Nakakura Shunsuke, Oogi Satomi, Tanoue Asaya, Miyoshi Teruyuki
Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan.
Miyoshi Eye Clinic, Department of Ophthalmology, Fukuyama, Japan.
Front Med (Lausanne). 2022 Oct 28;9:950148. doi: 10.3389/fmed.2022.950148. eCollection 2022.
Comorbidities like glaucoma and migraine are often observed among middle-aged individuals, especially women. Herein, we report a rare case of a patient who underwent automated perimetry during a migraine attack. A 52-year-old woman with a 1-year history of blurred vision in the nasal field of her right eye visited Miyoshi Eye Clinic. The intraocular pressures of the right and left eyes were 22 and 24 mm Hg, respectively. Retinal imaging revealed a retinal nerve fiber defect in the temporal superior macula with corresponding thinning of the superior ganglion cell complex in the right eye. The left eye appeared normal. Primary open-angle glaucoma was suspected, and the patient underwent a visual field examination on the same day. Perimetry showed that the mean deviations in the right and left eyes were -5.00 and -7.68 dB, respectively. A visual field defect in the inferior nasal aspect of the right eye corresponded to the retinal nerve fiber defect. However, right-sided homonymous hemianopia-like visual field defects were observed in both eyes. After the examination, the patient stated that a migraine attack had started 5 min before the examination and continued till after its end (attack duration was ∼20 min). In the follow-up examinations without migraine, homonymous hemianopia-like visual field defects disappeared, and only a glaucomatous visual field defect in the right eye was observed. Hence, the initial visual field examination findings reflected the effects of a migraine attack alongside glaucoma. Detailed interviews with patients may be beneficial for understanding visual field findings and preventing their untimely examination.
青光眼和偏头痛等合并症在中年人群中较为常见，尤其是女性。在此，我们报告一例罕见病例，一名患者在偏头痛发作期间接受了自动视野检查。一名52岁女性因右眼鼻侧视野模糊1年就诊于三好眼科诊所。右眼和左眼的眼压分别为22和24 mmHg。视网膜成像显示右眼颞上黄斑区存在视网膜神经纤维缺损，相应的神经节细胞复合体变薄。左眼外观正常。怀疑为原发性开角型青光眼，患者于同日接受了视野检查。视野检查显示右眼和左眼的平均偏差分别为-5.00和-7.68 dB。右眼鼻下象限的视野缺损与视网膜神经纤维缺损相对应。然而，双眼均观察到右侧同向性偏盲样视野缺损。检查后，患者表示在检查前5分钟开始偏头痛发作，并持续至检查结束（发作持续时间约20分钟）。在无偏头痛的后续检查中，同向性偏盲样视野缺损消失，仅观察到右眼的青光眼性视野缺损。因此，最初的视野检查结果反映了偏头痛发作与青光眼共同产生的影响。对患者进行详细访谈可能有助于理解视野检查结果并避免检查时机不当。
