儿童早期复发型视神经脊髓炎的成功治疗1例(英文)

目的:报告罕见的儿童早期复发型视神经脊髓炎的成功治疗1例。方法:病例报告。结果:患者,女,8岁,卡达山族,突发性双眼视力下降5d后,出现左下肢肌力减弱症状。发病时,患者双眼视力为光感,伴双眼视盘充血水肿。脑部与脊髓MRI显示:右额叶及颈5水平脊髓后部有白色增强信号的病变,诊断为视神经脊髓炎,给予静脉注射甲基强的松龙冲击治疗,随后转为口服泼尼松龙维持治疗。1mo后症状逐渐缓解。然而,停止口服泼尼松龙1wk后症状复发。复查脑脊髓MRI显示:在脑部的同样区域以及脊髓颈3到颈5段仍有持续的炎症存在,遂立即给予甲基强的松龙冲击治疗,并口服激素延缓减量。2mo后,患者已经可以行走并参与学校活动,此时双眼的视力提高到0.6,但还残留少量的色觉损害,下肢神经检查也正常。口服递减药量的泼尼松龙维持治疗持续4mo,随访1a没有复发。最终,患者视力恢复到右眼0.8,左眼0.6。结论:对于突发性双眼视力下降伴随肢体肌力减弱的儿童患者,必须对视神经脊髓炎有所警惕。早期诊断及治疗有利于患者的康复。

A giant traumatic iris cyst

A 52 year-old construction worker presented with progressive painful blurring of vision in the left eye associated with redness for past 1 month.There was a history of penetrating injury in the same eye 10 years ago and he underwent primary wound toilet and suturing,lens removal with intraocular lens implantation.Slit lamp examination revealed a corneal scar at 9’oclock,a large transilluminant iris cyst superotemporally and adherent to corneal endothelium.It was extended from angle of the pupil and obstructing the visual axis.The patient underwent excision of an iris cyst through superior limbal incision.Viscodissection was done to separate the cyst from the corneal endothelium and underlying iris stroma.Trypan blue ophthalmic solution was injected into the cyst to stain the cyst capsule.Post operatively 7 days,vision improved to 6/7.5 without complication.There was no recurrence up to 1 year postoperation.Histopathological finding revealed a benign cyst mass lined by simple cuboidal to nonkeratinized stratified squamous epithelium.We had achieved a good surgical outcome with no complication to date for our case study.We advocate this modified surgical method to completely remove iris cyst.

Masquerade syndrome:Retinoblastoma presenting as phacolytic glaucoma

We aim to report an uncommon presentation of retinoblastoma and its management.A 4-year-old boy presented with left eye pain for 1 week with eye redness after being hit by a ball.On examination,the visual acuity in his right eye was 6/6 and left eye was no perception to light.The conjunctiva in his left eye was injected and cornea was edematous.There was pseudohypopyon inferiorly.Lens was opaque and there was no fundus view.Intraocular pressure was 50 mmHg.Patient was initially treated as phacolytic glaucoma with severe inflammation.B scan showed intralesional calcification with retinal detachment.CT orbit showed left intraocular mass with calcification and optic nerve involvement.Thus,our final diagnosis was left eye retinoblastoma.Patient was performed a enucleation with chemotherapy in left eye.One year after the treatment,there was no local and distant invasion of the tumor.Anterior inflammation is a rare form of masquerade syndrome associated with retinoblastoma.

Vogt-Koyanagi-Harada disease in a 9-year-old girl

Uveitis secondary to Vogt-Koyanagi-Harada disease is rare in children.To the best of our knowledge,this patient is the first reported case of uveitis attributed to VKH in a child in Malaysia.A 9-year-old girl complained of non-resolving painful red eyes bilaterally for 3 months.Anterior segment of right eye showed mutton fat keratic precipitates,posterior synechiae and moderate anterior chamber reaction.Anterior segment of left eye revealed mutton fat keratic precipitates,band keratopathy on peripheral 3 and 9 o'clock of the cornea,iris bombe,iris nodule and seclusio pupillae.Fundus examination of right eye revealed subretinal deposit at superior and inferior arcades with flat retina while left eye showed hazy view.Patient was then noted to have poliosis and vitiligo after 1 month from initial presentation.Mild cataract and widespread atrophy of the retinal pigment epithelium accounting for the loss in vision remained.This case report is to highlight the importance of early recognition of paediatric Vogt-Koyanagi-Harada and treating it aggressively to prevent the irreversible destructive sequalae of the disease.

Bee sting keratopathy with retained stinger

This case report aims to report an uncommon case of bee sting keratopathy with retained stinger.A 55-year-old man presented with left cornea bee sting while gardening two days prior to first visit.He complained of severe eye pain with redness,tearing and blurring of vision.On examination,his right eye visual acuity was 6/6 and in left eye was hand movement.There was generalized conjunctival hyperemia and cornea showing significant descemet striae.A bee stinger with surrounding infiltration noted at 2 o'clock was associated with striate keratitis.It was deeply seated at the posterior third of cornea stroma near to paracentral area.Pupil was mid-dilated with absence of relative afferent pupillary defect.There was neither hypopyon nor cataract.The posterior segment could not be visualized due to severe corneal edema.However,B-scan ultrasound was normal.Bee stinger was removed under local anaesthesia on the day of presentation.Post-operatively,patient was administered with topical moxifloxacin and topical non steroidal anti-inflammatory drugs.Three weeks later,there was resolution of cornea infiltrate with improvement of striate keratitis and his vision was improved to 1/60.However,cornea edema did not regress but ended up with bullous keratopathy.The patient has undergone descemet-stripping automated endothelial keratoplasty and his vision was improved to 6/9.We recommend early stinger removal to reduce the possible sequelae of bee sting toxicity for better visual outcome.