Meng Yang, Sawut Abdulla, Tian Miao, Li Ying, Cai Liwei, Xiao Di, Yi Zuohuizi, Chen Changzheng
Eye Center, Renmin Hospital of Wuhan University, Wuhan, China.
Physical Examination Center, Renmin Hospital of Wuhan University, Wuhan, China.
Front Med (Lausanne). 2024 Oct 18;11:1394614. doi: 10.3389/fmed.2024.1394614. eCollection 2024.
Purtscher-like retinopathy (PLR) is a rare retinal microangiopathy with unclear pathogenesis. Paracentral acute middle maculopathy (PAMM) is an optical coherence tomography (OCT) sign proposed in recent years, which is characterized by infarction of the middle layer of the retina. This article reported a rare case of PRL and PAMM probably related to improper antihypertensive drug use in a middle-aged male.
A 49-year-old man presented with a complaint of sudden-onset vision loss and paracentral scotomas in the right eye for approximately 1 week. At presentation, the best-corrected visual acuity (BCVA) was 20/63 OD and 20/20 OS. Fundus examination showed multiple cotton-wool spots and Purtscher flecken in the posterior segment of the right eye. OCT revealed hyper-reflectivities in the inner nuclear layer (INL), consistent with PAMM. En face OCT showed PAMM's characteristic "fern-like" perivenular changes. Fluorescein angiography demonstrated prolonged arm-to-retina time, delayed artery and venous filling, and hypofluorescence corresponding to cotton-wool spots. Examinations of the left eye were unremarkable. Many imaging and laboratory tests were performed to detect the possible cause of PLR and PAMM, but no possible explanation was found except improper antihypertensive drug use. The patient was recommended to stop his antihypertensive medication, and prescribed other systemic medicines, including oral prednisolone (40 mg q.d. with gradual tapering), oral cobalamin (0.5 mg t.i.d.), and subcutaneous injections of compound anisodine (2.0 mL q.d.) beside the superficial temporal artery. Two weeks after onset, his BCVA improved to 20/25 in the right eye. During follow-ups, his BCVA recovered to 20/20, accompanied by the regression of fundus lesions. The patient reported no treatment-related adverse effects.
This is the first reported case of PLR and PAMM following improper antihypertensive drug use. Our report expands our understanding of the etiology and pathophysiology of PLR and PAMM. We also stress the importance of proper application of medications in clinical practice.
类Purtscher视网膜病变（PLR）是一种罕见的视网膜微血管病变，发病机制尚不明确。黄斑中心凹旁急性中层病变（PAMM）是近年来提出的一种光学相干断层扫描（OCT）征象，其特征为视网膜中层梗死。本文报道了一例可能与中年男性不当使用降压药有关的罕见PLR合并PAMM病例。
一名49岁男性患者，主诉右眼突发视力丧失及中心旁暗点约1周。就诊时，最佳矫正视力（BCVA）右眼为20/63，左眼为20/20。眼底检查显示右眼后极部有多个棉绒斑和Purtscher斑。OCT显示内核层（INL）高反射，符合PAMM表现。OCT表面成像显示PAMM特征性的“蕨样”静脉周围改变。荧光素血管造影显示臂-视网膜循环时间延长、动静脉充盈延迟以及与棉绒斑对应的低荧光。左眼检查未见异常。进行了多项影像学和实验室检查以寻找PLR和PAMM的可能病因，但除了不当使用降压药外未发现其他可能的解释。建议患者停用降压药，并开具了其他全身药物，包括口服泼尼松龙（40mg每日一次，逐渐减量）、口服钴胺素（0.5mg每日三次）以及在颞浅动脉旁皮下注射复方樟柳碱（2.0mL每日一次）。发病两周后，右眼BCVA提高到20/25。随访期间，BCVA恢复到20/20，眼底病变消退。患者未报告与治疗相关的不良反应。
这是首例报道的因不当使用降压药导致的PLR和PAMM病例。我们的报告扩展了对PLR和PAMM病因及病理生理学的认识。我们还强调了临床实践中合理用药的重要性。
