表现为双眼非对称性视盘水肿的白血病视神经浸润1例  

A case of leukemic optic nerve infiltration presenting as asymmetric papilledema in both eyes

作　　者：王爽 彭晓燕 王戈 李杨 刘丽娟 陈青华[2] Wang Shuang;Peng Xiaoyan;Wang Ge;Li Yang;Liu Lijuan;Chen Qinghua(Beijing Institute of Ophthalmology,Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key laboratory of Ophthalmology and Visual Sciences,Beijing 100730,China;Department of Radiology,Beijing Tongren Hospital,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心、北京市眼科研究所、北京市眼科学与视觉科学重点实验室,北京100730 [2]首都医科大学附属北京同仁医院放射科,北京100730

出　　处：《中华眼科杂志》2025年第3期215-220,共6页Chinese Journal of Ophthalmology

摘　　要：患者11岁男性, 因左眼视力下降4个月, 逐渐加重至视物不见1个月就诊。急性淋巴细胞白血病病史6年, 化疗后临床治愈3年后。左眼视力为眼前手动, 眼底表现为双眼不对称性视盘水肿, 右眼为典型的视乳头水肿表现, 左眼视盘边界不清, 视盘周围后极部视网膜下大量浓厚点片状黄白色病灶及渗出, 伴有明显的神经上皮层脱离。经荧光素眼底血管造影术相干光层析成像术、眼眶和头颅磁共振成像、脑脊液检查、外周血检测等确诊为中枢神经系统白血病复发、左眼浸润性视神经病变、右眼视乳头水肿、高颅压。给予化疗(甲氨蝶呤3.4~7.5 g)联合鞘内注射(甲氨蝶呤12.5 mg+阿糖胞苷35 mg)3个疗程后, 颅内压逐渐降低, 右眼视乳头水肿完全消退, 视力未受影响, 左眼视盘水肿逐渐消退, 视网膜下病灶和渗出减少。4年后随访, 患者全身状态稳定, 左眼视力恢复并稳定在0.05。A 11-year-old male patient presented with a 4-month history of decreased vision in the left eye,which gradually worsened to complete loss of vision in the left eye over the past 1 month.The patient had a 6-year history of acute lymphoblastic leukemia and had been clinically cured after chemotherapy for 3 years.The visual acuity of the left eye was hand-motion at near.Fundus examination revealed asymmetric papilledema in both eyes.The right eye showed typical papilledema,while in the left eye,the optic disc margin was blurred,and there were numerous thick patchy yellow-white lesions and exudates in the subretinal area of the posterior pole around the optic disc,accompanied by obvious neurosensory retinal detachment.Through fluorescein fundus angiography,optical coherence tomography,magnetic resonance imaging of the orbit and skull,cerebrospinal fluid examination,and peripheral blood tests,the patient was diagnosed with central nervous system leukemia recurrence with infiltrative optic neuropathy in the left eye and papilledema in the right eye.After three courses of chemotherapy(methotrexate 3.4-7.5 g)combined with intrathecal injection(methotrexate 12.5 mg+cytarabine 35 mg),the intracranial pressure gradually decreased.The papilledema in the right eye completely subsided,and the visual acuity was not affected.The papilledema in the left eye gradually subsided,and the subretinal lesions and exudates decreased.During the 4-year follow-up,the patient′s general condition was stable,and the visual acuity of the left eye recovered and stabilized at 0.05.

关 键 词：视乳头水肿 前体细胞淋巴母细胞白血病淋巴瘤 白血病浸润 

分 类 号：R73[医药卫生—肿瘤]