Arévalo Simental Diana E, Roig Melo-Granados Enrique A, Cortés Quezada Saúl, Páez Escamilla Manuel A, Soria Orozco Carmen L, Jacinto Buenrostro Jorge E
Antiguo Hospital Civil de Guadalajara, Universidad de Guadalajara, Guadalajara, JAL, Mexico.
Case Rep Ophthalmol Med. 2016;2016:5104789. doi: 10.1155/2016/5104789. Epub 2016 Dec 6.
. To report a case of hemiretinal artery occlusion in a child with dextrocardia, visceral heterotaxia, and secondary polycythemia. . Complete clinical examination, fundus photography, and retinal fluorescein angiography were performed. Laboratory testing included complete blood cell count, homocysteine, protein c, protein s, activated protein s, methyltetrahydrofolate and homocysteine activator genes, factor leiden V gene, antithrombin III, and activated protein c resistance. In addition, transthoracic and transesophageal echocardiogram and cardiac catheterism were performed. . We report an 11-year-old boy with a sudden, painless visual loss in his right eye. His past medical history is remarkable for a congenital cardiac disease. He presented with vision of light perception in the right eye and a relative afferent pupillary defect. Fundus findings included a macular cherry-red spot and inferior hemiretinal whitening consistent with hemiretinal artery occlusion. Laboratory testing showed increased red blood cell (RBC) count, hemoglobin, and hematocrit. The patient was treated with four phlebotomies with improvement of RBC count and after one month reperfusion of the retina and a visual acuity of 20/200 were observed. Thrombophilia and cardiac screening were negative, except for secondary polycythemia. . Hemiretinal artery occlusion is extremely rare in children and is often associated with congenital cardiac disease and hypercoagulative states.
报告一例患有右位心、内脏异位和继发性红细胞增多症的儿童发生半侧视网膜动脉阻塞的病例。进行了全面的临床检查、眼底照相和视网膜荧光血管造影。实验室检查包括全血细胞计数、同型半胱氨酸、蛋白C、蛋白S、活化蛋白S、甲基四氢叶酸和同型半胱氨酸激活基因、因子Ⅴ莱顿基因、抗凝血酶Ⅲ和活化蛋白C抵抗。此外，还进行了经胸和经食管超声心动图以及心导管检查。我们报告一名11岁男孩，右眼突然无痛性视力丧失。他既往有先天性心脏病史。他右眼视力仅存光感，并有相对性传入性瞳孔障碍。眼底检查发现黄斑樱桃红斑和下方半侧视网膜变白，符合半侧视网膜动脉阻塞。实验室检查显示红细胞计数、血红蛋白和血细胞比容升高。该患者接受了4次放血治疗，红细胞计数有所改善，1个月后视网膜再灌注，视力达到20/200。除继发性红细胞增多症外，血栓形成倾向和心脏筛查均为阴性。半侧视网膜动脉阻塞在儿童中极为罕见，常与先天性心脏病和高凝状态相关。
