白内障术后后部缺血性视神经病变一例并文献复习

Posterior ischemic optic neuropathy after cataract surgery: a case report and literature review

目的探讨手术相关性后部缺血性视神经病变诊断及治疗的最佳方法。方法复习1例78岁女性患者的病历资料。其于外院行白内障超声乳化联合后房型人工晶体植入术后4 d,诉右眼突发视力下降而就诊,经眼电生理检查及眼底荧光素血管造影,诊断为右眼白内障术后后部缺血性视神经病变,行右球后注射山莨菪碱及激素冲击治疗。结果治疗第19天右眼视力恢复至0.05。结论此为一罕见病例,且由于后部缺血性视神经病变(PION)尚无确切有效的治疗方法,应于术前警惕本病的发生,对PION高危患者详细询问病史并对其做必要的全身检查,特别是评估其全身血管血流动力学情况非常重要。对于中老年人突发视力急剧严重下降伴或不伴视野缺损,眼底又无明显改变者,在排除其他原因导致的视神经疾病后,应考虑PION的可能。

Objective To explore the best method for diagnosis and treatments of post-surgical posterior ischemic optic neuropathy(PION).Methods Review the medical records of a 78-year-old female patient who presented with sudden vision loss in her right eye on the fourth day after phacoemulsification and implantation of a posterior chamber intraocular lens in other hospital.After the electrophysiological examination and fundus fluorescein angiography,the patient was diagnosed as posterior ischemic optic neuropathy after cataract surgery in his right eye.She was administered with a retrobulbar injection of Anisodamine and placed on steroid pulse therapy.Results On the 19 th day after treatment,her visual acuity had recovered to 0.05.Conclusion This is a rare case,and since post-surgical posterior ischemic optic neuropathy(PION)has no definite and effective treatment yet,active vigilance should be maintained before surgery.Detailed systemic history and physical examination are important for patients with high risks of developing PION,especially for evaluating their systemic hemodynamics.To sum up,PION should be considered in patients who have sudden severe vision loss and/or visual field defects with no obvious changes in the fundus after excluding other optic nerve diseases.