼在50厘米距离处能数手指且光投射正确。静态视野检查显示双侧视野呈同心性缩小。双眼平行，各个方向的运动均无受限。患者无复视，双侧瞳孔对光直接反应迟钝，双眼前段无病变。眼底检查发现双侧视盘苍白，视杯缺如，边缘“块状”不清晰。即使未散瞳，双眼视乳头也可见蜡样珍珠样不规则病变。超声检查、眼底自发荧光和光谱域光学相干断层扫描证实了双侧视盘玻璃疣。
视盘玻璃疣通常无症状，常因普通眼部检查在眼底生物显微镜检查时偶然发现。视盘玻璃疣极少可导致视盘血液循环障碍并伴有典型的视野缺损。这就是为什么在鉴别诊断时我们不应忘记视盘玻璃疣。
