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題名:以急性視力受損為全身紅斑性狼瘡的初發表現--病例報告     (14點)
SYSTEMIC LUPUS ERYTHEMATOSUS PRESENTING BY SUDDEN VISION LOSS--A CASE REPORT
著者:陳俊寰(Jiun-Hwan Chen) ;劉美麟(Mei-Lin Liu)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:Systemic Lupus Erythematosus ; Occlusive Retinal Vasculitis ; Retinal Artery Occlusion ; Proliferative Retinopathy
刊名:中華民國眼科醫學會雜誌
卷期:47卷1期(2008.3)
頁碼:87-93
語言:繁體中文
摘要: 中文摘要PDF ; 英文摘要PDF

目的:報告一位十四歲女孩,因阻塞性血管炎及視網膜動脈阻 塞,以雙眼急性視力受損為全身紅斑性狼瘡的初發表現,及其後績的 臨床變化O 方法:單一病例報告O 結果:這位十四歲女孩因突發性雙眼視力劇減,至急診求診O 當 時最佳矯正視力右眼20/1 000 ,左眼20/500 ;眼底檢查發現雙眼除了 視網膜動脈阻塞所致黃斑部缺血水腫,還併有廣泛阻塞性視網膜血管 炎(occlusive retinal vasculitis) 0 患者臉頰有蝴蝶斑,手腳有圓盤狀紅 斑,關節炎,貧血及血小板缺乏,抗雙縷DNA 抗體(Anti- dsDNA Ab) 及抗細胞核抗體(ANA) 呈陽性反應'符合全身紅斑性狼瘡診斷O 雖積 極的以類固醇、免疫抑制劑、抗癢疾藥、抗凝血劑、及視網膜雷射治 療;但右眼仍併發生增殖性視網膜病變合併牽引性視網膜剝離,幸好 左眼經過治療追蹤兩年半,視力仍維持在20/25 至20/20 之間O 結論:紅斑性狼瘡因嚴重視網膜阻塞性血管炎而以急性視力受損 為初發表現,在文獻上甚少發表O 急性期可以類固醇、免疫抑制劑、 抗癢疾藥、抗凝血劑輔以血漿透析治療;之後還須積極的以全視網膜 雷射光凝固手術'以預防增殖性視網膜病變的發生O
Purpose: To report the clinical course of systemic lupus erythematosus which was first presented by sudden vision loss due to occlusive retinal vasculitis and retinal artery occlusion on a 14 year-old girl. Methods: A case report. Result: This 14 year-old girl visited our emergency room for sudden bilateral vision loss. Her best-corrected visua1 acuity was OD: 20/1000, OS: 20/500 at the initial visit. Occlusive retinal vasculitis (OU) with retinal infarction (OD>OS) was the initial impression. Butter-fly malar rash, discoid skin 1esions over her hands and feet, arthrit尬, and anemia with thrombocytopenia were noted. Anti ds-DNA Ab(+) and ANA (+) were revealed later. Systemic 1upus erythematosus induced retinal vasculitis (OU) with central retinal artery occlusion (OD) was the diagnosis. After aggressive systemic steroid pu1se therapy, immunosuppressive agents, anti-malaria drugs with anti-coagulation therapy following retina1 laser photocoagulation (OU), pro1iferative retinopathy with tractional retinal detachment was still present in her right eye. However, left eye retained visual acuity of 20/25~20/20 after two and a halffollow-up years. Conclusion: Systemic lupus erythematous rarely presents by sudden vision loss. Treatment of severe occlusive retinal vasculitis by systemic lupus erythematosus includes steroid pulse therapy, immunosuppressive agents, anti-coagulation, anti-malaria drugs, and plasmapheresis in the acute stage. Aggressive pan-retinal photocoagulation may prevent and treat the later proliferative retinopathy.


    

本卷期目次
中華民國眼科醫學會雜誌 47卷1期 (2008.3)
如何診斷正常眼壓青光眼/ 吳秀琛
INTRAVITREAL BEVACIZUMAB FOR CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION--A SHORT-TERM STUDY/ Yu-Lun LoCheng-Kuo ChengChi-Hsien PengTong-Sheng LeeChao-Chien HuTzu-En WuHueu-Chen LinPai-Huei PengChyi-Huey BaiHuey-Shyan Lin
我國與世界各國軍方空勤視力體檢之比較/ 洪啟庭蔡明霖劉峻正黃博宏吳怡昌袁本治孫卓卿
額前肌瓣前移術用於眼瞼下垂之矯正/ 張欣怡蔡顯揚袁漢良
CONJUNCTIVAL MUCOSA-ASSOCIATED LYMPHOID TISSUE (MALT) LYMPHOMA: REPORT OF 6 CASES/ Wan-Ju LeeSung-Huei TsengYing-Ting ChenHon-Chun ChengFu-Chin Huang
IRIS TUMOR AND SECONDARY GLAUCOMA AS INITIAL PRESENTATIONS OF LUNG CARCINOMA: A CASE REPORT/ Ching-Ya HuangKwou-Yeung Wu
ONE-MINUTE SCHIRMER TEST FOR BASAL TEAR SECRETION/ Yung-Ping TsuiWen-Lu ChenChun-Chi ChiangShih-Yuan HuangChiu-Chen HuangYi-Yu Tsai
BILATERAL CATARACTS AFTER PSORALEN AND LONG-WAVE ULTRAVIOLENT RADIATION(PUVA) TREATMENT FOR PSORIASIS/ Chi-Ting HorngKuang-Jen ChienDaih-Iluang KuoFu-An ChenChien-Te LinMing-Ling TsaiPo-Chuen Shieh
GRID PATTERN LASER TREATMENT FOR ATYPICAL CHRONIC RECURRENT CENTRAL SEROUS CHORIORETINOPATHY--CASE REPORT/ Yu-Kai WuCheng-Kuo Cheng
AIDS PRESENTING EARLY CYTOMEGALOVIRUS RETINITIS--A CASE REPORT/ Chieh-Feng ChengChien-Liang WuChih-Yu Chen
ACUTE ORBITAL COMPARTMENT SYNDROME IN A PATIENT WITH SINUSITIS AFTER LACRIMAL IRRIGATION--A CASE REPORT/ Chun-Hsien LiuHsiao-Hsuan TsaiPei-Yu LinChi-Te ChenChieh-Chih TsaiShu-Ching KaoWen-Ming Hsu
IN VIVO CONFOCAL MICROSCOPY OF COMBINED FUCHS' ENDOTHELIAL DYSTROPHY AND PRE-DESCEMET'S MEMBRANE CORNEAL DYSTROPHY--A CASE REPORT/ Chia-Ching HoHuey-Chuan ChengTzong-Shyne Liu
以急性視力受損為全身紅斑性狼瘡的初發表現--病例報告/ 陳俊寰劉美麟
外科手術成功解除因骨纖維結構不良症造成壓迫性視神經病變之病例報告/ 李美侖黃福進史敏秀
 
   
 
   

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