Tan Deborah Kl, Teh Gillian H, Ho Ching Lin, Quah Boon Long
Department of Paediatric Ophthalmology and Adult Strabismus, Singapore National Eye Centre.
Singapore Eye Research Institute.
Int Med Case Rep J. 2017 Jun 15;10:203-207. doi: 10.2147/IMCRJ.S134809. eCollection 2017.
Childhood glaucoma poses a diagnostic and therapeutic challenge to ophthalmologists. Difficulty in examination and limitations on ability to perform structural and functional testing of optic nerve make diagnosis and verification of glaucoma control difficult in children. It is well known that an excessive loss of hyperopia is a useful sign in alerting the examining ophthalmologist to the possible diagnosis of glaucoma. We present an interesting case of juvenile onset glaucoma presenting with anisohypermetropic amblyopia in one eye and normal vision in the fellow eye that has glaucoma. It is an unusual case as the left eye with abnormal vision from hypermetropic amblyopia, though by itself requiring treatment, was a red herring for a potentially blinding condition in the fellow eye with normal vision and lower and less amblyogenic hyperopia on examination. We believe that glaucomatous enlargement of the right eye resulted in significant loss of hyperopia in that eye and in turn contributed to anisohypermetropic amblyopia in the left eye. To the best of our knowledge, this is the first reported case of juvenile onset glaucoma presenting with anisohypermetropic amblyopia in one eye and normal vision in the fellow eye that has glaucoma.
儿童青光眼给眼科医生带来了诊断和治疗上的挑战。眼部检查困难以及对视神经进行结构和功能测试的能力受限，使得儿童青光眼的诊断和青光眼控制情况的核实变得困难。众所周知，远视度数过度降低是一个有用的体征，可提醒眼科检查医生注意青光眼的可能诊断。我们报告了一例有趣的青少年型青光眼病例，该病例表现为一只眼睛患有屈光参差性远视弱视，而另一只患有青光眼的眼睛视力正常。这是一个不寻常的病例，因为患有远视弱视且视力异常的左眼，尽管其本身需要治疗，但对于检查时视力正常且远视度数较低、弱视程度较轻的另一只患有青光眼的眼睛来说，却是一个潜在致盲情况的干扰因素。我们认为，右眼的青光眼性增大导致该眼远视度数显著降低，进而导致左眼出现屈光参差性远视弱视。据我们所知，这是首例报告的青少年型青光眼病例，表现为一只眼睛患有屈光参差性远视弱视，而另一只患有青光眼的眼睛视力正常。
