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中年男性视网膜血管炎合并中度近视,后极部视网膜裂孔导致后极部视网膜脱离。

Posterior pole retinal breaks causing posterior pole retinal detachment in a middle-aged man with retinal vasculitis and moderate myopia.

机构信息

Vitreo-Retina, LV Prasad Eye Institute, Hyderabad, India.

Vitreo-Retina, LV Prasad Eye Institute, Hyderabad, Telangana, India.

出版信息

BMJ Case Rep. 2021 Feb 26;14(2):e239012. doi: 10.1136/bcr-2020-239012.

Abstract

A 38-year-old man presented with sudden decreased vision in the right eye 3 years ago due to vitreous haemorrhage. During follow-up, right eye fundus showed evidence of vasculitis, non-perfusion areas and neovascularisation elsewhere. Systemic evaluation findings of positive Mantoux test, QuantiFERON Gold test and right apical pleuroparenchymal fibrosis observed on high-resolution CT of the chest were suggestive of postinfection probable tubercular aetiology. He was treated with oral steroids, antitubercular therapy, intravitreal bevacizumab and anterior retinal cryopexy, leading to resolution of vasculitis and vitreous haemorrhage. Later he developed peripheral retinal flap and posterior retinal breaks at 8-month and 11-month follow-up, respectively, which were managed by barrage laser. He maintained a stable visual acuity of 20/20, N6 for the next 2 years. He then presented with sudden decreased vision in the right eye (20/50, N10). Right eye fundus showed posterior pole retinal detachment with lifting of previously barraged posterior retinal breaks. He underwent vitreoretinal surgery with gas tamponade. Recent 1-month postoperative visit showed successful retinal reattachment and visual recovery of 20/20, N6.

摘要

一位 38 岁男性,3 年前因玻璃体出血导致右眼突然视力下降。随访期间,右眼眼底有血管炎、无灌注区和其他部位的新生血管形成的证据。系统评估发现,结核菌素纯蛋白衍生物试验、QuantiFERON Gold 试验阳性,胸部高分辨率 CT 显示右侧肺尖胸膜下实质纤维化,提示可能是感染后结核病因。他接受了口服类固醇、抗结核治疗、玻璃体内贝伐单抗注射和前部视网膜冷冻治疗,导致血管炎和玻璃体出血得到缓解。后来,他在 8 个月和 11 个月的随访中分别出现了周边视网膜瓣和后部视网膜裂孔,通过栅栏激光治疗得到了控制。在接下来的 2 年里,他的视力一直稳定在 20/20,N6。然后,他的右眼突然出现视力下降(20/50,N10)。右眼眼底显示后极部视网膜脱离,先前的栅栏状后部视网膜裂孔上抬。他接受了玻璃体视网膜手术联合气体填充。最近的 1 个月术后随访显示视网膜成功复位,视力恢复到 20/20,N6。

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