Arend Laurence W, Mazzulla D Anthony, Spiegel Jennifer A
Department of Ophthalmology, Ochsner Clinic Foundation, New Orleans, LA.
Ochsner J. 2015 Winter;15(4):473-5.
A cardiac transplant patient presented to the Ochsner ophthalmology clinic with flashes of light in the left eye and a retinal lesion of unclear etiology.
A 59-year-old male cardiac transplant patient was referred by an outside eye physician. Examination of the anterior chamber of his left eye showed inflammation, and a large hypopigmented lesion was discovered in the nasal retina of the left eye. The patient was admitted to the hospital. Empiric treatment was initiated, and all workup results were negative. During the next several days, the patient's retinal lesion extended. A tap of the eye's vitreous and aqueous fluid yielded no diagnosis. The patient underwent a chorioretinal biopsy through a pars plana vitrectomy. Fluid removed from the vitreous cavity was sent for polymerase chain reaction (PCR) testing, and intravitreal antibiotics were injected. The results of the PCR were negative for all organisms. However, the lesion stabilized, and the patient has remained stable on oral valganciclovir.
Cytomegalovirus PCR testing has 95% sensitivity in untreated patients but only 48% sensitivity in patients treated with systemic ganciclovir, foscarnet, or both. Cytomegalovirus retinitis was determined to be a possible diagnosis; however, the possibility exists that the patient had developed a fungal subretinal abscess.
一名心脏移植患者因左眼闪光及病因不明的视网膜病变就诊于奥施纳眼科诊所。
一名59岁男性心脏移植患者由外院眼科医生转诊而来。检查发现其左眼前房有炎症，左眼鼻侧视网膜有一个大的色素减退病变。患者入院。开始进行经验性治疗，所有检查结果均为阴性。在接下来的几天里，患者的视网膜病变扩大。抽取眼内玻璃体和房水未能明确诊断。患者通过经睫状体平坦部玻璃体切除术进行了脉络膜视网膜活检。从玻璃体腔抽取的液体送去进行聚合酶链反应（PCR）检测，并注射了玻璃体内抗生素。PCR检测结果显示所有微生物均为阴性。然而，病变稳定下来，患者口服缬更昔洛韦后病情一直保持稳定。
巨细胞病毒PCR检测在未治疗患者中的敏感性为95%，但在接受更昔洛韦、膦甲酸钠全身治疗或两者联合治疗的患者中敏感性仅为48%。巨细胞病毒性视网膜炎被确定为一种可能的诊断；然而，患者也有可能已发展为真菌性视网膜下脓肿。
