Iqbal Naeem, De Silva Samantha R, Downes Susan M
Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, GBR.
Department of Ophthalmology, John Radcliffe Hospital, Oxford, GBR.
Cureus. 2023 Jan 30;15(1):e34374. doi: 10.7759/cureus.34374. eCollection 2023 Jan.
A 75-year-old caucasian female presented with sudden severe visual deterioration in one eye reduced from 6/9 to counting fingers (CF), with second eye reduction in vision from 6/9 to CF three months later. Past medical history included a background of proliferative diabetic retinopathy, uncontrolled blood pressure, and a 44-year history of poorly controlled type 1 diabetes mellitus (T1DM). Previous ocular history included bilateral pan-retinal photocoagulation for proliferative diabetic retinopathy, followed by bilateral vitrectomies, with subsequent bilateral cataract surgery with intraocular lens implants. A diagnosis of anterior ischemic optic neuropathy (AION) was thought to be the most likely diagnosis due to sudden visual loss, pale discs, and previous long-term history of diabetes and blood pressure with variable control in the absence of a raised erythrocyte sedimentation rate (ESR). However, at the time of the second eye visual loss, the inferior peripheral retina examination revealed bilateral pseudophakic intraocular lens dislocations. With spectacle correction of +11.50/-1.00 x 75 right eye and +11.50/-1.00 x 65 left eye, her visual acuities were 6/12 right eye and 6/9 left eye, and subsequent secondary intraocular lens insertion was planned. This case highlights the importance of a careful review of the whole eye to ensure that remediable causes of visual loss are not missed.
一名75岁的白种女性，一只眼睛突然出现严重视力下降，从6/9降至数指（CF），三个月后另一只眼睛视力从6/9降至CF。既往病史包括增殖性糖尿病视网膜病变、血压控制不佳，以及44年控制不佳的1型糖尿病（T1DM）病史。既往眼科病史包括因增殖性糖尿病视网膜病变行双眼全视网膜光凝，随后行双眼玻璃体切除术，以及随后的双眼白内障手术并植入人工晶状体。由于突然视力丧失、视盘苍白，且既往有长期糖尿病和血压病史且控制情况不一，同时红细胞沉降率（ESR）未升高，最可能的诊断被认为是前部缺血性视神经病变（AION）。然而，在第二只眼睛视力丧失时，周边视网膜下部检查发现双眼人工晶状体脱位。右眼佩戴+11.50/-1.00×75的眼镜矫正，左眼佩戴+11.50/-1.00×65的眼镜矫正后，她的右眼视力为6/12，左眼视力为6/9，随后计划进行二期人工晶状体植入。该病例强调了全面仔细检查眼睛以确保不遗漏可补救的视力丧失原因的重要性。
