Joye Ashlin S, Bhisitkul Robert B, Pereira Daniel D S, Gonzales John A
Francis I. Proctor Foundation, 95 Kirkham St, University of California, San Francisco, CA, 94143, USA.
Department of Ophthalmology, 10 Koret Way, University of California, San Francisco, CA, 94143, USA.
Am J Ophthalmol Case Rep. 2020 Feb 15;18:100618. doi: 10.1016/j.ajoc.2020.100618. eCollection 2020 Jun.
This is a retrospective case report illustrating the diagnostic and therapeutic challenges associated with a chronic rhegmatogenous retinal detachment masquerading as a severe panuveitis with intense anterior chamber inflammation. We have included clinical features, anterior segment and fundus photography, B-scan ultrasonography, fluorescein angiography, and intraoperative findings.
A 26-year-old male presented with features of unilateral panuveitis: hypotony, anterior segment inflammation (posterior synechiae and anterior chamber cell with fibrin clumping), diffuse choroidal thickening, and retinal detachment. Laboratory investigations for infectious or rheumatologic processes were negative, and empiric systemic corticosteroid therapy was unsuccessful. This prompted suspicion for an alternate primary etiology, and pars plana vitrectomy revealed small retinal breaks as the underlying cause of the retinal detachment and inflammation.
Rhegmatogenous retinal detachments are a known cause of intraocular inflammation. Nevertheless, it remains a challenge to recognize retinal breaks in this setting, particularly with robust anterior segment inflammation and posterior findings resembling severe exudative uveitis. Being aware of this unique presentation may prevent delays in diagnosis and have important prognostic implications.
本报告为回顾性病例报告，阐述了伪装成伴有严重前房炎症的重度全葡萄膜炎的慢性孔源性视网膜脱离的诊断和治疗挑战。我们纳入了临床特征、眼前节和眼底照片、B超检查、荧光素血管造影以及术中所见。
一名26岁男性表现出单侧全葡萄膜炎的特征：低眼压、眼前节炎症（后粘连以及前房内有细胞和纤维蛋白团块）、脉络膜弥漫性增厚和视网膜脱离。针对感染性或风湿性疾病的实验室检查结果均为阴性，经验性全身皮质类固醇治疗无效。这引发了对其他原发性病因的怀疑，玻璃体切割术显示小的视网膜裂孔是视网膜脱离和炎症的根本原因。
孔源性视网膜脱离是眼内炎症的已知病因。然而，在此情况下识别视网膜裂孔仍然具有挑战性，尤其是在前节炎症强烈且后部表现类似严重渗出性葡萄膜炎时。认识到这种独特表现可能有助于避免诊断延误，并具有重要的预后意义。
