Noda Tomoko, Noda Kousuke, Hirooka Kiriko, Kase Satoru, Ishida Susumu
Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Am J Ophthalmol Case Rep. 2022 May 4;27:101568. doi: 10.1016/j.ajoc.2022.101568. eCollection 2022 Sep.
To report a case of polycythemia vera (PV) with subretinal fluid accumulation after the administration of prostaglandin I2 (PGI2) analogue.
A 57-year-old woman diagnosed as having PV was referred to our department for the evaluation of severe metamorphopsia in the left eye, which gradually progressed after the initiation of oral administration of PGI2 mimetics. At the first visit, the patient's best-corrected visual acuities (BCVAs) were 20/20 OD and 20/30 OS. Fundus examination and optical coherence tomography revealed the presence of subretinal fluid (SRF) in the left eye and multiple serous pigment epithelial detachments (PEDs) in both eyes. Fluorescein angiography revealed central serous chorioretinopathy (CSC)-like lesions, consisting of dye pooling corresponding to the PEDs in both eyes and dye leakage in the left eye. Indocyanine green angiography and laser speckle flowgraphy revealed dilated choroidal veins and reduced choroidal blood flow, respectively. The central choroidal thickness (CCT) measured at the first visit showed a relatively thickened choroid in the left eye. Laboratory data showed mild pancytosis. The patient was diagnosed as having CSC associated with a background of PV, presumably triggered by the PGI2 analogue. One month after cessation of drug administration, the patient's BCVA improved, the CCT slightly decreased, and serous retinal detachment and PED disappeared in the left eye.
Our case of PV presenting with CSC-like lesions after PGI2 analogue administration indicates the possible risk of SRF accumulation by PGI2 analogues in patients with PV.
报告1例真性红细胞增多症（PV）患者在使用前列腺素I2（PGI2）类似物后出现视网膜下液积聚的病例。
一名57岁被诊断为PV的女性因左眼严重变形视被转诊至我科，在开始口服PGI2模拟物后症状逐渐加重。初诊时，患者右眼最佳矫正视力（BCVA）为20/20，左眼为20/30。眼底检查和光学相干断层扫描显示左眼存在视网膜下液（SRF），双眼均有多个浆液性色素上皮脱离（PED）。荧光素血管造影显示中心性浆液性脉络膜视网膜病变（CSC）样病变，包括双眼与PED对应的染料渗漏和左眼的染料渗漏。吲哚菁绿血管造影和激光散斑血流图分别显示脉络膜静脉扩张和脉络膜血流减少。初诊时测量的中心脉络膜厚度（CCT）显示左眼脉络膜相对增厚。实验室检查数据显示轻度全血细胞增多。该患者被诊断为与PV背景相关的CSC，可能由PGI2类似物引发。停药1个月后，患者的BCVA改善，CCT略有下降，左眼浆液性视网膜脱离和PED消失。
我们报道的该例PV患者在使用PGI2类似物后出现CSC样病变，提示PV患者使用PGI2类似物可能存在SRF积聚的风险。
