目的:维生素A缺乏视网膜病是一种潜在的致盲疾病。在发达国家,由于营养不良导致的维生素A缺乏是罕见的。然而,维生素A缺乏可由肠道切除或药物治疗引起的吸收不良引起。在这项回顾性研究中,我们介绍了5例维生素A缺乏症视网膜病变与继发于医学干预的吸收不良有关。
方法:对10年(2012-2022年)的电子图表进行维生素A缺乏视网膜病变筛查。仅包括经实验室检查证实的维生素A缺乏患者。症状,病史,视敏度,光学相干层析成像,眼底自发荧光,电生理检查,并对维生素A水平进行了综述。
结果:确定了5例合格病例。中位年龄为44.7岁(范围22.2-88.9),诊断前眼部症状的中位持续时间为14个月,中位视力为1.0(范围为0.5-1.0,Snellen,decimal)。三名患者有减肥手术史,一名患者接受了小肠切除术,正在接受奥曲肽治疗,1例患者患有囊性纤维化,有小肠切除和严重肝病史。光学相干断层扫描显示各种异常,包括减少的交叉区域,视网膜下树状软骨沉积,和外部核层变薄。视网膜电图发现范围从异常振荡电位到不可记录的杆状反应。
结论:维生素A缺乏视网膜病变可发生在与吸收不良相关的医学干预之后。在夜盲症的情况下,应该测量维生素A水平。
Vitamin A deficiency retinopathy is a potentially blinding disease. In developed countries, vitamin A deficiency due to malnutrition is rare. However, vitamin A deficiency can be caused by malabsorption resulting from bowel resection or medication. In this retrospective study, we present five cases of vitamin A deficiency retinopathy related to malabsorption secondary to medical interventions.
Electronic charts over a ten-year period (2012-2022) were screened for vitamin A deficiency retinopathy. Only patients with vitamin A deficiency confirmed by laboratory tests were included. Symptoms, medical history, visual acuity, optical coherence tomography, fundus autofluorescence, electrophysiological examination, and vitamin A levels were reviewed.
Five eligible cases were identified. Median age was 44.7 years (range 22.2-88.9), median duration of ocular symptoms prior to diagnosis was 14 months, and median visual acuity was 1.0 (range 0.5-1.0, Snellen, decimal). Three patients had a history of bariatric surgery, one patient had a small bowel resection and was on octreotide treatment, and one patient suffered from cystic fibrosis and had a history of small bowel resection and severe hepatopathy. Optical coherence tomography showed various abnormalities, including a reduced interdigitation zone, subretinal drusenoid deposits, and a thinned outer nuclear layer. Electroretinogram findings ranged from abnormal oscillatory potentials to non-recordable rod responses.
Vitamin A deficiency retinopathy can occur following medical interventions associated with malabsorption. In cases of night blindness, vitamin A levels should be measured.