Beck A D, Newman N J, Grossniklaus H E, Galetta S L, Kramer T R
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
Surv Ophthalmol. 1994 May-Jun;38(6):555-66. doi: 10.1016/0039-6257(94)90148-1.
We present four patients with sarcoidosis of the anterior visual pathways. The first patient presented with unilateral visual loss, a mass lesion at the optic nerve head, and an enlarged orbital optic nerve. The second patient presented with bilateral progressive painless visual loss, associated with optic nerve pallor and visual field loss. In these two patients, optic nerve biopsy was diagnostic of sarcoidosis. The third patient developed optic nerve and chiasmal involvement after sarcoidosis was established by lacrimal gland biopsy. The fourth patient had optic nerve, pulmonary, and lymph node involvement with sarcoidosis. A conjunctival and lung biopsy were diagnostic. Computed tomography and magnetic resonance imaging have greatly facilitated diagnosis of sarcoidosis of the anterior visual pathways. Sarcoidosis of the anterior visual pathways may occur alone or in association with other ocular or systemic manifestations. A conjunctival or lacrimal gland biopsy may be preferable as the initial diagnostic approach. Treatment of patients with this condition may require systemic immunosuppression, in addition to corticosteroids, to prevent permanent visual loss.
我们报告了4例前视觉通路结节病患者。首例患者表现为单眼视力丧失、视神经乳头肿块病变以及眶内视神经增粗。第二例患者表现为双侧进行性无痛性视力丧失，伴有视神经苍白和视野缺损。在这两名患者中，视神经活检确诊为结节病。第三例患者在泪腺活检确诊结节病后出现视神经和视交叉受累。第四例患者有视神经、肺部和淋巴结受累的结节病表现。结膜和肺部活检确诊。计算机断层扫描和磁共振成像极大地促进了前视觉通路结节病的诊断。前视觉通路结节病可单独发生或与其他眼部或全身表现相关。结膜或泪腺活检作为初始诊断方法可能更可取。除皮质类固醇外，治疗此类患者可能需要全身免疫抑制，以防止永久性视力丧失。
