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題名 | Acute Retinal Necrosis-Early Manifestation and Successful Treatment with Steroid and Acyclovir: Case Report=急性視網膜壞死症候群-其早期表現與成功的類固醇-熱威樂合併治療:病例報告 |
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作者 | 林彥君; 何正廉; | 書刊名 | 長庚醫學 |
卷期 | 21:4 1998.12[民87.12] |
頁次 | 頁493-497 |
分類號 | 416.746 |
關鍵詞 | 急性視網膜壞死症候群; 類固醇; 熱威樂; Acute retinal necrosis; Steroid; Acyclovir; |
語文 | 英文(English) |
中文摘要 | 本文探討一位19歲女性,因左眼疼痛、發紅及視力模糊而至本院急診求診。初步眼 科學檢查發現左眼視力為無光覺,前房及玻璃體有嚴重的發炎現象,超音波檢查則發現視網 膜完全剝離及廣泛的脈絡膜增厚;初步診斷為泛葡萄膜炎故以口服類固醇治療。左眼對治 療的反應相當良好,但是2天後病人卻抱怨其右眼視力模糊,檢查發現右眼僅有輕微的發炎 反應,但是在邊緣視網膜下方三分之二的部份卻發現許多散佈的粒狀白點。在接下來的數天 中,這些白點逐漸增加、擴大並且融合成一片,血液檢查亦證實病人有最近的單純皰疹病毒 感染(HSV IgG及HSV IgM均呈陽性反應);此時診斷改變為急性視網膜壞死症候群。我們在 並未停止使用類固醇的同時開始加上針劑的熱威樂為病人治療。4天後視網膜病灶逐漸硬化 並消失,之後我們逐漸減少類固醇的劑量並將熱威樂改成口服方式,又以雷射將病灶處的視 網膜圍住;病人出院後仍維持口服的類固醇-熱威樂合併治療。在病人回診追蹤的一年半期 間,其右眼玻璃體始終保持清澈無發炎反應,而視力則為1.0。 |
英文摘要 | A healthy 19-year-old woman suffering from pain, redness, and blurred vision of her left eye came to our emergency unit for help. Initial examination revealed no light-perception, tenderness and marked inflamation of the left eye. There was sever inflammation both in the anterior chamber and vitreous cavity. Total retinal detachment accompanied by diffuse thickening of choroid was demonstrated using echography. Under the impression of panuveitis, oral steroids were given. The response of the left eye was dramatic but the patient complained of blurred vision of her right eye 2 days after steroid therapy. There was only mild reaction in the right eye; however, multiple granule-appearing white dots were found on the inferior two-thirds of the peripheral retina. The nummular white lesions increased in size and number and finally became confluent in following days. The diagnosis was shifted to acute retinal necrosis and intravenous acyclovir was started while continuing systemic steroid therapy. The retinal necrosis began to consolidate four days after the administration of acyclovir and gradually regressed. We tapered the systemic steroids when the intra-venous acyclovir was shifted to oral form. The vitreous of the right eye remained clar during the follow-up period. The antiviral agent still suppressed the disease process even though steroids had been used beforehand. Furthermore, the systemic steroids seemed to ameliorate the vitritis and secondary complications in the right eye compared with the fulminant, disastrous course of the left eye. |
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