Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Stanford, California.
Retin Cases Brief Rep. 2020 Summer;14(3):282-288. doi: 10.1097/ICB.0000000000000700.
To analyze an unusual case of widespread chorioretinopathy after cardiac transplantation for its potential etiology and clinical significance.
Clinical examinations included widefield and macular color and fundus autofluorescence photography, spectral domain optical coherence tomography, fluorescein angiography and indocyanine green angiography, full-field electroretinography, and Goldmann visual fields.
A 44-year-old Hispanic woman was referred to rule out retinitis pigmentosa. Medical history revealed cardiac transplantation 6 months previously for idiopathic cardiomyopathy.
Visual acuity was 20/20 in both eyes. The fundi showed widespread gray mottling and little pigmentation, but fundus autofluorescence revealed black speckling broadly across the fundus, and geographic retinal pigment epithelium loss in the nasal midperiphery of the left eye. Spectral domain optical coherence tomography showed normal inner retina, and surprising preservation of outer nuclear layer, but the ellipsoid zone line was fragmented, and the interdigitation zone line was replaced with irregular debris. Retinal pigment epithelium was very thin with occasional excrescences. Electroretinography showed mild loss of both rods and cones, with mild flicker peak delay only in the left eye. Fluorescein angiography showed no leakage, but a reticular pigment pattern in the macula. Indocyanine green angiography showed irregular arteriolar remodeling, and few large arteries.
Serous retinopathy is well known after organ transplantations, but this patient had retinal pigment epithelium and retinal damage well into the periphery and no leakage. Retinal dystrophy was deemed unlikely given the relatively good electroretinography. The indocyanine green vascular changes raise the possibility of a transient choroidal ischemic event during or shortly after cardiac surgery. The event altered retinal pigment epithelium diffusely, but allowed for enough regeneration to sustain retinal function. Diffuse transplant chorioretinopathy may be discovered if postcardiac transplant patients get peripheral retinal examinations.
分析心脏移植后广泛发生脉络膜视网膜病变的罕见病例，探讨其潜在病因和临床意义。
临床检查包括广角和黄斑彩色及眼底自发荧光摄影、谱域光相干断层扫描、荧光素血管造影和吲哚青绿血管造影、全视野视网膜电图和 Goldmann 视野检查。
一名 44 岁西班牙裔女性，因疑似色素性视网膜炎前来就诊。患者病史显示，6 个月前因特发性扩张型心肌病行心脏移植。
双眼视力均为 20/20。眼底检查显示广泛的灰色斑驳和少量色素沉着，但眼底自发荧光显示眼底广泛出现黑色斑点，左眼鼻侧中周部视网膜色素上皮丧失呈地图样。谱域光相干断层扫描显示内层视网膜正常，外核层出人意料地完整保留，但椭圆体带线呈碎裂状，内丛状层带线被不规则碎片取代。视网膜色素上皮非常薄，偶尔有赘生物。视网膜电图显示视杆细胞和视锥细胞轻度丢失，左眼仅轻度闪烁峰潜伏期延迟。荧光素血管造影未见渗漏，但黄斑部呈网状色素图案。吲哚青绿血管造影显示小动脉不规则重塑，且仅有少量大动脉。
器官移植后发生浆液性视网膜病变较为常见，但该患者的视网膜色素上皮和视网膜病变已累及周边，且无渗漏。鉴于视网膜电图相对较好，认为不太可能是视网膜营养不良。吲哚青绿血管变化提示心脏手术后或手术后不久可能发生短暂性脉络膜缺血事件。该事件弥漫性改变了视网膜色素上皮，但足以维持视网膜功能进行再生。如果对心脏移植后患者进行周边视网膜检查，可能会发现弥漫性移植后脉络膜视网膜病变。
