Zainuddin Muhamad Zulhilmi Akmal, Che Hamzah Jemaima, Cheng Teck Chee
Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS.
Cureus. 2025 May 2;17(5):e83336. doi: 10.7759/cureus.83336. eCollection 2025 May.
A 72-year-old male with hypertension, dyslipidemia, ischemic heart disease, chronic kidney disease, and gout presented with painless blurred vision in the right eye, with intermittent ipsilateral headache for six months. Upon presentation, the right eye vision was 6/60 pinhole 6/36, with the presence of a relative afferent pupillary defect. An anterior segment examination revealed right eye ciliary injection and corneal edema, with anterior chamber cells and fibrin. The right eye intraocular pressure (IOP) was 52 mmHg, and gonioscopy showed an open angle with rubeosis at the angle. The right eye fundus revealed a glaucomatous optic disc with a 0.7 cup-to-disc ratio, multiple dot-blot hemorrhages over the mid-peripheral retina, and narrowed retinal arteries suggesting ocular ischemic syndrome (OIS). The left eye examination was unremarkable. The diagnosis was further confirmed by fundus fluorescein angiography, which showed a marked delay in arterio-venous transit time with a profound area of capillary fall-out at the peripheral retina. To tackle the ischemic component, a pan-retina photocoagulation laser was conducted. Topical and systemic antiglaucoma medications, topical steroids, and cycloplegics were commenced. He subsequently required a glaucoma drainage device in his right eye to control the IOP. He was investigated for the cause of OIS. Ultrasound carotid Doppler and computed tomography angiography of carotid arteries revealed bilateral internal carotid artery atherosclerotic disease with less than 50% stenosis. Double antiplatelet therapy was commenced to reduce the risk of cerebrovascular and cardiovascular events. Two months after the operation, his right eye's intraocular pressure was controlled without antiglaucoma medications. After seven months of follow-up, his right eye vision improved to 6/12 with an IOP of 10 mmHg.
一名72岁男性，患有高血压、血脂异常、缺血性心脏病、慢性肾脏病和痛风，右眼出现无痛性视力模糊，并伴有同侧间歇性头痛6个月。就诊时，右眼视力针孔下为6/60，矫正后为6/36，存在相对传入性瞳孔障碍。前段检查发现右眼睫状充血和角膜水肿，前房有细胞和纤维素。右眼眼压（IOP）为52 mmHg，房角镜检查显示房角开放，但房角有新生血管。右眼眼底显示青光眼性视盘，杯盘比为0.7，视网膜中周部有多处点状出血，视网膜动脉变窄，提示眼部缺血综合征（OIS）。左眼检查未见异常。眼底荧光血管造影进一步证实了诊断，显示动静脉 transit时间明显延迟，周边视网膜有大片毛细血管无灌注区。为解决缺血问题，进行了全视网膜光凝激光治疗。开始使用局部和全身抗青光眼药物、局部类固醇和睫状肌麻痹剂。随后他右眼需要植入青光眼引流装置来控制眼压。对其眼部缺血综合征的病因进行了检查。颈动脉超声多普勒和颈动脉计算机断层血管造影显示双侧颈内动脉粥样硬化疾病，狭窄程度小于50%。开始双联抗血小板治疗以降低脑血管和心血管事件的风险。术后两个月，他右眼眼压在未使用抗青光眼药物的情况下得到控制。经过7个月的随访，他右眼视力提高到6/12，眼压为10 mmHg。
