Sethi Harinder Singh, Naik Mayuresh, Gandhi Aastha
Department of Ophthalmology, V.M.M.C and Safdarjung Hospital, New Delhi, India.
Taiwan J Ophthalmol. 2020 Mar 4;10(1):71-75. doi: 10.4103/tjo.tjo_27_18. eCollection 2020 Jan-Mar.
A 28-year-old male presented with insidious-onset, painless, progressive diminution of vision in both eyes. He denied any other ocular symptoms. On examination, visual acuity in both eyes was 6/60. Color vision and contrast sensitivity were maintained in both eyes. Direct ophthalmoscopy revealed that the optic discs were bilaterally hyperemic and congested, with blurring of all the disc margins and loss of spontaneous venous pulsations. Besides this bilateral disc edema, rest of the clinical examination was normal. Primary intensive search for any intracranial space-occupying lesions returned negative on computed tomography scan imaging. Blood investigations revealed a hemoglobin level of 9.2 g/dl, leukocyte count of 7000 cells/mm, and serum Vitamin B12 level of 155 pg/ml (200-835 pg/ml). Serum homocysteine and methylmalonic acid levels were done and were found to be elevated. After 4 weeks, visual acuity improved to 6/6 in both the eyes, and laboratory investigations showed no signs of Vitamin B12 deficiency. Nonsurgical causes for papilledema should be considered in the differential diagnosis. Early diagnosis and prompt treatment is the key to a good prognosis in Vitamin B12-deficient optic neuropathy, which has shown to have a good prognosis if treatment is initiated in the first few months after the onset of symptoms.
一名28岁男性，双眼视力逐渐下降，起病隐匿，无痛。他否认有任何其他眼部症状。检查时，双眼视力均为6/60。双眼色觉和对比敏感度保持正常。直接检眼镜检查显示双侧视盘充血、淤血，所有视盘边缘模糊，自发性静脉搏动消失。除了双侧视盘水肿外，其余临床检查均正常。对任何颅内占位性病变进行的初步强化检查在计算机断层扫描成像中结果为阴性。血液检查显示血红蛋白水平为9.2 g/dl，白细胞计数为7000个/mm，血清维生素B12水平为155 pg/ml（200 - 835 pg/ml）。血清同型半胱氨酸和甲基丙二酸水平检测发现升高。4周后，双眼视力提高到6/6，实验室检查未显示维生素B12缺乏迹象。视乳头水肿的非手术病因应在鉴别诊断中予以考虑。早期诊断和及时治疗是维生素B12缺乏性视神经病变良好预后的关键，如果在症状出现后的头几个月内开始治疗，该病预后良好。
