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因视力下降误诊为视神经病变的圆锥角膜患者的临床特征

Clinical features of patients with keratoconus misdiagnosed as optic neuropathy due to decreased vision
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摘要 目的报告因短期内视力下降被误诊为视神经病变的圆锥角膜患者的临床特征。设计回顾性病例系列。研究对象2010-2020年北京同仁眼科中心被误诊为视神经病变但经过相关检查后最终确诊为圆锥角膜的患者26例(33眼)。方法回顾患者的病历资料及眼科辅助检查结果,包括角膜地形图、视觉诱发电位、视野等,总结其临床特征。主要指标视力、屈光度、角膜曲率、眼部体征。结果26例中男性20例(76.9%)。平均年龄(27.8±8.2)岁。19例(73.1%)单眼发病,7例(26.9%)双眼发病。诊断视神经病变时矫正视力0.02~1.0。患眼球镜屈光度(-7.18±3.63)D,柱镜屈光度(-2.09±1.86)D。患眼角膜曲率K1为(52.83±3.89)D,K2为(47.55±3.64)D。19例单眼患者中,患眼球镜平均为(-6.51±2.99)D,明显高于健眼的(-3.06±2.09)D(Z=-3.52,P<0.001);患眼柱镜平均为(-2.27±1.60)D,明显高于健眼的(-1.11±1.03)D(Z=-1.98,P=0.048)。28/33眼(84.8%)的彩色眼底像稍模糊。裂隙灯显微镜检查,18/33眼(54.6%)角膜形态正常,仅15/33眼(45.4%)发现轻微角膜锥形突出、基质轻度混浊。所有患者相对性瞳孔传入障碍均阴性。后极部眼底、视野、视觉诱发电位、视网膜电图均正常。结论因视力下降被误诊为视神经病变的圆锥角膜患者常存在近视度数、散光度数短期内增加,无视神经病变体征。角膜地形图检查有利于圆锥角膜的诊断。 Objective To study the clinical characteristics of patients with keratoconus who were misdiagnosed as optic neuropathy due to short-term vision loss.Design Retrospective case series.Participants 26 patients(33 eyes)were initially misdiagnosed as optic neuropathy,but finally diagnosed as keratoconus after relevant examinations from 2010 to 2020 in Beijing Tongren Eye Center.Methods The patients'medical records and auxiliary ophthalmic examination results,including corneal topography,visual evoked potentials(VEP),visual field and etc were reviewed.Main Outcome Measures Visual acuity,refraction,corneal curvature,ocular signs.Results Among all 26 cases,20 patients were male(76.9%),and mean age was(27.8±8.2)years.19 patients(73.1%)were affected unilaterally,and 7 patients(26.9%)were affected bilaterally.The corrected visual acuity was from 0.02 to 1.0 when diagnosed as neuropathy.The average sphere refraction of affected eyes was(-7.18±3.63)D,cylinder refraction was(-2.09±1.86)D.The corneal curvature K1 and K2 was(52.83±3.89)D and(47.55±3.64)D respectively in affected eyes.Among 19 monocular patients,the sphere and cylinder refraction was(-6.51±2.99)D and(-2.27±1.60)D in affected eyes,significantly higher than the lateral eyes(-3.06±2.09)D and(-1.11±1.03)D(P<0.001 and P=0.048).The color fundus images of 28/33 eyes(84.8%)were slightly blurred.The corneal morphology with slit lamp microscopy was normal in 18/33 eyes(54.6%),and only 15/33 eyes(45.4%)were found slight corneal cone-like protrusion and mild stromal opacity.The relative afferent pupillary defect(RAPD)of all patients were negative.No abnormalities were observed in the posterior fundus,VEP and electroretinogram.Conclusion Keratoconus patients misdiagnosed as optic neuropathy due to decreased vision often have a short-term increased myopia and astigmatism,ignoring the signs of optic neuropathy.Corneal topography examination is beneficial to the diagnosis of keratoconus.
作者 郭寅 刘丽娟 李建军 梁庆丰 田磊 张阳 Guo Yin;Liu Lijuan;Li Jianjun;Liang Qingfeng;Tian Lei;Zhang Yang(Department of Ophthalmology,Beijing Haidian Hospital and Haidian Section of Peking University Third Hospital,Beijing 100080,China;Beijing Institute of Ophthalmology,Beijing Tongren Eye Center,Beijing Key Laboratory of Ophthalmology and Visual Science,Beijing Tongren Hospital,Capital Medical University,Beijing 100005,China)
出处 《眼科》 CAS 2022年第2期94-98,共5页 Ophthalmology in China
关键词 圆锥角膜 视神经病变 误诊 keratoconus optic neuropathy misdiagnosis
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