Neo Yan Ning, Sobti Manvi, Zambarakji Hadi
Ophthalmology Department, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
Ophthalmology Department, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
BMJ Case Rep. 2021 May 4;14(5):e242847. doi: 10.1136/bcr-2021-242847.
We report a case of bilateral symmetrical superior visual field defects in a 72-year-old man first reported during the recovery from systemic capillary leak syndrome (SCLS). During the acute illness, he required extensive and prolonged fluid replacement and mechanical ventilation for severe hypotension, shock and multiorgan dysfunction. His visual field defect and optic nerve changes were consistent with a diagnosis of ischaemic optic neuropathy. These remained unchanged over 3 years and he retained excellent 6/7.5 visual acuity bilaterally. We hypothesised the mechanism of bilateral segmental infarction of the optic nerve head to be caused by the hypercoagulable and hypovolaemic state, in addition to pre-existing vascular disease and hypertension. This case highlights the importance of including optic nerve examination in the management plan of SCLS, particularly in individuals with underlying vascular risk factors.
我们报告了一例72岁男性双侧对称性上视野缺损的病例，该病例首次在系统性毛细血管渗漏综合征（SCLS）恢复过程中被报道。在急性发病期间，由于严重低血压、休克和多器官功能障碍，他需要大量且长时间的液体复苏及机械通气。他的视野缺损和视神经改变符合缺血性视神经病变的诊断。这些情况在3年中保持不变，并且他双侧视力均保持在6/7.5的良好水平。我们推测，除了既往存在的血管疾病和高血压外，高凝和低血容量状态导致了双侧视神经乳头节段性梗死。该病例强调了在SCLS管理计划中纳入视神经检查的重要性，特别是对于有潜在血管危险因素的个体。
