Wilkins Carl S, McCabe Katherine, Deobhakta Avnish, Chelnis James
Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY 10003, USA.
Am J Ophthalmol Case Rep. 2018 Mar 8;10:249-252. doi: 10.1016/j.ajoc.2018.03.003. eCollection 2018 Jun.
To report a rare case of isolated, unilateral CRAO in a young patient with mitral valve prolapse secondary to Barlow's disease.
A 29-year-old woman with history of premature ventricular contractions and cardiac ablation presented to the emergency room after sudden onset painless visual loss in her left eye (OS). Her vision was 20/20 in her right eye and hand motion in the left. Fundus exam demonstrated a central retinal artery occlusion (CRAO) OS. Computerized tomography of head and neck were unremarkable. She underwent cerebral angiogram and local intra-arterial thrombolysis. Her vision remained stable post-procedure, with marked APD and stable fundus examination. Her cardiac work-up revealed a left atrial mass with calcified mitral valve, and small atrial septal defect. Rheumatologic, hematologic, and auto-immune work-up were unremarkable. She underwent resection of the mass with repair of mitral valve and ASD closure. Surgical pathology was compatible with diagnosis of Barlow's disease, a cause of mitral valve prolapse. The patient underwent intravitreal injection of anti-VEGF therapy at one month follow-up, with vision stable at hand motion and without neovascularization on subsequent evaluation.
In young patients presenting with CRAO, aggressive work-up for systemic disease or embolic source must be undertaken to avoid future sequelae.
报告一例罕见的年轻患者孤立性单侧视网膜中央动脉阻塞（CRAO），该患者患有继发于巴洛病的二尖瓣脱垂。
一名29岁女性，有室性早搏和心脏消融病史，因左眼（OS）突然无痛性视力丧失而就诊于急诊室。她右眼视力为20/20，左眼为手动视力。眼底检查显示左眼视网膜中央动脉阻塞（CRAO）。头颈部计算机断层扫描无异常。她接受了脑血管造影和局部动脉内溶栓治疗。术后视力保持稳定，有明显的传入性瞳孔障碍（APD），眼底检查稳定。心脏检查发现左心房肿块伴二尖瓣钙化，以及小的房间隔缺损。风湿、血液和自身免疫检查无异常。她接受了肿块切除、二尖瓣修复和房间隔缺损封堵术。手术病理与巴洛病（二尖瓣脱垂的一个病因）的诊断相符。患者在随访1个月时接受了玻璃体内抗血管内皮生长因子（VEGF）治疗，随后评估时视力稳定在手动视力，且无新生血管形成。
对于出现CRAO的年轻患者，必须积极检查全身性疾病或栓子来源，以避免未来的后遗症。
