视神经脊髓炎相关视神经炎合并中心性浆液性脉络膜视网膜病变1例  

A case of concurrent neuromyelitis optica-associated optic neuritis and central serous chorioretinopathy

作　　者：缪金鑫 袁松涛[1] 刘庆淮[1] 胡仔仲 MIAO Jinxing;YUAN Songtao;LIU Qinghuai;HU Zizhong(Department of Ophthalmology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院眼科,南京210029

出　　处：《中国眼耳鼻喉科杂志》2024年第S01期11-14,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：40岁男性,因“左眼突发视力下降1周”入院。患者3个月前因“左视神经脊髓炎相关视神经炎”行激素冲击及序贯减量治疗,1周前感染新型冠状病毒后自觉左眼视力下降。体格检查:左眼最佳矫正视力为FC/5cm,前节未见明显异常,左眼相对性瞳孔传入障碍(RAPD)(+),眼底见视盘边界清晰,杯盘比(C/D)约0.5,A:V约2:3,视网膜平伏、色泽正常;右眼未见异常。入院后光学相干层析成像(OCT)检查提示左眼颞下血管弓位置一约2 PD直径的视网膜神经上皮层脱离区域。完善感染相关检查、血清脱髓鞘抗体检测、眼眶磁共振成像(MRI)平扫+增强后,患者确诊:①左眼复发性抗体双阴性视神经脊髓炎相关视神经炎;②双眼中心性浆液性脉络膜视网膜病变(CSC)。仍予以激素冲击及序贯减量治疗视神经炎,随访观察CSC。治疗6个月后,患者右眼BCVA为0.6,双眼CSC病变消退。讨论体会:视神经脊髓炎相关视神经炎合并未累及中心凹的CSC,仍应该给予规范性的激素冲击治疗及序贯减量。A 40-year-old man presented with 1 week of blurred vision in the left eye.The patient was previously diagnosed with neuromyelitis optica-associated optic neuritis in the left eye 3 months ago and had been treated with high-dose intravenous methylprednisolone in acute phase and low-dose corticosteroid therapy in chronic phase.One week ago,the patient was attacked by Covid-19 coronavirus,and then complained of vision loss in the left eye.The Ocular examination of the left eye showed that the best corrected visual acuity was FC/5cm,no specific abnormality was detected in the anterior segment except for a positive relative afferent pupillary defect.Fundus examination showed the edge of optic disc was clear,and the C/D ratio was 0.5.OCT indicated a detached retinal neuroepithelial layer(approximately 2PD)in the inferotemporal retina.Serum tests of infection and demyelination anti-bodies were negative,while MRI showed remarkable demyelination sign in the left optic nerve.The patient was diagnosed with 1.left recurrent serum-negative neuromyelitis optica-associated optic neuritis,and 2.bilateral central serous chorioretinopathy(CSC).High-dose intravenous methylprednisolone and sequential tapering was still administered for his optic neuritis,with follow-up suggested for CSC.After 6 months of treatment,the BCVA of the left eye was 0.6,and the CSC have resolved in both eyes.Summary:Neuromyelitis optica-related optic neuritis combined with foveal-spare CSC is rare and we still suggest to standardize the treatment of steroid and sequential tapering.

关 键 词：视神经脊髓炎 中心性浆液性脉络膜视网膜病变 视网膜下液 激素 

分 类 号：R744.52[医药卫生—神经病学与精神病学] R774.61[医药卫生—临床医学] R774.1