背景:该病例报告适用于眼科领域,因为与临床表现相关的医学文献很少,诊断,葡萄膜积液综合征的治疗。这是一个紧迫的问题,因为与这种疾病相关的严重并发症,包括非孔源性视网膜脱离,闭角型青光眼,可能的失明。本报告将使用患者示例填补临床知识空白。
方法:一名68岁的白人男性,具有多种心血管危险因素,最初向眼科研究所紧急护理诊所就诊,并出现新的视觉症状,包括眼痛,眼睑肿胀,发红,和撕裂他的左眼。他在演讲前几周在左眼和双侧漂浮物中经历了异物感。病人接受了检查,两只眼睛的视力都是20/30,右眼眼压为46,左眼眼压为36。经过初步评估,包括压迫性角镜检查,怀疑间歇性闭角型青光眼.他口服diamox500毫克,两眼都有一滴Alphagan,在两只眼睛一滴拉坦前列素,两眼都注射了一滴多佐胺,和两眼一滴2%的毛果芸香碱。眼内压仅有轻微反应。由于双侧闭角,他接受了激光周边虹膜切开术,以降低眼压并打开房角镜检查发现的闭合角度。患者口服和局部青光眼滴剂出院,并计划前往青光眼诊所。当他在青光眼诊所接受随访时,对他进行了评估,发现他在20岁中期有双侧狭窄角度和眼压。进行了亮度扫描(B扫描),并注意到双侧脉络膜积液,由Optos眼底照片确认。他开始服用泼尼松,每天一次(QD)60mg,并逐渐减少,继续口服和局部青光眼药物,和视网膜评估。视网膜专家的评估显示左眼脉络膜积液得以解决。他按照规定继续使用泼尼松锥度和青光眼滴剂。青光眼诊所的随访显示为3级开角。他继续泼尼松锥度,两只眼睛每天都选择两次,停用了溴莫尼定.进行的磁共振成像(MRI)显示出显着的结果。无出血或肿块。视网膜专家的随访发现脉络膜积液已完全消退。
结论:本病例报告强调早期发现的价值,敏锐的诊断评估,以及多个眼科专家之间的交叉合作,以优化葡萄膜积液综合征患者的医疗结果。
BACKGROUND: This case report is applicable to the field of ophthalmology because there is a paucity of medical literature related to the clinical presentation, diagnosis, and management of uveal effusion syndrome. This is an urgent concern because there are severe complications associated with this disease, including non-rhegmatogenous retinal detachment, angle closure glaucoma, and possible blindness. This report will fill clinical knowledge gaps using a patient example.
METHODS: A 68-year-old white male with multiple cardiovascular risk factors initially presented to the Eye Institute Urgent Care Clinic with new onset visual symptoms, including eye pain, eye lid swelling, redness, and tearing of his left eye. He had experienced a foreign body sensation in the left eye and bilateral floaters weeks prior to his presentation. The patient was examined, and vision was 20/30 in both eyes, and intraocular pressure was 46 in the right eye and 36 in the left eye. After initial assessment, including compression gonioscopy, intermittent angle closure glaucoma was suspected. He received oral diamox 500 mg, one drop of alphagan in both eyes, one drop of latanoprost in both eyes, one drop of dorzolamide in both eyes, and one drop of 2% pilocarpine in both eyes. There was only slight response in intraocular pressure. Owing to the bilateral angle closure, he underwent laser peripheral iridotomy to decrease intraocular pressure and open the angle that was found closed on gonioscopy. The patient was discharged on oral and topical glaucoma drops and scheduled for the glaucoma clinic. When he presented for follow-up in the glaucoma clinic, he was evaluated and noted to have bilateral narrow angles and intraocular pressure in the mid-twenties. A brightness scan (B-scan) was performed and was noted to have bilateral choroidal effusions, confirmed by Optos fundus photos. He was started on prednisone at 60 mg once per day (QD) with taper, continuation of oral and topical glaucoma medications, and a retina evaluation. Evaluation with a retina specialist showed resolving choroidal effusion in the left eye. He continued the prednisone taper as well as glaucoma drops as prescribed. Follow-up in the glaucoma clinic revealed a grade 3 open angle. He continued the prednisone taper, cosopt twice per day in both eyes, and discontinued brimonidine. The magnetic resonance imaging (MRI) that was performed showed results that were remarkable. No hemorrhage or mass was present. Follow-up with the retina specialist found that the choroidal effusions had resolved completely.
CONCLUSIONS: This case report emphasizes the value in early detection, keen diagnostic evaluation, and cross-collaboration between multiple ophthalmology specialists to optimize healthcare outcomes for patients with uveal effusion syndrome.