Ophthalmology, All India Institute of Medical Sciences-Rishikesh, Rishikesh, India
Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
BMJ Case Rep. 2022 Nov 11;15(11):e249327. doi: 10.1136/bcr-2022-249327.
A male patient presented with a sudden visual decline in the right eye (OD). Fundus revealed bilateral vasculitis; OD also showed an occluded inferior retinal vein and a wedge-shaped retinal opacification of the inferior macula and nasal retina. Fluorescein angiography revealed occlusive retinal vasculitis, while optical coherence tomography showed paracentral acute middle maculopathy (PAMM) in the OD. A thorough systemic evaluation revealed hyperhomocysteinemia and a positive Mantoux test. A diagnosis of PAMM with occlusive retinal vasculitis in presumed intraocular tuberculosis and hyperhomocysteinemia was made. Retinal vasculitis improved with oral corticosteroid, intravitreal anti-vascular endothelial growth factor and laser photocoagulation. However, the patient declined antitubercular therapy despite recommendations. This unique report indicates that PAMM may complicate tubercular retinal vasculitis, especially in the presence of systemic hypercoagulable states.
一位男性患者右眼（OD）突然出现视力下降。眼底检查显示双侧血管炎；OD 还显示闭塞性下视网膜静脉和下方黄斑及鼻侧视网膜楔形视网膜混浊。荧光素血管造影显示闭塞性视网膜血管炎，而光学相干断层扫描显示 OD 出现旁中心性急性中黄斑病变（PAMM）。全面的系统评估显示高同型半胱氨酸血症和曼托氏试验阳性。诊断为 PAMM 合并闭塞性视网膜血管炎，考虑眼内结核和高同型半胱氨酸血症。视网膜血管炎在口服皮质类固醇、眼内抗血管内皮生长因子和激光光凝治疗后得到改善。然而，尽管有建议，患者仍拒绝进行抗结核治疗。这一独特的报告表明，PAMM 可能使结核性视网膜血管炎复杂化，尤其是在存在全身性高凝状态的情况下。
