患者双眼周边部视网膜劈裂，对侧出现青光眼视神经损伤：病例报告。

Glaucomatous optic nerve damage in the contralateral eye of a patient with peripapillary retinoschisis: a case report.

机构信息

Department of Ophthalmology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.

出版信息

BMC Ophthalmol. 2023 Apr 3;23(1):134. doi: 10.1186/s12886-023-02887-4.

DOI:10.1186/s12886-023-02887-4

PMID:37013512

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10069137/

Abstract

BACKGROUND

Peripapillary retinoschisis (PPRS) is often associated with glaucomatous eyes. It usually occurs in eyes with a more advanced stage of glaucoma with obvious optic nerve damage. We report a patient who was found to have PPRS in one eye during a routine physical examination without obvious glaucoma symptoms. Further examination revealed glaucomatous visual field loss and retinal nerve fiber layer defects in the contralateral eye.

CASE PRESENTATION

A 55-year-old man presented for a routine physical examination. The anterior segment was normal in both eyes. Fundus examination revealed an elevated and red optic disc in the right eye. In addition, scattered patchy red lesions were seen on the retina on the temporal side of the optic disc. The color and boundary of the left optic disc were normal, and the cup-to-disc ratio was 0.6. Optical coherence tomography showed retinoschisis on the optic nerve head of the right eye throughout the entire circumference, extending to the retina on the temporal side of the optic disc. The intraocular pressure was 18 mmHg OD and 19 mmHg OS. The patient was diagnosed with PPRS (OD). However, no optic disc pit or optic disc coloboma was found. Further examination showed that the visual field of the patient's right eye was generally normal, while a glaucomatous visual field defect was found in the left eye, which manifested as a nasal step visual field defect. Moreover, stereophotography and a red-free fundus image revealed two retinal nerve fiber layer defects in the supratemporal and infratemporal regions of the retina of the left eye. Continuous intraocular pressure measurement found that the intraocular pressure fluctuated between 18 and 22 mmHg OD and 19-26 mmHg OS during the daytime. Primary open-angle glaucoma was then diagnosed.

CONCLUSIONS

In this case, we found that PPRS was associated with glaucomatous optic nerve changes and visual field defects in the fellow eye.

摘要

背景

视盘旁视网膜劈裂症（PPRS）常与青光眼眼相关。它通常发生在青光眼进展更明显、视神经损伤明显的眼中。我们报告了一例患者，在常规体检中发现一只眼患有 PPRS，且无明显青光眼症状。进一步检查发现对侧眼存在青光眼视野缺损和视网膜神经纤维层缺损。

病例介绍

一位 55 岁男性因常规体检就诊。双眼眼前段正常。眼底检查发现右眼视盘抬高且充血。此外，在视盘颞侧视网膜上可见散在的斑片状红色病变。左眼视盘颜色和边界正常，杯盘比为 0.6。光学相干断层扫描显示右眼视神经头整个圆周的视网膜劈裂，延伸至视盘颞侧视网膜。右眼眼压为 18mmHg，左眼眼压为 19mmHg。患者被诊断为 PPRS（右眼）。然而，未发现视盘小凹或视盘缺损。进一步检查显示，患者右眼视野大致正常，左眼出现青光眼视野缺损，表现为鼻侧阶梯状视野缺损。此外，立体照相和无赤光眼底图像显示左眼视网膜颞上和颞下区域有两个视网膜神经纤维层缺损。连续眼压测量发现右眼日间眼压在 18-22mmHg 之间波动，左眼日间眼压在 19-26mmHg 之间波动。诊断为原发性开角型青光眼。