Hassan Muhammad, Maleki Arash, Ying Qian, Nguyen Nam, Halim Muhammad Sohail, Sepah Yasir J, Do Diana V, Nguyen Quan Dong
Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Am J Ophthalmol Case Rep. 2019 Jan 9;14:21-25. doi: 10.1016/j.ajoc.2019.01.007. eCollection 2019 Jun.
To report a case of presumed bilateral chorioretinitis secondary to alendronate therapy.
A 71-year-old female presented to the clinic in July 2017 with six months history of difficulty in reading along with floaters in both eyes which were more severe in the right eye. Past medical and surgical history revealed a history of hypertension, gout, hyperthyroidism, osteoporosis, and humerus fracture. She was started on alendronate three months before developing ocular symptoms. On ocular examination, best corrected visual acuity was 20/30 in the right and 20/25 in the left eye. Slit-lamp examination demonstrated normal anterior chamber examination in both eyes. Dilated fundus examination revealed geographic chorioretinal lesions around the optic nerve head in both eyes, more extensively in the right eye; and superior and temporal to the macula in the right eye. Past ocular records in February 2015 did not reveal any such findings. Fundus autofluorescence demonstrated hyper-autofluorescence in the peripapillary lesions in both eyes. The lesion adjacent to the macula in right eye displayed mixed hyper and hypo-autofluorescence. Fluorescein angiography showed combined hyper- and hypo-fluorescence compatible with window defect, staining and blockage. However, no leakage was appreciated in the macula, peripapillary, and peripheral lesions in both eyes. Optical coherence tomography scan showed septate hyporeflective intraretinal spaces in the right eye.
The index report underscore the importance of considering alendronate as an etiologic cause of chorioretinitis, especially in subjects with atypical lesions developing after alendronate therapy. We, therefore, recommend discontinuation of this medication in subjects who develop chorioretinitis after employing this medication.
报告一例推测为阿仑膦酸钠治疗继发的双侧脉络膜视网膜炎病例。
一名71岁女性于2017年7月就诊于诊所，有6个月阅读困难史，双眼有飞蚊症，右眼更严重。既往病史和手术史显示有高血压、痛风、甲状腺功能亢进、骨质疏松症和肱骨骨折史。她在出现眼部症状前三个月开始服用阿仑膦酸钠。眼部检查时，右眼最佳矫正视力为20/30，左眼为20/25。裂隙灯检查显示双眼前房检查正常。散瞳眼底检查发现双眼视神经乳头周围有地图状脉络膜视网膜病变，右眼更广泛；右眼黄斑上方和颞侧也有病变。2015年2月的既往眼部记录未发现任何此类病变。眼底自发荧光显示双眼视乳头周围病变处高自发荧光。右眼黄斑附近的病变显示高自发荧光和低自发荧光混合。荧光素血管造影显示高荧光和低荧光并存，符合窗样缺损、染色和遮挡。然而，双眼黄斑、视乳头周围和周边病变均未发现渗漏。光学相干断层扫描显示右眼视网膜内有分隔的低反射间隙。
本病例报告强调了将阿仑膦酸钠视为脉络膜视网膜炎病因的重要性，尤其是在阿仑膦酸钠治疗后出现非典型病变的患者中。因此，我们建议在使用该药物后发生脉络膜视网膜炎的患者中停用此药。
