眼黄斑囊样水肿(cystoid macular edema,CME)是白蛋白结合型紫杉醇的罕见并发症。该文报告了一例60岁女性患者，在右侧乳腺癌根治术后进行为期7周的白蛋白结合型紫杉醇化学治疗，治疗过程中出现双眼视力下降，经眼科检查诊断为由白蛋白结合型紫杉醇引起的双眼CME。确诊后即刻停用白蛋白结合型紫杉醇，并采用口服乙酰唑胺治疗。经随访，患者停药20个月时双眼CME基本消失，同时双眼矫正视力恢复至1.0。该病例为化学治疗药物引起的CME，机制可能与紫杉烷类药物对Müller细胞和视网膜色素上皮层产生毒性作用有关。值得注意的是，其典型的特征表现为荧光素眼底血管造影未见明显的荧光渗漏。文章回顾了该病例的病程发展，并对其他文献中报道的白蛋白结合型紫杉醇诱导的CME病例的临床特点及诊疗进行了总结。同时，对白蛋白结合型紫杉醇诱导CME的潜在发病机制进行了讨论，旨在为眼科医生提供早期诊断和治疗此类疾病的思路。
Cystoid macular edema (CME) is a rare complication of nab-paclitaxel.. In our article, it is reported a case of a 60-year old woman who had undergone nab-paclitaxel chemotherapy for 7 weeks after a radical surgery for breast cancer.During the treatment, she reported vision declined, and was diagnosed as CME caused by nab-paclitaxel through ophthalmic examinations. The nab-paclitaxel was immediately discontinued after the diagnosis, and the patient was treated with oral acetazolamide instead. In the follow up visit, after stopping nab-paclitaxel for 20 months, CME was found to disappear basically, and the corrected visual acuity was restored to 1.0 in patient's both eyes. his case is CME caused by chemotherapy drugs. Its mechanism may be related to toxic effects of paclitaxel to Müller cells and the retinal pigment epithelial layer. Notably, its typical feature is that there is no obvious fluorescence leakage could be observed on fundus fluorescein angiography. In the article, the course and development of this case is reviewed, and the clinical characteristics and diagnosis and treatment of nab-paclitaxel induced CME cases reported in other literature are also summarized. At the same time, the potential the potential pathogenesis of nab-paclitaxel-induced CME is discussed, to provide reference to ophthalmologists for early diagnosis and treatment for this disease.
一名47岁男性患者因双眼复视、左眼上斜2个月就诊。既往Graves病半年。门诊检查发现双眼眼球突出、左眼上斜视、左眼下转受限，遂以“甲状腺相关眼病”收入院。入院后发现患者双眼复视、左眼上斜视呈晨轻暮重的特点，结合患者眼眶MRI结果考虑眼肌型重症肌无力，进行眼肌型重症肌无力相关检查，新斯的明试验(+)、乙酰胆碱受体抗体(+)，确诊为甲状腺相关眼病合并眼肌型重症肌无力，予溴吡斯的明联合小剂量激素治疗。治疗4个月后双眼眼位正常，双眼眼球运动正常，复视消失。
A 47-year-old man presented with binocular diplopia and hypertropia of left eye for 2 months. He was diagnosed with Graves’ disease for half a year. The patient was protruding in both eyes with hypertropia and limited of infraduction in left eye. Therefore, the patient was admitted to our ophthalmology department with the diagnosis of thyroid-associated ophthalmopathy. After admitting to hospital, binocular diplopia and left eye hypertropia grew worse by the end of the day or after exertion, and improved in the morning of the day or upon rest. Combining with the orbital MRI results, the patient was considered with ocular myasthenia gravis. The related examination of ocular myasthenia gravis was performed. The following test results were: neostigmine test (+), acetylcholine receptor antibody (+). Therefore, the patient was diagnosed with thyroid-associated ophthalmopathy combined with ocular myasthenia gravis. The patient had marked improvement after treatment with pyridostigmine and oral glucocorticoid.
眼肌型重症肌无力(ocular myasthenia gravis，OMG)是一种累及神经肌肉接头突触后膜的自身免疫性疾病。OMG波动性的临床特征易导致较高的漏诊率和误诊率，严重影响患者的生活质量。因此，检测方法在早期确诊OMG中发挥重要作用。本文围绕临床检查、新斯的明试验、自身抗体检测、电生理检测等方面对OMG检测方法作一综述，以期为OMG的早期确诊提供有益的指导。
Ocular myasthenia gravis (OMG) is an autoimmune disease involving the postsynaptic membrane of the neuromuscular junction. The fluctuation of OMG and the clinical characteristics of fatigue easily lead to a high rate of missed diagnosis and misdiagnosis, which seriously affects the quality of life of patients. Therefore, detection methods play an important role in the early diagnosis of OMG. In this paper, OMG detection methods were reviewed in clinical examination, neostigmine test, autoantibody detection, electrophysiological detection, and other aspects, in order to provide useful guidance for the early diagnosis of OMG.
患儿因“左眼红肿12 d”就诊。左上睑红肿(++++)，眼眶鼻侧可触及约黄豆大小硬结，界不清，质地中等，压痛(?)，伴上睑下垂，遮盖角膜下缘。双眼眼位正，左眼眼球外转轻度受限。眼眶及视神经MRI显示左眼上睑软组织肿胀，考虑炎性改变。入院诊断为左眼特发性眼眶炎性假瘤(Idiopathic orbital inflammatory pseudotumor，IOIP)。予以激素治疗后症状好转且随访期间无复发。本例患儿为拒绝外院活检而就诊于暨南大学附属第一医院的小儿IOIP病例，提示早期规范治疗是降低此病复发率的关键，尤其是儿童患者。
The pediatric patient was referred to our hospital with a 12-day history of left eye redness and swelling. On the orbital and nasal side of the eye, there was a firm, nontender mass about the size of soybeans, with unclear boundary, medium texture. Orbital examination showed left ptosis, covering limbus. Motility examination revealed both eyes were in normal position, and the left eye was slightly limited in extraocular rotation. Magnetic resonance imaging (MRI) revealed evidence of diffuse inflammation of left eyelid, and orbital inflammatory was considered. Excluding other etiologies, the child was diagnosed initially with idiopathic orbital inflammatory. The symptoms improved after hormone therapy and there was no recurrence during follow-up. This case was a case of IOIP in a child who was admitted to the First Affiliated Hospital of Jinan University for refusing biopsy from another hospital. The paper suggests that early standardized treatment is the key to reduce the recurrence rate of this disease, especially in children.
眼肌型重症肌无力(ocular myasthenia gravis，OMG)是一种累及神经肌肉接头突触后膜的自身免疫性疾病。OMG波动性的临床特征易导致较高的漏诊率和误诊率，严重影响患者的生活质量。因此，检测方法在早期确诊OMG中发挥重要作用。本文围绕临床检查、新斯的明试验、自身抗体检测、电生理检测等方面对OMG检测方法作一综述，以期为OMG的早期确诊提供有益的指导。
Ocular myasthenia gravis (OMG) is an autoimmune disease involving the postsynaptic membrane of the neuromuscular junction. The fluctuation of OMG and the clinical characteristics of fatigue easily lead to a high rate of missed diagnosis and misdiagnosis, which seriously affects the quality of life of patients. Therefore, detection methods play an important role in the early diagnosis of OMG. In this paper, OMG detection methods were reviewed in clinical examination, neostigmine test, autoantibody detection, electrophysiological detection, and other aspects, in order to provide useful guidance for the early diagnosis of OMG.
患儿因“左眼红肿12 d”就诊。左上睑红肿(++++)，眼眶鼻侧可触及约黄豆大小硬结，界不清，质地中等，压痛(?)，伴上睑下垂，遮盖角膜下缘。双眼眼位正，左眼眼球外转轻度受限。眼眶及视神经MRI显示左眼上睑软组织肿胀，考虑炎性改变。入院诊断为左眼特发性眼眶炎性假瘤(Idiopathic orbital inflammatory pseudotumor，IOIP)。予以激素治疗后症状好转且随访期间无复发。本例患儿为拒绝外院活检而就诊于暨南大学附属第一医院的小儿IOIP病例，提示早期规范治疗是降低此病复发率的关键，尤其是儿童患者。
The pediatric patient was referred to our hospital with a 12-day history of left eye redness and swelling. On the orbital and nasal side of the eye, there was a firm, nontender mass about the size of soybeans, with unclear boundary, medium texture. Orbital examination showed left ptosis, covering limbus. Motility examination revealed both eyes were in normal position, and the left eye was slightly limited in extraocular rotation. Magnetic resonance imaging (MRI) revealed evidence of diffuse inflammation of left eyelid, and orbital inflammatory was considered. Excluding other etiologies, the child was diagnosed initially with idiopathic orbital inflammatory. The symptoms improved after hormone therapy and there was no recurrence during follow-up. This case was a case of IOIP in a child who was admitted to the First Affiliated Hospital of Jinan University for refusing biopsy from another hospital. The paper suggests that early standardized treatment is the key to reduce the recurrence rate of this disease, especially in children.
