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首页> 外文期刊>BMC Ophthalmology >Atypical acute retinal necrosis accompanied by Terson’s syndrome: a case report
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Atypical acute retinal necrosis accompanied by Terson’s syndrome: a case report

机译：非典型急性视网膜坏死伴特森氏综合征：一例报告

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Acute retinal necrosis (ARN) has characterized by panuveitis, vitritis, severe vaso-occlusive vasculitis, and diffuse necrotizing retinitis. There are no case reports on atypical ARN combined with Terson’s syndrome. Herein, we report a case of ARN with atypical clinical features combined with Terson’s syndrome that we successfully treated by intravitreal ganciclovir injection. A 64-year-old man visited our eye clinic with a complaint of decreased visual acuity in his right eye. At the initial visit, his best corrected visual acuity was 20/125 in the right eye. Slit-lamp examination demonstrated mild hyperemia, keratic precipitates, and anterior chamber inflammatory reaction. Fundus examination revealed multiple diffuse white-yellowish infiltrations in the peripheral retina combined with dot hemorrhages. Ultra-wide-field fluorescence angiography showed obstructive arteritis with peripheral non-perfusion and leakage from the retinal vessels. As a result of the PCR analysis, varicella zoster virus DNA was identified in the aqueous humor. Under the diagnosis with VZV-mediated ARN, we started with intravenous acyclovir and oral prednisolone. After 3?days of the above treatment, the anterior chamber inflammation and vitreous opacity were increased. On fundus examination, multiple whitish infiltrations were increased. In addition, newly developed vitreous and peripapillary hemorrhages were detected. On the T2 brain magnetic resonance imaging (MRI) demonstrated a sub-acute or old hemorrhagic infarction in the right occipital lobe, and contrast-enhancing lesions in the right basal ganglia. The spinal tapping was performed in the department of neurology in our hospital at the time when the patient complained of headache, and intracranial pressure was 31?mmHg. Under the diagnosis of ARN with Terson’s syndrome, we started intravitreal ganciclovir (2?mg/0.5?ml) injections. After 5 intravitreal ganciclovir injections over a period of 8?months, the diffuse whitish infiltrating retinal lesions combined with dot hemorrhage were decreased. The vitreous and peripapillary hemorrhage was significantly reduced. There was no recurrence in the patient’s right eye, in which his visual acuity had improved to 20/60. In the event of a poor response to traditional treatment such as intravenous acyclovir, intravitreal ganciclovir may have a role as an adjunctive therapy in patients of VZV associated ARN combined with Terson’s syndrome.
机译：急性视网膜坏死（ARN）的特征是胰腺炎，玻璃体炎，严重的血管闭塞性血管炎和弥漫性坏死性视网膜炎。没有关于非典型ARN合并Terson综合征的病例报告。在此，我们报告了一例具有非典型临床特征并伴有Terson综合征的ARN病例，我们通过玻璃体内更昔洛韦注射液成功治疗了该病例。一名64岁的男子因右眼视力下降而去了我们的眼科诊所。初诊时，右眼的最佳矫正视力为20/125。裂隙灯检查显示轻度充血，角膜沉淀和前房炎症反应。眼底检查发现周围视网膜出现多处弥漫性白黄色浸润，并伴有斑点出血。超宽视野荧光血管造影显示阻塞性动脉炎，周围无灌注和视网膜血管渗漏。 PCR分析的结果，在房水中鉴定出水痘带状疱疹病毒DNA。在VZV介导的ARN的诊断下，我们开始使用静脉注射阿昔洛韦和口服泼尼松龙。上述治疗3天后，前房炎症和玻璃体混浊增加。在眼底检查中，增加了多次发白渗透。此外，还发现了新近发生的玻璃体和乳头周围出血。在T2上，脑磁共振成像（MRI）显示右枕叶有亚急性或陈旧性出血性梗塞，右基底神经节有造影剂增强病灶。病人头痛时，在我院神经内科进行脊柱拍打，颅内压为31？mmHg。在诊断患有Terson综合征的ARN后，我们开始进行玻璃体内更昔洛韦（2？mg / 0.5？ml）注射。在8个月内注射5次玻璃体内更昔洛韦后，弥漫性发白的浸润性视网膜病变和点状出血减少了。玻璃体和乳头周出血明显减少。病人的右眼没有复发，其视力提高到了20/60。如果对传统治疗（如静脉注射阿昔洛韦）反应不佳，玻璃体内更昔洛韦可能在VZV相关性ARN合并Terson综合征的患者中作为辅助治疗剂。

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