South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
BMJ Case Rep. 2021 Jan 27;14(1):e237727. doi: 10.1136/bcr-2020-237727.
Bilateral optic disc swelling is an important clinical sign for potentially life-threatening and sight-threatening conditions, with the most common being raised intracranial pressure and pseudopapillitis. Perhexiline-related and amiodarone-related optic disc swellings are diagnoses of exclusion. This report describes the diagnosis of a man with perhexiline-induced and amiodarone-induced optic neuropathy after extensive investigation consisting of full ophthalmic examination, biochemical screen, temporal artery biopsy, CT, MRI, positron emission tomography and lumbar puncture. There was partial to complete resolution of optic neuropathy following cessation of the causative medication. We postulate that the underlying mechanism of perhexiline toxicity could be mitochondrial dysfunction related. Our case demonstrates that patients treated with perhexiline and amiodarone should be monitored closely for ocular side effects.
双侧视盘肿胀是一种重要的临床征象，可能危及生命和视力，最常见的原因是颅内压升高和假性视乳头炎。与丙炔苯丙胺相关和胺碘酮相关的视盘肿胀是排除性诊断。本报告描述了一例经广泛检查（包括全面眼科检查、生化筛查、颞动脉活检、CT、MRI、正电子发射断层扫描和腰椎穿刺）诊断为丙炔苯丙胺诱导和胺碘酮诱导的视神经病变的患者。停止致病药物治疗后，视神经病变部分至完全缓解。我们推测丙炔苯丙胺毒性的潜在机制可能与线粒体功能障碍有关。我们的病例表明，接受丙炔苯丙胺和胺碘酮治疗的患者应密切监测眼部副作用。
