【摘要】 我们报告4例双眼特发性黄斑囊样水肿(CME)的临床表现、眼底血管荧光造影和干涉光断层扫描(OCT)检查结果。患者均为男性，年龄30～52岁之间。均以双眼视物不见1wk主诉就诊。眼底检查显示双眼后极部黄斑水肿。荧光造影检查结果显示:1例未见特异性改变;其余可见典型的花瓣状图像。OCT检查均见视网膜下积液。所有患者均按特发性黄斑囊样水肿之诊断治疗，6wk后，视力提高。
【关键词】 黄斑囊样水肿(CME)；双眼；特发性；眼底血管荧光造影(FA)；干涉光断层扫描(OCT)·Case report·
Unusual retinal manifestations of PORN combined complications of central retinal artery and vein occlusions
EShawn Goh , Stephen C.B.Teoh, Albert T.H. Lim
Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
AbstractAIM: To describe an unusual combination of retinal manifestations in an AIDS patient with progressive outer retinal necrosis (PORN), complicated by combined central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO).
METHODS: A case report.
RESULTS: The patient presented with PORN with primary optic nerve involvement complicated by combined central retinal artery occlusion(CRAO) and central retinal vein occlusion(CRVO) as a primary manifestation of Varicella Zoster Virus (VZV). Aggressive treatment with intravitreal and specific systemic antiVZV therapy, in addition to systemic highly active antiretroviral therapy (HAART) achieved retinal quiescence with sparing of the fellow eye. Visual outcome of the affected eye was poor.
CONCLUSION: We present the first report of PORN associated with the unusual combined complications of CRAO and CRVO. Aggressive local treatment was combined with systemic therapy, which achieved local control and empirical prophylaxis for the fellow eye.
KEYWORDS:acquired immunodeficiency syndrome (AIDS); central retinal artery occlusion (CRAO); central retinal vein occlusion (CRVO); progressive outer retinal necrosis (PORN); combined complications
Goh ES, Teoh SCB, Lim ATH. Unusual retinal manifestations of PORN combined complications of central retinal artery and vein occlusions. Int
J Ophthalmol(Guoji Yanke Zazhi)2008;8(11):21852186
INTRODUCTION
Progressive outer retinal necrosis (PORN) follows advanced immunosuppression when CD4 levels <50 cells/mm3, usually secondary to a member of the herpesfamily viruses. It is a rapidly progressive deep peripheral retinitis with poor visual outcomes. We present the first case of PORN complicated by optic neuritis associated with the combined complications of central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO).
CASE REPORT
A 36 years old HIVpositive Chinese man with a year history of AIDS [antiretroviral therapy na(i)ve] presented with 4days of acute right eye no light perception (NLP) and relative afferent pupillary defect. CD4 count was 10 cells/mm3 and viral load >105 copies/mL. CMV serology was negative.
There was extensive disc swelling and diffusely pale retina secondary to fulminant retinal necrosis and extensive flame hemorrhages. Retinal veins were tortuous and arteries segmented. There was peripheral deep retinal granular opacification and vascular sheathing seen in Figure 1. Fundal fluorescein angiography (FFA) showed delayed filling of retinal arterial (90 seconds armCRA time) and venous vasculatures (7 minutes and 30 seconds arteriovenous transit time). Multiple areas of capillary fallout and blocked fluorescence can be seen in Figure 2.
The clinical and fluorescein appearance was consistent with the diagnosis of PORN with optic neuritis complicated by combined CRAO and CRVO.
The patient was commenced on HAART and systemic Acyclovir. Local therapy was commenced with induction doses of intravitreal Ganciclovir 2mg/0.04mL twice weekly for one month followed by 2mg/0.04mL weekly. At 2 months, weekly 1mg/0.02mL maintenance doses were administered. Foscarnet was not used. Panretinal photocoagulation was performed for extensive retinal ischemia. PORN quiescence was achieved after 8weeks, see Figure 3. Right eye vision remained NLP in spite of quiescence. After 3 months,local therapy was withdrawn when CD4 >150 cells/mm3. He has remained recurrencefree for 48 months to date and the left unaffected eye maintained an unaided VA of 20/20.
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