病例报告

马方综合征合并双眼晶状体半脱位手术治疗一例

Surgical treatment of Marfan syndrome with subluxation lens: a case report

:168-174
 
马方综合征(Marfan syndrome,MFS)是与晶状体异位有关的常见的全身性疾病,约50%~80%的MFS患者存在晶状体异位。该文报道一例21岁的男性患者,因患有MFS致双眼晶状体半脱位伴双眼并发性白内障,先后实施白内障摘除人工晶状体植入合并囊袋张力环悬吊固定术,术后保留低度近视,随访期间未发现眼压升高、人工晶状体严重移位及囊袋皱缩等并发症。
Marfan syndrome (MFS) is a common systemic disease associated with lens heterotopia, and about 50%~80% of Marfan patients have lens heterotopia. This article reports a case of a 21-year-old male patient who suffered from bilateral lens subluxation and concurrent cataract due to MFS, who underwent cataract extraction and IOL implantation with CTR suspension fixation was performed to preserve low-grade myopia after surger y. No complications such as increased intraocular pressure, intraocular lens severely displacement and capsular bag shrinkage were found during follow-up.
中山眼科中心病例挑战专栏

继发性青光眼术中发生暴发性脉络膜上腔出血1例

Subchoroidal expulsive hemorrhage in secondary glaucoma: A case report

:1-5
 
暴发性脉络膜上腔出血(subchoroidal expulsive hemorrhage,SEH)是内眼手术中罕见且严重的并发症,广东省人民医院眼科收治1名因晶状体完全脱位继发青光眼的女性患者,73岁,其手术过程中发生SEH,现报告如下。通过回顾病例,讨论及分析SEH的原因、危险因素及治疗。
Subchoroidal expulsive hemorrhage (SEH) is one of the rarest and worst complications of intraocular surgery. We treated one patient with secondary glaucoma due to complete dislocation of the lens, who developed SEH during the surgery. In this case report, the causes, risk factors and treatment of subchoroidal expulsive were discussed and analyzed by reviewing the case.
病例报告

双眼瞳孔残膜切除联合有晶状体眼后房型环曲面人工晶状体植入治疗先天性视力不佳一例

Bilateral pupil residual membrane resection combined with TICL implantation in the treatment of congenital poor vision: a case report

:770-774
 
该文报道一例30岁的男性患者因“双眼自幼视力不佳,强光下视物模糊加重4年余”就诊,经过眼部检查评估,诊断为双眼瞳孔残膜、双眼屈光不正。患者接受一期双眼瞳孔残膜切除、二期双眼行有晶状体眼后房型环曲面人工晶状体(toric implantable collamer lens,TICL)植入手术,术后视力恢复良好。文章回顾了该例患者的诊治过程,为临床屈光不正同时伴有瞳孔残膜患者的诊治提供参考。
A 30-year-old male patient presented at our institution with a history of poor vision in both eyes since childhood, exacerbated by blurriness under bright light for over four years. Following a comprehensive ophthalmic examination, the patient was diagnosed with bilateral pupillary membrane remnants and refractive errors. The patient underwent a two-stage surgical intervention, starting with the removal of the pupillary membrane remnants, followed by the implantation of toric implantable collamer lenses (TICL) in the posterior chamber of the lensless eyes. Postoperative outcomes were favorable, with significant improvement in visual acuity. This article reviews the therapeutic journey of the patient, offering insights into the diagnosis and management of individuals with concurrent refractive anomalies and pupillary membrane remnants, thereby contributing to the clinical discourse on the subject.
临床病例讨论

急性轮状外层视网膜病变1例

Acute annular outer retinopathy: A case report

:191-195
 
患者女,60岁,因“右眼前黑影飘动1月,视力下降8天”就诊。视力:右眼0.1,不能矫正;左眼0.6矫正0.9。右眼眼底见视盘周围边界清晰不规则灰白色区,并波及中心凹。视野检查:右眼对应眼底病灶的视野缺损;左眼正常。光学相干断层成像术(optical coherence tomography,OCT)显示灰白色区域椭圆体带不规则、缺失,视网膜色素上皮(retinal pigment epithelium,RPE)层见数个指状隆起。眼底自发荧光(autofluorescence,AF)示:受影响区域内呈高荧光和部分不规则低荧光区。荧光素眼底血管造影(fundus fluorescein angiography,FFA)示:早期见荧光渗漏,晚期荧光着染、蓄积。吲哚菁绿血管造影(indocyanine green angiography,ICGA)示:见以视乳头为中心,边界清晰的低荧光区。诊断:右眼急性轮状外层视网膜病变。治疗:给予抗炎和改善血循环4周,眼底灰白色环状带消失,视力明显好转。随访6个月,患者病情控制良好。
A 60-year-old woman was admitted to Chengdu Aidi Eye Hospital because of “dark shadow fluttering in the right eye for 1 month and vision loss for 8 days”. Visual acuity—with a myopic correction—was 0.1 with the right eye and 0.9 with the left eye. The right eye fundus presented a well-defined, irregular, grayish white area around the optic disc, and affected the fovea, corresponding to the visual field defect of the fundus lesion. Optical coherence tomography (OCT) showed that the ellipsoid bands in this region were irregular and absent, and several finger-like ridges were seen in the retinal pigment epithelium (RPE) layer. Fundus autofluorescence (AF): High fluorescence and some irregular low fluorescence in the affected area. Fundus fluorescein angiography (FFA): Fluorescence leakage was seen in the early stage, fluorescence staining and accumulation in the late stage. Indocyanine green angiography (ICGA): A well-defined low-fluorescence area centered on the optic nipple was observed. Diagnosis:Acute annular outer retinopathy. Treatment: Anti-inflammatory and improved blood circulation for 4 weeks, the gray and white ring of fundus disappeared and the visual acuity improved obviously
病例报告

白蛋白结合型紫杉醇致黄斑囊样水肿一例

Cystoid macular edema induced by nab-paclitaxel:a case report

:587-594
 
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.
病例报告

双眼白内障术后单眼人工晶状体混浊一例

One eye intraocular lens opacity after bilateral cataract surgery:a case report

:580-586
 
人工晶状体混浊是白内障术后较为少见的并发症,患者多于手术后数月或数年因不明原因视力下降或视朦就诊。本文报道一例73岁女性患者,在同一时期双眼先后植入同一型号亲水性丙烯酸酯人工晶状体,术后6年右眼人工晶状体完全混浊,而左眼人工晶状体仍为完全透明状态。两眼的临床眼部体征、眼前节光学相干断层成像(optic coherence tomography,OCT)、超声生物显微镜检查(ultrasound biomicroscopy,UBM)等检查结果均有明显差异,人工晶状体混浊眼通过手术治疗后视力恢复满意。文章详细记录了该例患者术前的相关资料、手术治疗以及手术取出人工晶状体的检查结果,并进行了分析讨论,供专家同行参阅,为该类患者的诊疗提供参考。
Intraocular lens opacity is a relatively rare complication after cataract surgery. Many patients seek medical service serveral months or years after surgery, due to unexplained visual impairment or blurred vision. A case is reported in this article that a 73-year-old female patient who was implanted the same type of hydrophilic acrylate intraocular lens in both eyes during the same period. After 6 years of surgery, the right intraocular lens was completely cloudy, while the left intraocular lens remained completely transparent. Significant differences were found in two eyes clinical symptoms,optical coherence tomography (OCT), and ultrasound biomicroscopy (UBM) examination results. After surgical treatment, the vision of eye with intraocular lens opacity has recovered satisfactorily. In the article, the detailed record of  the patient's preoperative relevant information, surgical treatment, and examination results of removing the intraocular lens were stated. The analysis and discussion results were also indicated to provide reference on the diagnosis and treatment of this type of patient for experts and colleagues.
临床病例讨论

无色素性视网膜色素变性1例

Retinitis pigmentosa sine pigmento: A case report

:274-277
 
报告1例2019年1月因无色素性视网膜色素变性而就诊的病例。患者因发现视力差,常规眼科检查及全身的检查未发现异常,给予眼底荧光造影后确诊。给予眼底荧光造影后最终确诊为罕见的无色素性视网膜色素变性,防止了疾病的漏诊和误诊。对于缺乏视网膜色素变性典型的三联征的无色素性视网膜色素变性患者,临床要谨防漏诊,眼底荧光血管造影(fundus fluorescein angiography,FFA)可明确诊断。
We reported a case of achromatic retinitis pigmentosa admitted to the hospital in January 2019. The patient was diagnosed by fundus fluorescein angiography because of poor vision, and no abnormality was found by routine ophthalmological examination and general examination. After fundus fluorescein angiography (FFA), a rare non-pigmented retinitis pigmentosa was finally diagnosed, which prevented misdiagnosis and missed diagnosis of the disease. For the patients without typical triad of retinitis pigmentosa, we should pay attention to missing the diagnosis in clinical practice. FFA can make a definite diagnosis of retinitis pigmentosa.
临床病例讨论

滤过泡相关性真菌性眼内炎1例

Filtering bleb-associated fungal endophthalmitis: A case report

:268-273
 
真菌性眼内炎是临床上少见的眼内感染疾病。因为其诊断延迟和抗真菌药物的有效性有限,因此真菌性眼内炎常常导致视力严重损害。按照感染性途径,真菌性眼内炎包括内源性和外源性,其中外源性眼内炎常见,进展较快,眼部手术术后感染是常见原因之一。小梁切除术是抗青光眼滤过性手术,是目前手术治疗青光眼的有效方法之一。滤过泡相关性眼内炎是其并发症之一,对患者视功能的损害尤为严重。本文通过回顾1例滤过泡相关性真菌性眼内炎患者的临床病例资料,讨论及分析滤过泡相关性的真菌性眼内炎的危险因素及诊治方法。
Fungal endophthalmitis is a disease which is a rare kind of interocular infection in clinic. Fungal endophthalmitis often results in severe visual impairment because of delayed diagnosis and limited effectiveness of antifungal drugs.Fungal endophthalmitis includes endogenous and exogenous endophthalmitis which is common and progresses rapidly. Postoperative infection is one of the common causes of fungal endophthalmitis. Trabeculectomy is an anti-glaucoma filtering operation, and it is one of the effective methods for glaucoma surgery at present. Glaucoma-filtering bleb infection is one of the complications of trabeculectomy, which can lead to severe visual impairment.In this article, we analyzed and discussed the risk factors, diagnosis and treatment methods about the filtering bleb-associated fungal endophthalmitis.
病例报告

甲状腺相关眼病合并眼肌型重症肌无力误诊1例

Misdiagnosis of thyroid-associated ophthalmopathy combined with ocular myasthenia gravis: a case report

:942-946
 
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.
病例报告

以视网膜错构瘤为首发特征的早产儿结节性硬化症1例

Tuberous sclerosis complex presenting as retinal hamartomas in a preterm infant: A case report

:825-829
 
结节性硬化症(tuberous sclerosis complex,TSC)是一种累及多系统的常染色体显性遗传病,早期呈单一表现,容易漏诊、误诊,以眼部症状为首发特征的新生儿期病例少有报道。本文报告1例早产男婴,出生后1 d眼底筛查发现右眼视网膜散在多个灰白色半透明隆起灶及脱色素斑,回溯胎儿期超声心动图异常高度怀疑TSC,进一步行头颅MRI检查及家族基因检测,在新生儿期明确了这一诊断。
Tuberous sclerosis complex is a multisystemic disease with an autosomal dominant inheritance pattern. Missed diagnosis and misdiagnosis are common for patients with single manifestation in the early stage. There are few documented neonatal cases with ocular symptoms as primary presentation. Here we report a newborn boy presented with retinal hamartoma, retinal achromic patch, fetal cardiac rhabdomyoma and subependymal nodules.Subsequent genetic tests confirm a diagnosis of TSC.
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  • 眼科学报

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    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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