Krzemińska Julia, Kurek Anna, Żebrowska Agnieszka, Waszczykowska Arleta
Department of Ophthalmology, Medical University of Lodz, 90-153 Lodz, Poland.
Department of Dermatology and Venereology, Medical University of Lodz, 90-647 Lodz, Poland.
J Clin Med. 2024 Aug 15;13(16):4808. doi: 10.3390/jcm13164808.
A 54-year-old, one-eyed Caucasian male was admitted to the Ophthalmology Clinic due to a gradual deterioration of vision in the right eye for approximately two weeks. The patient denied any trauma or viral infection during this time. On the day of admission, the patient's best corrected visual acuity (BCVA) in the right eye was 0.5 on the Snellen scale. The patient's left eye had been atrophied for several years, with no light perception and no visibility of the fundus due to previous trauma and multiple surgeries. Ophthalmologic examination of the anterior segment and vitreous body of both eyes showed no signs of inflammation. Fundus examination of the right eye revealed scattered inflammatory foci, creamy-yellow and round, visible in all sectors. Laboratory tests, imaging studies, optical coherence tomography (OCT) angiographies, OCTs of the macula and optic nerve head, fluorescein angiographies (FAs), electroretinograms (ERGs), and visual field tests were performed. These examinations led to a diagnosis of a disease resembling birdshot-like chorioretinopathy. Immunogenetic testing of the patient did not reveal the presence of human leukocyte antigen (HLA)-A29. Dermatological and immunological consultations were conducted, and a differential diagnosis was made. Due to the reduced visual acuity (VA) observed and the inability to assess the left eye, a high-dose corticosteroid therapy was initiated, which was gradually tapered, along with the application of an immunosuppressive drug. The course of the disease was typical for birdshot chorioretinopathy, with chronic periods of remissions and exacerbations. The patient's clinical improvement was only achieved after co-administration of general corticosteroids at a dose of 0.5-1 mg/kg/day, mycofenolate mofetil, and periocular (sub-Tenon's) triamcinolone.
一名54岁的独眼白种男性因右眼视力逐渐下降约两周而入住眼科诊所。在此期间，患者否认有任何外伤或病毒感染。入院当天，患者右眼的最佳矫正视力（BCVA）在斯内伦视力表上为0.5。患者的左眼因先前的外伤和多次手术已萎缩数年，无光感且眼底不可见。双眼眼前节和玻璃体的眼科检查未显示炎症迹象。右眼眼底检查发现散在的炎性病灶，呈乳黄色圆形，各个象限均可见。进行了实验室检查、影像学检查、光学相干断层扫描（OCT）血管造影、黄斑和视神经乳头的OCT、荧光素血管造影（FA）、视网膜电图（ERG）和视野检查。这些检查导致诊断为一种类似鸟枪弹样脉络膜视网膜病变的疾病。患者的免疫遗传学检测未发现人类白细胞抗原（HLA）-A29的存在。进行了皮肤科和免疫学会诊，并做出了鉴别诊断。由于观察到视力下降（VA）且无法评估左眼，开始了高剂量的皮质类固醇治疗，并逐渐减量，同时应用一种免疫抑制药物。该疾病的病程符合鸟枪弹样脉络膜视网膜病变的典型表现，有慢性的缓解期和加重期。仅在联合使用剂量为0.5-1mg/kg/天的全身皮质类固醇、霉酚酸酯和眼周（Tenon囊下）曲安奈德后，患者才取得临床改善。
