Ashok Sudhat, Pilling Andrew, Lee-Kwen Peterkin, Guterman Lee R, Weiner Asher
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), 955 Main St., Buffalo, NY 14203, USA.
Department of Ophthalmology, Ross Eye Institute, University at Buffalo/State University of New York (SUNY), 1176 Main St., Buffalo, NY 14209, USA.
Case Rep Ophthalmol Med. 2024 May 10;2024:3878152. doi: 10.1155/2024/3878152. eCollection 2024.
. We describe a patient with normal tension glaucoma (NTG) of several years whose management was complicated by the presence of a giant internal carotid-ophthalmic artery aneurysm. . A 72-year-old woman presented to our glaucoma clinic with accelerated deterioration of her vision in her left eye (OS) over a 1-month period. Her ophthalmic history was most notable for bilateral NTG diagnosed 3 years prior which had been treated with several laser trabeculoplasty OS and topical bimatoprost 0.01% eye drops in both eyes (OU). Upon evaluation, her visual acuity OS had worsened, and visual field (VF) testing showed extensive progressive losses temporally and pericentrally OS over a year with stable IOP measurements and no neurological complaints. Given her atypical NTG progression, she was referred for an urgent neurological evaluation which revealed an unruptured giant left internal carotid-ophthalmic aneurysm. Following the successful treatment of the aneurysm with platinum coils, she continued to demonstrate additional bilateral ophthalmic changes including further progression of VF loss and RNFL thinning OS > OD on follow-up. . Overall, this report describes a unique complication in the management of a patient with chronic bilateral NTG in the form of a giant internal carotid-ophthalmic aneurysm. Moreover, it highlights the need for clinicians to maintain a degree of suspicion for compressive lesions of the optic nerve when presented with atypical progression of VFs and/or visual acuity loss in glaucomatous patients.
我们描述了一位患有数年正常眼压性青光眼（NTG）的患者，其治疗因巨大的颈内动脉 - 眼动脉瘤的存在而变得复杂。一名72岁女性因左眼（OS）视力在1个月内加速恶化前来我们的青光眼诊所就诊。她的眼科病史最显著的是3年前诊断出的双侧NTG，曾接受过多次左眼激光小梁成形术以及双眼使用0.01%的比马前列素滴眼液治疗。经评估，她的左眼视力恶化，视野（VF）检查显示在一年时间里左眼颞侧和中心周围广泛进展性丧失，眼压测量稳定且无神经学症状。鉴于她非典型的NTG进展情况，她被转诊进行紧急神经学评估，结果发现一个未破裂的巨大左侧颈内动脉 - 眼动脉瘤。在用铂金线圈成功治疗该动脉瘤后，随访时她仍出现了额外的双侧眼部变化，包括视野丧失进一步进展以及左眼视网膜神经纤维层（RNFL）变薄程度超过右眼（OD）。总体而言，本报告描述了慢性双侧NTG患者管理中一种独特的并发症，即巨大的颈内动脉 - 眼动脉瘤。此外，它强调了临床医生在青光眼患者出现视野和/或视力丧失的非典型进展时，需要对视神经受压病变保持一定程度的怀疑。
