Seo Yuri, Kim Min, Kim Jin Hyoung, Park Jae Jun, Lee Sung Chul
*MD Departments of Ophthalmology (YS, JHK, SCL) and Internal Medicine (JJP), Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, Republic of Korea.
Optom Vis Sci. 2016 Dec;93(12):1567-1570. doi: 10.1097/OPX.0000000000000971.
To report a case of central retinal vein occlusion without macular edema associated with ulcerative colitis and its novel treatment with intravitreal dexamethasone.
A 40-year-old man with ulcerative colitis presented with sudden visual disturbances. An initial fundus examination showed subtle yellow-to-white patches within the inner retina of the right eye superotemporal to the fovea. There were intraretinal hemorrhages and cotton-wool spots within the superior vascular arcade and nasal to the optic disc. Despite initiation of systemic corticosteroids, 2 weeks later there was an increase in retinal hemorrhages, formation of cotton wool spots, and development of optic disc swelling in the right eye. The patient was eventually diagnosed with nonischemic central retinal vein occlusion associated with ulcerative colitis. He received sustained-release intravitreal dexamethasone, which led to the resolution of retinal hemorrhage, optic disc swelling, and cotton-wool spots. Three months after the injection, retinal hemorrhages were not detectable. However, ocular coherence imaging showed marked thinning of the inner retina at the locations that were previously hyper-reflective.
Central retinal vein occlusion is an uncommon ophthalmologic manifestation associated with ulcerative colitis. Injection of intravitreal dexamethasone could be a viable treatment option in these patients even without the presence of macular edema.
报告一例与溃疡性结肠炎相关的无黄斑水肿的中央视网膜静脉阻塞病例及其玻璃体内注射地塞米松的新治疗方法。
一名患有溃疡性结肠炎的40岁男性出现突发视力障碍。初次眼底检查显示，右眼黄斑中心凹颞上方的视网膜内层有细微的黄白色斑块。在上方血管弓内及视盘鼻侧有视网膜内出血和棉絮斑。尽管开始使用全身皮质类固醇治疗，但2周后右眼视网膜出血增加，棉絮斑形成，视盘肿胀。该患者最终被诊断为与溃疡性结肠炎相关的非缺血性中央视网膜静脉阻塞。他接受了玻璃体内缓释地塞米松治疗，这使得视网膜出血、视盘肿胀和棉絮斑消退。注射后三个月，视网膜出血无法检测到。然而，光学相干成像显示，先前高反射区域的视网膜内层明显变薄。
中央视网膜静脉阻塞是与溃疡性结肠炎相关的一种罕见眼科表现。即使没有黄斑水肿，玻璃体内注射地塞米松也可能是这些患者的一种可行治疗选择。
